The influence of standardisation and task load on team coordination patterns during anaesthesia inductions

Abstract

The use of different forms of coordination according to situational demands plays a crucial role in teams working in complex environments. This study aimed to describe patterns of coordinative actions (CAs) as they occur during anaesthesia induction and to analyse the influence of two crucial situational factors on these patterns, namely the amount of existing standards and the level of task load. METHODS: 23 anaesthesia inductions were videotaped, and CAs of the anaesthesia teams were coded. The coding system distinguished between implicit and explicit coordination, coordination via leadership and heedful inter-relating as the individual effort to reach smooth coordination. Five phases within anaesthesia inductions were determined according to their level of standardisation and task load. RESULTS: Overall, 67.7% of all CAs were rated as explicit CA and 32.3% as implicit CAs. When we considered the duration of those CAs, we found the reverse tendency (coordination was explicit 40% of the time and implicit 60% of the time). In highly standardised phases, we observed less explicit coordination, less leadership behaviour and less heedful interrelating compared with less standardised phases. In high-task-load phases, we observed more heedful interrelating than in low-task-load phases. CONCLUSIONS: The anaesthesia teams relied greatly on implicit coordination, which contrasts with findings indicating a performance benefit through explicit coordination in other work settings. Standardisation in the form of written departmental directives may have a supportive effect on coordination by partially substituting for other forms of coordination. The effect of high task load should be tested further in a simulator setting, where high task load can be induced in a more controlled fashion.

Standard deviation? The role of perceived behavioural control in procedural violations

“…For example, Zala-Mezö et al (2009) argue that rules are important for anaesthetic practice to the extent that they facilitate coordination between different members of the anaesthetic team when working under pressure. However, they note, as do Grote et al (2009), that the challenge for this work setting, and others that are similarly complex and dynamic, is to provide a set of rules that standardizes task behaviour but allows flexibility to deal with the contingencies that are prone to occur.…”

Leadership and teamwork in anesthesia – Making use of human factors to improve clinical performance

“…In contrast, implicit co-ordination by tacit agreement requires a common understanding of the situation, and is best used for the management of standardized routine tasks. 24,25 Standardization as such can even substitute leadership in certain situations. 24,26 3.…”

“…24,25 Standardization as such can even substitute leadership in certain situations. 24,26 3. How leadership, teamwork and co-ordination influence patient outcomes…”

“…In contrast to some other professional teams, anesthesia teams seem to prefer implicit co-ordination with little leadership during routine work flow. 3,24,26,39 Implicit co-ordination is less time-consuming than explicit co-ordination. Hence, such routine phases can be used to optimize efficiency of the work without compromising safety.…”

“…35 In a field with inherently high risks, different professional groups are working closely together, but often with conflicting priorities and differing interpersonal relationships. 35,36 Anesthesia professionals frequently experience routine changes, 24 but also non-routine events and occasionally more severe events, many of which are unpredictable. 35 Decision making interrelates with the resulting actions due to rapid physiological responses of the patients, and unforeseen surgical events.…”