Investigation Project

Introduction

      According to Swales, a discourse community is a group of people that have these six specific attributes: a broadly agreed upon set of common and public goals, ways of intercommunication between group members, use of communication mechanisms to provide information and feedback, at least one genre that furthers the goals of the group, a specialized language, and members of the community at all different levels of experience. A surgical team is undoubtedly a discourse community as it fits in all six of the specialized categories. Surgical teams are very important and have high stakes in the workplace. The decisions and actions they make can actually be a matter of life or death. With that in mind, effective communication is huge. This alone checks off three of the six specific discourse community attributes: ways of intercommunication between group members, use of communication mechanisms to provide information and feedback, and a specialized language. 

      A major genre that surgical teams use is their specialized communication methods. All medical language is important, however, when in the operating room the use of concise, precise, and informative communication is undoubtedly critical. An additional genre that is prevalent in all medical professions and practices is notes/documentation. Surgical notes are very important as it is the way that the surgical team can keep record of what they did in the operating room as well as communicate with the patient in a very secure and organized manner. Surgical teams are particularly important to me because I have had an ACL reconstruction and am preparing for a second one in early May of 2023. My brother has also had elbow and knee surgery and it is very important to me that both myself and the people I love are in good hands.

 

Methods

      Within my research on communication within surgical teams I found an academic journal study from BMC Health Services Research titled “Communication and relationship dynamics in surgical teams in the operating room: an ethnographic study.” This study observed and interviewed different members of surgical teams while in the operating room. The researchers focussed on surgical team members who were involved in hip and knee replacements to maintain a consistent time range and level of anesthetic given to the patient. This study took place in 2014 over a ten month period where sixty surgical procedures were observed. The researchers were observing and interviewing surgical team members in efforts to identify patterns or habits in surgical team members to compare them to those in surgery with differing complexities. Initially, this was kept rather vague, however further into the study the researchers focussed on the communication and interactions between the members of the surgical team in the operating room. 

      I also used an article from Johns Hopkins titled “Surgical Teams” going into detail of each role of each individual found in the operating room while a surgery takes place. According to the article, there are typically plus or minus eight people in the operating room with room for a few more or less depending on the complexity of the surgery. Generally speaking, there is one-two surgeon(s), an anesthesiologist, a certified registered nurse anesthetist (CRNA), an operating room nurse/circulating nurse, a surgical tech, residents or medical students (typically in a teaching hospital), a physician assistant, and a representative from the medical device company (if medical devices are being used). All of these individuals make an impact and the communication amongst them is vital to a successful surgery. 

      I also was able to obtain my own personal surgical notes from my first ACL reconstruction that occurred in August of 2021. These notes, much like any surgical notes, are essentially the specialized language used by surgical teams put on paper to be expressed to those not in the operating room and keep precise records of what was done while the patient was under anesthesia. They are very precise and extremely organized as it is the documentation showing exactly what occurred during the operation. It is important to recognize that communication between surgical teams doesn’t end in the operating room, as the patient needs to be informed of what occurred while they were under the anesthetic.

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Findings & Discussion

      According to BMC, the results of the study on communication and relationship dynamics of surgical teams in operating rooms has determined that there are four communication and relational categories. These are proactive and intuitive communication, silent and ordinary communication, attentive and ambiguous communication, and contradictory and highly dynamic communication. 

      Proactive and intuitive communication is considered type 1. The study found that surgical teams that are in this “type 1” category are typically characterized by being oriented around shared goals, having a mutual respect for one another, and most of all being very timely and accurate when it comes to their problem solving communication. The complexity level of the surgeries would determine the importance of managing the shared responsibilities in order to have a simplified day of surgeries. This group makes decisions together and tends to have probable solutions to issues before they even occur. The advanced preparation and high prioritization of streamlined simplicity observed in the study led to the categorization of this group being called “proactive and intuitive.”

      Silent and ordinary communication is categorized as type 2 communication based on this ethnographic study. Much like type 1, type 2 is characterized by shared goals and mutual respect for one another. However, surgical teams categorized as “silent and ordinary” are typically in surgeries that are shorter in duration with fewer problems and shared opinions. The communication is considerably less dynamic and the instances of verbal communication are very brief. There is no small talk in a type 2 surgical team, all speech is “informative and instructive” and straight to the point, especially during the procedures. However, it was observed that the OR nurses were the liveliest in the pre operation preparation process as they did have a higher level of communication. The observation of all groups deemed “type 2” were also found to not prepare or converse over any sort of unlikely issue that may arise and had a sort of “deal with it if it happens” attitude towards the unknown. 

      Attentive and ambiguous communication is categorized as type 3. According to the study, type 3 communication is based more on functional goals as opposed to shared goals. It was less reliant on everyone agreeing and it was actually observed that some members in these teams were disrespectful to one another and placed blame as opposed to using problem solving strategies if issues were to appear. A lot of unpreparedness was observed especially by the nurses as they were not ready for the next steps as the surgeon needed them. It was also found that the surgeons were difficult to get a hold of and communication was lacking in more ways than one.  This resulted in delays and prolongation of surgeries. Overall, type 3 seemed very disorganized and their insufficient methods of communication is most likely to blame. 

      Contradictory and highly dynamic communication is considered type 4 and it is the final group of communication determined by the study. Type 4 communication was primarily characterized as being inconsistent. In some instances, there was streamlined, respectful, and timely communication that was preparing for all possibilities. However, in others it was quite frankly the opposite with minimal communication and a lot of ambiguous communication. Type 4 is essentially a combination of types 1,2, and 3 as you never know what you are going to get. 

      Surgical notes are also very crucial for communication from the surgical team to the patient. The patient is not technically part of the surgical team, however they are definitely crucial to the operation and need an understanding of what the surgeon did to his or her body while under anesthesia. In addition to the communication benefit of surgical notes, it also ensures that there is accurate and secure documentation of what happened while in the surgery. Therefore, if there were to be any postoperative complications, there is a descriptive and accurate depiction of exactly what happened during surgery. 

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Conclusion

      Imagine you were going in for a surgery tomorrow. How would you hope that your surgical team communicates? Personally, I would be hoping for type 1 communication, however, how would you ever know if your OR nurse had a poor attitude and was disrespectful to your surgeon? This goes to show that all teams communicate in different ways, yet it seems to work out one way or another. The procedure is so precise and streamline and all kinks can be worked through. This study in particular really puts the spotlight on how different methods of communication between those in the operating room can be different yet still have positive outcomes. The level of efficiency and productivity may differ, but the job gets done regardless, so long as the communication falls in one of the four types. 

      Specified communication and surgical notes both impact the overall goal of a streamlined and successful surgery. Without specified communication between all the members of a surgical team regardless of which type they are, the surgery is nearly guaranteed to fail. Even type 3, being somewhat disrespectful and disorganized, can still get the job done because their communication is still effective and allows everyone to one way or another be on the same page and keep the patient's best interest in mind. 

 

References

Tørring, B., Gittell, J.H., Laursen, M. et al. Communication and relationship dynamics in surgical teams in the operating room: an ethnographic study. BMC Health Serv Res 19, 528 (2019). https://doi.org/10.1186/s12913-019-4362-0

Surgical team. Surgical Team | Johns Hopkins Medicine. (2021, August 8). Retrieved April 13, 2023, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/the-surgical-team 

My own surgical notes by Dana Piasecki of OrthoCarolina