Challenging authority during a life-threatening crisis: the effect of operating theatre hierarchy

Abstract

This study did not show a significant effect of OT team hierarchical structure on trainee's ability to challenge authority; however, the results are concerning. The challenges were suboptimal in quality and there was an alarming high rate of blood checking and administration in both groups. This may reflect lack of training in appropriately and effectively challenging authority within the formal curriculum with implications for patient safety.

Using qualitative and mixed methodologies to explore hierarchy in the operating room

“…The simulations were video recorded, and the behaviours of the residents in challenging the order to transfuse were rated using the modified Advocacy Inquiry Scale (mAIS). 2 The results of this quantitative component of their study had been previously reported. 2 This present paper focuses on the findings from the qualitative part of their study where the residents were subsequently debriefed and interviewed post-simulation.…”

“…2 The results of this quantitative component of their study had been previously reported. 2 This present paper focuses on the findings from the qualitative part of their study where the residents were subsequently debriefed and interviewed post-simulation. As qualitative and mixed methods studies are relatively less common in anesthesia research, it is useful to review these approaches prior to commenting further on the findings of this study.…”

“…2 Les résultats de cette composante quantitative de l'étude ont déjà été publiés ailleurs. 2 L'article présenté ici se concentre sur les résultats qualitatifs de leur étude, soit les résultats tirés du débriefing des résidents après la simulation.…”

“…10 Sydor et al have engaged in a unique investigation that uses a simulated environment in order to create the relatively new concept of ''sociological fidelity'' with respect to hierarchy amongst operating room team members. 2 In this simulation, purportedly meant to study team behaviour, the investigators used deliberate deception in order to examine the response of residents to directions from a faculty member to transfuse a Jehovah's Witness patient contrary to explicit written instructions from the patient. The deception involved telling the residents that this faculty member was a recent appointment to their department, although, unbeknownst to them, the person was actually an actor and part of the research team.…”

“…The mAIS scores did not differ between the two groups. 2 This finding suggests that there are deeper structures of hierarchy that act to constrain the residents' behaviour. This finding has implications for decision-making and patient safety in crisis situations.…”