Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May;36(5):3087-3093.
doi: 10.1007/s00464-021-08608-6. Epub 2021 Sep 14.

Influence of hierarchy on risk communication during robot-assisted surgery: a preliminary study

Taylor Kunkes  1   2 , Lora Cavuoto  1   2 , Jeff Higginbotham  1   3 , Ann Bisantz  1   2 , Ahmed S Elsayed  1   4 , Naif A Aldhaam  1   4 , Ahmed A Hussein  1   4 , Khurshid A Guru  5   6
Affiliations

Influence of hierarchy on risk communication during robot-assisted surgery: a preliminary study

Taylor Kunkes et al. Surg Endosc. 2022 May.

Abstract

Introduction: A hierarchical structure is where all individuals are organized according to importance and are subordinate to a single person. In the operating room (OR), this structure may negatively impact the quality of communication and jeopardize patient safety. We examined how the surgical team's hierarchical relationships affect the frequency and timing of risk communication, and their influence on situational awareness (SA) in the OR.

Methods: Overhead cameras and lapel microphones were used to record the OR environment. Recordings and transcriptions of 10 robot-assisted prostatectomies were examined for risk utterances among team members. Utterances were classified by sender-recipient exchange, timing (determined by phrasing to be proactive or reactive to an error/negative event), and the Oxford Non-Technical Skills (NOTECHS) SA score. Surgeon's and trainee surgeon's utterances were classified by their on-console status. Chi-square tests were used to determine associations between dependent factors, and ANOVAs were used to evaluate the effect of hierarchy and timing on NOTECHS score.

Results: Of 4,583 examined utterances, 329 (7%) were risk-related. There was no significant difference in utterance frequency based on hierarchical status of sender and recipient (p = 0.16). Utterances made by the surgeon or trainee surgeon had higher NOTECHS scores when off versus on the console (scores: 1.8 vs 2.4, p < 0.01). These utterances were more reactive on the console (32%) and proactive off the console (28%). Proactive utterances had higher NOTECHS scores than reactive utterances (scores: 2.5 vs 1.8, p < 0.01).

Conclusion: The surgical hierarchy significantly impacted the frequency of risk communication within the OR. Timing and on-console status further influenced the efficacy of risk communication.

Keywords: Breakdown; Communication; Medical hierarchy; Near miss; Robot-assisted surgery.

PubMed Disclaimer

References

    1. Lingard L, Espin S, Whyte S, Regehr G, Baker G, Reznick R et al (2004) Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 13(5):330–334 - DOI
    1. Sutcliffe K, Lewton E, Rosenthal M (2004) Communication failures: an insidious contributor to medical mishaps. Acad Med 79(2):186–194 - DOI
    1. Bould M, Sutherland S, Sydor D, Naik V, Friedman Z (2015) Residents’ reluctance to challenge negative hierarchy in the operating room: a qualitative study. Can J Anesth 62(6):576–586 - DOI
    1. Sydor DT, Bould MD, Naik VN, Burjorjee J, Arzola C, Hayter M et al (2013) Challenging authority during a life-threatening crisis: the effect of operating theatre hierarchy. Br J Anaesth 110(3):463–471 - DOI
    1. Morgan M, Fischoff B, Bostrom A et al (2001) Introduction. Risk communication: a mental models approach. Cambridge University Press, Cambridge, pp 1–18 - DOI

Publication types

LinkOut - more resources