We are constantly being told that medicine could learn a thing or two from aviation, and that the aircraft industry has managed to solve all the problems around working in teams. If only this were true.
The airline industry works with a rigid structure of authority and responsibility. All the crew work for the same company and follow the same procedures. When an aircraft is in flight the captain has complete authority over every member of his or her team.
Now contrast that with work in an operating theatre, where there are anaesthetists, surgeons, nurses, ODPs and support staff. Each of them is a member of a separate department, and each of them works within their own professional and other rules of engagement. To say that all of them are working together for the good of the patient is a slight simplification, since they are each working to their own rules with different priorities.
When there is conflict between the members of this ‘team’ there are no clear lines of authority or responsibility. The surgeon naturally assumes that he is the leader of the team. The anaesthetist does too (and is probably correct). The nurses have written a ‘Philosophy of Care’ on the wall of the theatre claiming responsibility for everything that goes on within it.
The lesson we should learn from aviation, but haven’t done yet, is how that team should function. Each member of the team has their own individual role – navigator/pilot and surgeon/anaesthetist. But the interrelationships between these roles needs to be made much clearer. If anything these relationships have got less clearly defined, and when things go wrong it becomes critical.
We are also less familiar with the colleagues with whom we are working. Shift patterns and management efficiencies sometimes result in us working with people who we don’t really know. We don’t know their capabilities and we don’t know the difficulties they are having.
The WHO checklist requires each member of the theatre team to introduce themselves to one another at the beginning of a case. With true British reserve we find this excruciatingly embarrassing, but it could go a long way to helping. It would be especially useful in the emergency situation, where not everyone knows each other.
The concept of a ‘team’ is a complex one and many teams are more realistically a collection of representatives from separate independent teams. Once we understand this concept we can move forward.
Tags: Patient safety
