An approach to multidisciplinary team development in cardiothoracic theatres utilising video reflexive ethnography

Abstract

Introduction Safety in healthcare is predicated on excellent teamwork, this is particularly the case in cardiothoracic theatres where the complex interplay of multiple healthcare professionals is required to deliver successful patient outcomes. Improvements in healthcare habitually focus on the scientific basis of our interventions, evidence-based medicine and randomised control trials (RCTs), however these fail to consider the impact of a high functioning team on delivery of intended outcomes.1 Team development in healthcare is often neglected, despite its connection to patient safety.2 At best, organisations offer sporadic simulation training, however this falls short of the depth of training offered in other industries. Methods We present here a novel approach to the development of clinical expertise. Video reflexive ethnography (VRE) is a powerful tool utilising video to present a fresh perspective of in situ practice to participants.3 The potential for VRE lies in the rich descriptive power of video, and its ability to challenge participants to view their practice with fresh eyes. This results in exposure of tacit behaviour, development of shared understanding across a team and challenge to damaging hierarchy and inequalities.4 We recorded a multidisciplinary team engaged in cardiac surgery requiring cardio-pulmonary bypass. Short clips were selected and edited with a focus on interdisciplinary communication The edited clips were used in a facilitated reflexivity session where the whole multidisciplinary team engaged in reflexive discussion. Results The reflexivity session explored: i) Communication: Differences between surgeon/anaesthetist communication, versus surgeon/perfusionist. There are shared visual guides for the anaesthetic/surgical relationship, but our perfusionists cannot visualise the surgical field and surgeons have no visual cue for blood volume available to return to the circuit, both instead rely on verbal communication. This risks break down under unusual circumstances e.g. unanticipated complications or unfamiliar teams. ii) Hierarchy: Examples surfaced during the reflexivity session, such issues have frequently been shown to have negative consequences.2 The VRE process offered a safe space to explore, challenge and flatten these hierarchies. Discussion Having demonstrated the power of the technique within our department our ongoing work will focus on the integration of this process into the normal working of the team.