Decoding the perioperative process breakdowns: a theoretical model and implications for system design.

Area of Science:

• Healthcare Systems Engineering
• Patient Safety Research
• Clinical Process Analysis

Background:

• Breakdowns in communication and coordination are primary causes of adverse events in healthcare, particularly in operating rooms.
• Existing research often focuses on teamwork dynamics, neglecting systemic and inter-team process breakdowns.
• This study addresses the need for a detailed understanding of breakdowns at the hospital system level.

Purpose of the Study:

• To deeply understand the impact of breakdowns on surgical processes by analyzing hospital system-level interactions.
• To explore the implications of this understanding for designing more effective clinical systems.
• To move beyond teamwork dynamics and examine breakdowns within broader hospital system processes.

Main Methods:

• Inductive derivation of breakdown and repair properties to create a formal coding scheme.
• Systematic content analysis of 79 hours of observed elective surgery unit data.
• Statistical hypothesis testing to identify relationships between breakdown and repair variables.

Main Results:

• Breakdown properties significantly influence repair properties.
• Most identified breakdowns occurred at the inter-team coordination level, beyond individual teamwork.
• Breakdowns tend to propagate downstream, increasing communication costs for repairs; longer propagation leads to higher costs.

Conclusions:

• A process-oriented perspective provides initial insights into breakdown features, forming a basis for a theoretical model of perioperative breakdowns.
• A design framework is proposed to address breakdowns early in system development.
• Exploiting the breakdown-repair association can inform IT and organizational design to prevent or mitigate breakdowns, with a focus on preventing propagation.