Transforming communication and relationships in surgical teams improved relational coordination and treatment quality. A mixed methods study.

Introduction: In surgical teams, health professionals are highly interdependent, and a well-functioning interdisciplinary teamwork is pivotal to high-quality treatment and patient safety. This necessity is shaped among others by health professionals’ growing specialization. Today, most surgical teams are established ad hoc with different team members from day to day. This fluid team structure challenges the team’s adaptive capacity and team members’ interactive dynamics, which highlights the need to more deeply understand relationships between team members in fluid teams. Relational coordination (RC) theory and methodology may be key to understanding what lies at the root of successful collaboration, communication, and relationships in surgical teams. Few studies have explored how RC can be improved at the micro level in this specialized context. This study explores surgical teams in selected operating rooms (OR) in order to improve our understanding of how surgical teams practice communication and relationships and to inform recommendations on how best to improve the quality of such teams’ future collaboration. Methods: The study is a mixed methods study with a multiphase design. Phase I was an ethnographic field study where data were collected through observations (39 teams), semi-structured interviews (15), and focus group interviews (2) over a 10-month period in 2014 at two orthopedic surgical wards in a Danish university hospital. Directed contents analysis based on RC theory was used to identify different communication and relationship patterns in the surgical teams. Phase II focused on planning, implementing, and evaluating an organizational intervention process inspired by the Relational Model of Organizational Change. In Phase III, relational coordination was measured before, during, and after implementation of interventions using the Relational Coordination Survey. Phase IV integrated the findings. Results: Surgical teams’ interdisciplinary collaboration was found to be challenged by uncertainties and interdependency among team members. Four different communication and relationship patterns were identified: Proactive & Intuitive Communication, Silent & Ordinary Communication, Inattentive & Ambiguous Communication, Contradictory & Highly Dynamic Communication. Collaboration was found to be appropriate in some teams and inappropriate and requiring transformation in others. Based on these findings, we developed an intervention. RC measures showed non-reciprocal relationships between surgeons and nurses, and across clinical specialties in the OR. RC theory and methodology were useful frameworks for instituting organizational change processes to improve surgical teams’ collaboration, and paved the way for significant changes in RC over time. Implication: Implementation of an organizational intervention based on RC measures may improve surgical OR teams’ communication and relationships, thereby enhancing treatment quality and safety culture.