The teamwork structure, process, and context of a paediatric cardiac surgery team in Mongolia: A mixed-methods approach

Abstract

Introduction: Effective teamwork in paediatric cardiac surgery is known to improve team performance and surgical outcomes. However, teamwork in low- and middle-income countries (LMICs), including Mongolia, is understudied. We examined multiple dimensions of teamwork to inform a team-based training programme to strengthen paediatric cardiac surgical care in Mongolia.

Methods: We used a mixed-methods approach, combining social network analysis and in-depth interviews with medical staff, to explore the structure, process, quality, and context of teamwork at a single medical centre. We conceptualised the team's structure based on communication frequency among the members (n = 24) and explored the process, quality, and context of teamwork via in-depth interviews with select medical staff (n = 9).

Results: The team structure was highly dense and decentralised, but the intensive care unit nurses showed high betweenness-centrality. In the quality and process domain of teamwork, we did not find a regular joint decision-making process, leading to the absence of common goals among the team members. Although role assignment among the medical staff was explicit, those strictly defined roles hindered active communication about patient information and responsibility-sharing. Most interviewees did not agree with the organisational policies that limited discussions among team members; therefore, medical staff continued to share training and work experiences with each other, leading to strong and trustworthy relationships.

Conclusion: The findings of this study underscore the importance of well-structured and goal-oriented communication between medical staff, as well as the management of the quality of collaboration within a team to increase teamwork effectiveness in paediatric cardiac surgery teams in LMICs.

Keywords: ICU nurses; LMICs; cardiovascular disease; child health; social network analysis; team-based training.

FIGURE 1

Sociogram of social network among Mongolian medical staff attending paediatric cardiac surgery in 2019 (n = 24). CS, cardiovascular surgeon; GS, general surgeon; ANES, anaesthesiologist; SN, scrub nurse; ICUN, ICU nurse; ANN, anaesthesiologist nurse; WDN, wounded dressing nurse; AN, assistant nurse; C, cardiologist. Note: The larger size of the circle denotes higher betweenness centrality, and the colour of the nodes are labelled according to the profession; We randomly assigned a number to an individual for distinction; The node labelled two professions by a slash mark indicates the person who dual positions, and the main profession is mentioned first

FIGURE 2

Betweenness‐centrality among Mongolian medical staff attending paediatric cardiac surgery in 2019 (n = 24). CS, cardiovascular surgeon; GS, general surgeon; ANES, anaesthesiologist; SN, scrub nurse; ICUN, ICU nurse; ANN, anaesthesiologist nurse; WDN, wounded dressing nurse; AN = assistant nurse