Résultat de la recherche
Improving the work of surgeons: identifying sources of stress and introduction of a tool to facilitate good teamwork in the operating room
This dissertation is composed of three papers and four manuscripts. The papers form the first main topic of this thesis, identifying sources of stress. The manuscripts form the second main topic, introduction of a tool to facilitate good teamwork in the operating room. The first paper (The workday of hospital surgeons: What they do, what makes them satisfied, and the role of core tasks and administrative tasks; a diary study) aimed to relate everyday work experiences of surgeons to felt stress. For this, 105 surgeons responded to a general questionnaire regarding their working conditions, 87 of them also participated in a diary study. Surgeons worked a mean of 11.86 hours per day. About one fifth each was spent on tasks directly related to surgery (21.2%) and to patients (21.7%); about ten percent (10.4%) on meetings and communicating about patients, and somewhat less than one fifth (18.6%) on documentation and administration. Performing surgery – a surgeon’s core activity- was rated as the most, and administration as the least attractive task. The higher the percentage of administrative work, the lower was its perceived adequacy. The extent to which the amount of administrative work was perceived as adequate was associated with job satisfaction. The second paper (Noise in the Operating room distracts member of the surgical team. An observational study) examined how noise pollution in operating rooms (OR) may distract members of the surgical team. Especially during phases of high task complexity, noise can jeopardize concentration. Phases of high complexity are related to specific characteristics of the tasks and can therefore be different for the different members of the surgical team. Noise exposure was measured during 110 surgeries and related to self-report of distraction by main and secondary surgeons, scrub nurses and anesthetists participating in the surgeries. Second surgeons were more distracted by noise during the main phase and anesthetists more during the closing phase. The concentration of the other team members were not impaired. The third paper (More than talking about the weekend: content of case-irrelevant communication within the OR team) evaluated the content of case-irrelevant communication (CIC) of the team during surgeries and whether they regulate CIC according to different concentration demands (surgical phases and difficulty of surgery). In 125 surgeries, 1396 CIC events were observed. Workrelated CIC was significantly more frequent (2.49 per hour) than social CIC (1.42 per hour). Across phases, frequency of work-related CIC was constant, whereas social CIC increased significantly. In surgeries rated as highly difficult by the surgeons, less social and work-related CIC were observed. 3 The analyses in the four manuscripts are all part of a larger project, the StOP? project. In this project, the StOP? protocol, an intraoperative briefing aimed at enhancing information exchange within the surgical team, was introduced in surgical departments of four hospitals. At critical moments during each procedure, the leading surgeon interrupted the surgery and informed the team in terms of the current Status (St) and Objectives (O) of the surgery, Problems that may occur (P), and encouraged questions of other team members (?). The first manuscript (Preparation and implementation of intraoperative briefings to enhance teamwork during surgeries: The StOP? Protocol) describes details on the conceptualization and development of the StOP? protocol. To adapt the StOP? protocol to the operation room and pinpoint the right moment for the StOP?, interviews with 23 surgeons were carried out and analyzed. Several surgeons mentioned similar preferred points to conduct a StOP?, such as after initial exposure, before important steps, and before or after anastomosis. The demand of the surgeons for a StOP? nevertheless varied for different kinds of surgeries and local practice. The second manuscript (Context and task-related factors influencing the compliance of surgical teams with an intra-operative briefing intervention) analysed the compliance with the StOP? protocol. Possible positive effects of briefing interventions depend on compliance of the surgical team. Compliance with the StOP? protocol was measured and factors influencing compliance were evaluated. Compliance was measured using a post-surgery questionnaire filled in by scrub nurses. Results of three hospitals show that nurses provided information in 79.1% of eligible surgeries. In these surgeries, compliance rate (at least one StOP? protocol) was 83.6%. Influences on compliance were hospital, urgency (elective vs emergency), duration, and surgical access (minimal invasive vs open surgery). The third manuscript (Two are better than one – Introducing an intra-operative briefing enhances the quality of an established pre-operative briefing: a pre-post intervention study) analysed if and what influences the newly introduced StOP? has on the quality of the already established preoperative timeout (briefing before skin incision). Observers rated the quality of the timeout in 267 surgeries in two hospitals. As compared to the baseline, after the implementation of StOP?, observed timeouts were rated significantly less noisy, higher in engagement, less rushed, in a better social atmosphere and had a higher rate of completion. The fourth manuscript (Supporting situation awareness and ease of speaking up by a short intervention to foster information exchange during surgical procedures: An intervention study) compared situation awareness and ease of speaking up of surgical team members during surgeries before and after the introduction of the StOP?. Members of the OR team filled in self-report questionnaires at the end of 371 surgeries in three hospitals. The intervention improved situation 4 awareness of anaesthesia and circulating nurses. Ease of speaking up was enhanced for scrub nurses, anaesthesia care providers, and circulators. The contribution and implications of each paper and manuscript in means of the dissertation topics are discussed as well as the limitations and future perspectives of the present work.
Human Factors in the operating room - the surgeons view
The quality of surgical performance depends not only on the technical skills of the surgical team, but also on non-technical skills. Identification and improvement of such non-technical skills is an important aim to improve overall surgical outcomes. Non technical skills primarily include three factors. The first factor is efficient communication among a multidisciplinary team. This requires strong leadership and coor- dination of role-related tasks for the surgical team members. The second factor is coping with distractors in the operating room. Distractors may impact team performance and must be identified and reduced to ensure maximum concentration in the most of unavoidable distractions. The third factor is the impact of stress and fatigue of the surgical team. Potential methods of addressing these topics include training, procedural support for human factors requirements, and specified phases for information reflection as well as for mental recovery
On regulating emotion expression in social interaction : the interplay of goal attainment, regulatory effort, and well-being
Expressing emotions carries important social functions in our daily lives. Although research has demonstrated that the regulation of emotion expression induces discrepancies and could be effortful and detrimental to individual well-being; possible beneficial outcomes, such as goal attainment, could ensue from expressing appropriate emotions during social encounters. This could, in turn, influence well-being outcomes. Using an event-sampling methodology (ESM) of studying one week of naturally-occurring social encounters (more than 3000 interactions collected) reported by 115 Swiss participants, this thesis investigated several related phenomena under the domain of the social function of emotion: what mechanisms of display regulation of emotion are associated with regulatory effort during daily social encounters (Study 1); whether positive emotion expression and its amplification predicts attaining goals in the workplace, and how these results could differ, depending on the interaction partner (superior vs colleague) with whom the person is interacting (Study 2). Lastly, whether success in goal attainment could reduce the negative impact, on well-being associated with regulatory effort (Study 3). We performed multilevel and polynomial regression whenever appropriate in our analyses. Variables at the personal level, such as age, gender and personality (big five) were controlled in all of our analyses. Results, as well as implications for any future research and practice, are discussed.
Faut-il réfléchir pour être performant en groupe ?: les conditions de l’efficacité de la réflexivité
In this dissertation I concentrate on some of the boundary conditions of reflexivity in teams. Research has shown that reflexivity (collectively reflecting on the teams’ objectives, strategies, and processes and adapting them accordingly) can enhance team performance and innovation. This effect, however, may have boundary conditions. Indeed, prior research has shown that the positive effects of reflexivity were often not straightforward, but depended on other variables. Given the many variables that moderate the relationship between reflexivity and team outcomes, it remains important to investigate under what conditions reflexivity really benefits teams. Therefore, I decided to study team reflexivity and take into account potential moderators, based on the assumption that reflexivity enhances performance and innovation if the reflection process is useful for the actual task or cooperation requirements. This dissertation is composed of a conceptual part (Chapter 1, 2, 3) and an empirical part (chapter 4, 5, 6) that present three papers each testing a specific aspect of the relationship between reflexivity and team performance and innovation. In all of the papers, the hypotheses were tested with field studies and the variables were evaluated with self-report questionnaires. A preliminary step in this dissertation was to validate the reflexivity scale for a French speaking sample. This first step enabled me to have an appropriate measure of reflexivity for the following next steps. The next steps represent the core project of this dissertation. The aim was first to test whether task reflexivity influences team performance and innovation more when teams need coordination because of task variety and when teams can implement the results of their reflection thanks to autonomy. And second, to test the relative importance of task reflexivity compared to transactive memory system, for team performance and innovation. In the first paper (chapter 4), two studies were conducted with 80 teams (320 participants) to validate the French version of reflexivity scale. In study 1, exploratory factor analysis revealed 3 factors which partially confirm the 2 factor structure expected from the original study (Carter & West, 1998). Two items of the original task reflexivity scale loaded on a third factor named ‘strategic reflexivity’. The three factor structure was replicated in study 2 with confirmatory factor analysis. Criterion validity is confirmed by correlations between reflexivity and team performance. Task, social and strategic reflexivity correlate with different aspects of team and individual performance. From these studies, it was concluded that the French version of the reflexivity scale is reliable and appropriate for evaluating team reflexivity. In the second paper (chapter 5), a study was conducted with 84 heterogeneous teams (334 participants) that performed a wide variety of tasks. First, I tested whether task reflexivity influences team performance more when teams need coordination because of task variety. Results indicated that task reflexivity improved team performance more when there was greater task variety. Second, I investigated whether the effects of task reflexivity on team innovation depend on the level of autonomy. Again, results showed that teams with greater autonomy benefited more from task reflexivity than teams with less autonomy. The results support my argument that task reflexivity benefits teams when teams perform non-routine tasks that may require more integration and coordination; and is most helpful when they are autonomous, and thus able to implement the results of their reflection. In the third paper (chapter 6), I surveyed 101 teams (420 participants) to test the relationships between explicit coordination (task reflexivity) and implicit coordination (transactive memory system). Results show that task reflexivity fostered team innovation and team performance. Transactive memory systems enhanced not only team performance but also innovation. As expected, task reflexivity and transactive memory did interact. Task reflexivity only enhanced team performance in teams with a less well developed transactive memory system (as evidenced by low level of specialization). Similar results were found for team innovation. Task reflexivity fostered team innovation in teams with a less well developed TMS (as evidenced by specialization and coordination) but high task reflexivity also impacted team innovation for teams with a good transactive memory system (as evidenced by high specialization and coordination). These results support the argument that task reflexivity is most helpful when a team has a poor transactive memory system that may require a reflection on who knows what. Second, the results supports the argument that task reflexivity also benefits team innovation when a team is highly specialized and coordinated and thus explicit reflection with specialized, diverse well coordinated team members, increases innovation. The primary contribution of this dissertation was to provide explanation for understanding the mixed results of task reflexivity on team performance. On one hand, this study highlights the importance of both task characteristics and enabling conditions of the effects of reflexivity on team performance and innovation; and on the other hand the importance of studying the relationship among explicit and implicit coordination mechanism on team outcomes. Future research should further address reflexivity and its boundary conditions.
Wirkungsweise und Effekte sozialer Unterstützung in Ausbildung und Schule
La transition de l'école au travail est l'une des principales gageures pour le développement des jeunes adultes et a des conséquences importantes pour la poursuite d’une carrière. Elle est également un défi particulier pour les jeunes ayant des difficultés d'apprentissage. Le soutien social est considéré comme un facteur de facilitation important dans le développement de carrière et est donc particulièrement important pour cette population. De façon générale, il est perçu comme ayant des effets positifs directs sur divers indicateurs, comme le bien-être et la performance, et est censé amortir les effets négatifs du stress. Compte tenu des résultats empiriques contradictoires à ce sujet, il existe un débat scientifique sur la thèse que le soutien social soit spécifique à un environnement ainsi que sur la thèse que la probabilité de trouver des effets du soutien social remonte au "matching" entre les exigences du poste de travail et les ressources professionnelles. Les deux premiers articles de cette thèse se réfèrent à ce débat et abordent le rôle du soutien social dans le cadre de l’enseignement et la formation professionnels (EFP).
Les objectifs de la première étude sont doubles. Premièrement, il s’agit de vérifier si le soutien social atténue les effets négatifs du stress, subi dans le cadre de l’enseignement et la formation professionnels, sur la performance subjective que ce soit dans le contexte de l’école EFP ou de l’entreprise EFP ainsi que sur l'attitude positive envers la vie. Deuxièmement, il s’agit de mettre en évidence quelles personnes sont utiles, dans quelles situations et à l'égard de quels résultats. En nous basant sur les données d'une étude d'évaluation d'un programme EFP en Suisse (N = 525), il ressort que l’appui donné par les formateurs EFP a des effets directs sur la performance subjective alors que le soutien des mères influe davantage sur les attitudes positives envers la vie. De plus, nous avons trouvé un effet d'interaction inattendu concernant le soutien des formateurs EFP. Le soutien des pères atténue les effets du stress, dans les contextes de l’école et de l'entreprise, sur l'attitude positive envers la vie.
Dans la deuxième étude, nous nous focalisons sur les différentes voies de soutien offert par les enseignants des écoles EFP et par les formateurs en entreprise pour favoriser les aspirations de carrière des apprentis et les encourager à s’engager dans la formation continue. Les modèles d’équations structurelles ont été utilisées pour analyser les données longitudinales de l’étude d'évaluation mentionnée ci-dessus. Les résultats montrent que le soutien de l’enseignant est directement et indirectement lié aux aspirations de carrière à la fin de l'apprentissage, tandis que le soutien du formateur en entreprise n'influence qu’indirectement les aspirations professionnelles. Il en ressort aussi que des concepts spécifiques aux deux lieux de formation, comme les compétences scolaires, la diversité des tâches au travail, et l’estime de soi sont importants comme variables intermédiaires.
Dans la troisième étude, nous avons cherché à comprendre dans quelle mesure les expériences vécues à l'école dans les groupes de pairs influencent la perception du soutien global perçu dans le contexte social. À cet effet, nous avons analysé les données de 321 élèves (avant et après la transition de l'école primaire à l'école secondaire) et de leurs enseignants à l'aide de modèles d’équations structurelles. Les résultats concordent avec notre hypothèse de départ, à savoir que les expériences d’intégration sociale passées et présentes ont une influence significative sur le soutien social perçu et sur la satisfaction de vivre. Dans l'ensemble, on peut conclure que l'école joue un rôle important en tant qu’espace où faire des expériences, qui a des effets bien au-delà de ses frontières.
Nous en tirons la conclusion que, malgré le fait qu'il existe de nombreuses recherches portant sur le soutien social, il reste important de chercher à mieux comprendre encore les mécanismes et les conditions de soutien utiles ainsi que de détecter les problèmes de relations inefficaces, voire nuisibles, dans et autour des situations d’EFP ou au sein des écoles. Une meilleure compréhension nous aidera ainsi à optimiser l'impact positif du soutien., The transition from school to work is one of the major developmental tasks for young adults and has important consequences for further career development. It is also a particular challenge for young people with learning difficulties. Social support is considered to be an important facilitating factor in early career development and is therefore particularly important for these young people. In general, social support is thought to have direct positive effects on different outcomes (e.g. well-being, performance) and to “buffer” negative effects of stress by providing coping assistance. In view of inconsistent empirical findings regarding this, there is a debate whether social support is domain-specific and about whether the probability of finding effects of social support is a question of “matching” between job demands and resources. The first two articles of this thesis refer to this idea and address the role of social support during vocational education and training (VET) for low achieving apprentices.
The questions of the first study were (1) if social support mitigates the negative effects of stress in VET on self-rated performance in the VET-school or VET-company and on positive attitude towards life (“buffer-hypothesis”) and (2) which people are helpful in which situations and in regard to which outcomes (“matching-hypothesis”). Using data from an evaluation study of a VET-programme in Switzerland (N=525), we found direct effects of VET-trainers’ support on self-rated performance and of mothers’ support on positive attitudes towards life. Furthermore, we found an unexpected interaction effect of VET-trainers’ support. As expected, fathers’ support “buffered” the effects of stress at the VET-school and the VET-company on a positive attitude towards life.
In the second study, we were interested in the various pathways of support provided by teachers at VET-schools and trainers at VET-companies to foster apprentices’ career aspirations and to encourage the undertaking of further training. Structural equation modelling was used to analyse longitudinal data from the same evaluation study. Results show that VET-teacher support is directly and indirectly related to career aspirations at the end of the apprenticeship, whereas VET-trainer support only influences career aspirations indirectly. Domain specific constructs (ability self-concept at VET-school, skill variety at the VET-company) and self-esteem are important as intermediary variables. Ability self-concept at VET-school had a strong influence on further education three years after the apprenticeship.
These findings suggest that it is important to distinguish between different support sources and outcome variables to better understand how social support works in VET.
In the third study, we focused on the question of how peer-group experiences at school influence the overall perceived support in the social context. For this purpose, we analysed data from 321 pupils (before and after the transition from primary to secondary school) and their teachers using structural equation modelling. The results concur with our hypothesis that past and present experiences of being socially integrated have a significant influence on perceived social support and on life satisfaction. Overall, it can be concluded that school has an important function as an experiential space, which has effects beyond its boundaries.
In summary, we consider that in spite of the fact that there has been much research into social support, it is still important to better understand the mechanisms and conditions of helpful support and to detect the problems of ineffective or even harmful relationships in and around VET-situations or schools. A better understanding will help us to optimise the positive impact of support and this is vital, given the limited resources that young people with learning difficulties have.