Ready, set, go!
by Laura Fruhen
In some work contexts, teams are expected to work effectively within an instant even though members barely know each other. According to US-based research, such ‘ad-hoc teams’ make up roughly 1/3 of teams in organisations. Classic examples are airplane crews, project teams, or - in our case - operating theatre teams.
A key challenge for operating teams that come together for the first time, yet need to be ready to perform in a co-ordinated way within an instant, is how members achieve a shared understanding of their tasks and roles (that is, a “shared mental model” ). Complicating matters is the fact that operating theatre teams involve nurses, surgeons, technicians and anaesthetists, all with unique expertise yet also diverse backgrounds and experiences.
So how do such teams build shared mental models within minutes? This question has been the focus of one of the projects at our research centre.
Our research has involved evaluating the effects of short inter-disciplinary briefings, involving all operating theatre team members, just before the start of an operating theatre list (a list covers all the procedures that this particular team will conduct). In our research, we have focussed on these briefings from a theoretical and research angle using surveys and observations. Today we apply a more artistic approach!
After a quick search for the anaesthetist who is already with the first patient, the theatre team comes together around the operating theatre table. Stewart, the surgeon, initiates the briefing. He starts by reflecting on why it is important for the team to come together: “We all may have worked together or know each other in some way, but we have never worked together as this team. So the briefing is about helping us become this team for the list today.”
Stewart makes clear that he wants everyone to contribute and that this openness can help everyone to develop a habit of speaking up when issues or uncertainties arise: “It is important that we ask questions now. We all need to get into the habit of communicating well, so let’s do it right from the start.”
Each team member (including myself and the artist, Lynne) introduce each other, stating role and name. This loosens up the room, and helps to break down any hierarchies. Lynne and I already feel more included. Then the team quickly overviews each of the four operations that is on the list. All members contribute their individual pieces of information.
The surgeon describes what he is planning for each procedure and what equipment might be needed.
Nurses and anaesthetists add their information, ask questions, and make suggestions throughout. Alan, the anaesthetist, makes the team aware that the third case will be a teenager who might be anxious and advises the team to be careful not to make him nervous.
Stephanie, one of the nurses, asks the surgeon about alternative plans should the initial plan not work for an operation that involves an older injury. Based on the discussion, the nurses can ensure they have additional equipment at hand, which they end up using later on during the procedure.
At the end, everyone summarises the main issues. Stewart checks again if anyone has any questions and concludes with an “Are we all ok for today?”.
There is a strong sense that the team is now ready. Everyone is clearly energised by the briefing and the shared sense of purpose it has created. In just five minutes, the team briefing has accelerated the sense of ‘team’ and paved the way for efficient and safe surgery.
 Devine, D. J., Clayton, L. D., Philips, J. L., Dunford, B. B., & Melner, S. B. (1999). Teams in organizations: Prevalence, characteristics, and effectiveness. Small group research, 30(6), 678-711.
 Mathieu, J. E., Heffner, T. S., Goodwin, G. F., Salas, E., & Cannon-Bowers, J. A. (2000). The influence of shared mental models on team process and performance. Journal of applied psychology, 85(2), 273.