A Network Analysis of Communication Patterns in a Perioperative Military Setting

The operating room (OR) is a fast-paced, dynamic environment and one of the most complex work settings in healthcare. The OR is the most frequent location of adverse events and medical errors in hospitals with two-thirds of all errors attributed to surgical care. Because of patient volume, hierarchical power disparity, and the unique culture of the multidisciplinary clinicians that work in this setting, the OR is particularly susceptible to communication failures. These communication failures may lead to errors resulting in suboptimal care, serious patient injury, or death. Typically, communication is studied using linear theory and focuses on the behavior of the individual to understand group-level concepts. To understand OR communication, it is crucial to not only study individual communication patterns, but also the relationships among individuals.

This study will use social network analysis (SNA) to explore the culture and multilevel relations of individuals and teams in the OR. The PI will administer a sociometric survey to OR team members at Malcolm Grow Medical Clinics and Surgery Center (MGMCSC) to develop the communication network for analysis. The study will occur over 16 weeks to identify the typical communication patterns and how the interdependent relationships in the OR potentially affect individual and group behavior. After revealing the underlying factors that shape clinician communication patterns in the OR, we can conduct future research with the ultimate aim of improving healthcare quality and safety.

To our knowledge, no investigators have used SNA techniques to evaluate OR communication. We propose a network-centric study to characterize the OR communication network at the individual, interpersonal, and group levels.

The specific aims are:

Aim 1. Assess the correlation of the Individual Communication Index (ICI) with individual centrality within the network.

Aim 2. Identify the factors that shape interpersonal communication.

Aim 3. Explain how network structure affects group communication.

This research will aid the Defense Health Agency (DHA) initiative to become a High-Reliability Organization (HRO) by dissecting the complex safety problems related to OR communication. Building effective communication among teams of surgical members at the organization and microsystem level will potentially improve healthcare quality and safety, increase readiness, and is a crucial step to becoming an HRO.

Final Report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2018101...