Presentation
HE12 - Perceptions of Resilience in Operating Rooms Impacted by Role and Built Environment
DescriptionBackground: Within the healthcare field, burnout is a significant concern leading to staff turnover, reduced productivity, diminished patient satisfaction, and increased incidence of medical errors. Resilient healthcare systems can be used to address burnout. Resilience has also allowed for the continued evolution of the built environment. Much of the literature in this area has focused on the built environment within the context of natural disasters with very little focus on healthcare facilities. This is an underexplored topic with literature reviews exploring the built healthcare environment not mentioning it’s connection to resilience. While there is some research that has shown the impact of the built environment on resilient performance and the connection between resilience and burnout, little is known about how these interplay within operating rooms. This study explored individual resilience, team resilience, teamwork and communication, and well-being among staff who worked in three operating rooms (ORs) at differing levels of modernity with the most recent updates having taken place in 1993, 2017, and 2021.
Methods: This study was carried out in three ORs all on the same floor of the hospital. This study utilized these ORs specifically as they had differing spatial layouts and were at different levels of modernization. Clinical staff that work in one or more of the ORs of interest were recruited to participate in this study (n=19). Using a mixed-methods approach that utilized surveys and focus groups, we examined how teams from different operating rooms rated their levels of resilience and well-being. Additionally, this study explored how staff in different roles (i.e., CRNA, nurse, physician, etc.) experienced these concepts. The survey was adapted from a questionnaire that explore the so-called "resilient capabilities" (anticipate, monitor, respond, and learn) as they apply to a team and an additional 18 questions that explore individual resilience. Additionally, this survey was used to collect basic demographic information, explore team communication, and gauge participant burnout and well-being. Following the survey, focus groups were then used to understand the challenges of and potential solutions to the physical environment of the ORs and how this impacts staff stress and satisfaction.
Results: Survey responses were examined by OR and by profession. Mean scores were calculated for each of the four areas of team resilience (anticipate, monitor, respond, and learn), overall team resilience, team communication and relationship, and individual resilience.
The group of participants that worked in more than one OR tended to exhibit lower team resilience than those who worked in only one OR. Those who worked in OR-3, however, tended to have the highest scores in team resilience. When examining the overall team resilience scores compared to individual resilience score and relationship and communication score, results indicate that those worked in more than one OR had the lowest scores in individual resilience and the second lowest score in relationship and communication. Also, even though those who work in OR-3 rated their individual resilience quite low, they had the highest relationship and communication score and team resilience score. These trends were also found in the well-being data. Participants who worked in more than one OR had the lowest feelings of joy while those who worked in OR-3 had the highest sense of belonging and the lowest feelings of burnout.
These same survey aspects differed between professions in the ORs. In terms of team resilience, those who were classified as “other” tended to have the highest score in each area of team resilience. Physicians, however, tended to have the lowest scores in each area of team resilience. When comparing overall team resilience, individual resilience, and team relationship and communication scores, nurses rated their relationship and communication with their team the highest but had the lowest individual resilience scores and the second lowest team resilience scores. CRNAs, conversely, had the lowest relationship and communication score while demonstrating the second highest individual and team resilience scores. Those categorized as "other" consistently rated each category highly. In terms of well-being, physicians had the highest sense of belonging but also noted higher burnout and the lowest amount of joy. CRNAs and nurses appear to have the best overall well-being: both groups had higher levels of belonging and joy without a large sense of burnout.
The focus groups highlighted factors that positively and negatively affect resilience, as well as coping mechanisms for stress. Participants noted that factors such as working with the same team, familiarity with coworkers, and case briefings positively influenced resilience. Conversely, the distant location of the staff lounge and locker rooms, staff turnover, and inadequate staffing were indicated as negative influences on resilience. Focus group participants mentioned coping strategies such as engaging in discussions with coworkers, having access to natural lighting, and decompressing by discussing and venting about their experiences.
Conclusions: Previous research has demonstrated the interplay between the built environment, resilience, and burnout. However, much less is known about how these concepts interact within the healthcare system, specifically operating rooms. This study set out to examine the impact of diverse operating room environments on resilience and well-being of staff and how resilience and well-being differ between those in different roles.
The first key finding from this study is that the layout and modernization of the OR space appears to affect both team and individual resilience, communication, and well-being. Participants in OR-3, the most recently renovated OR studied, demonstrated the highest mean overall team resilience score and the highest potential for team resilience in anticipation, learning, and monitoring. Additionally, this group scored the highest in communication. However, they had lower scores in response and individual resilience. Despite lower individual resilience scores, the results suggest that the changes made in OR-3 contribute to improved team resilience and enhanced communication. In terms of well-being, individuals working in OR-3 reported a strong sense of belonging and a low level of burnout, indicating positive effects of the modernized OR environment.
Another crucial finding corroborates earlier research indicating that working in multiple teams can negatively impact individual and team performance. Participants working across multiple ORs scored lower in both individual and team resilience compared to those working in a single OR. This group also experienced lower levels of joy and communication, underlining the importance of consistent team dynamics and effective briefings, especially when the OR comprises clinicians not always present in that specific OR.
Furthermore, this study highlighted distinct experiences of resilience, communication, and well-being based on different roles within the OR. Participants classified as "other" (not CRNA, nurse, or physician) tended to have the highest scores in each resilience category and the highest overall team resilience score. In contrast, physicians consistently demonstrated the lowest scores in team resilience categories and the second lowest overall team resilience score. CRNAs had the lowest communication score but ranked second highest in individual and team resilience scores. Surprisingly, physicians reported the greatest sense of belonging alongside the lowest levels of joy.
The incorporation of focus groups alongside the survey allowed for deeper exploration of potential causes behind differences observed among OR teams and roles. Participants provided valuable suggestions for infrastructure improvements both within and outside the OR, as well as shared strategies to minimize stress. The need for clinicians to work in multiple ORs highlighted the necessity of reinforcing pre-operation briefings to bolster both individual and team resilience. This study has shown that it is possible to identify the inconveniences originating from the built environment, expose the expertise, creativity and dedication shown by clinicians to overcome these burdens, and develop solutions to improve resilience.
Methods: This study was carried out in three ORs all on the same floor of the hospital. This study utilized these ORs specifically as they had differing spatial layouts and were at different levels of modernization. Clinical staff that work in one or more of the ORs of interest were recruited to participate in this study (n=19). Using a mixed-methods approach that utilized surveys and focus groups, we examined how teams from different operating rooms rated their levels of resilience and well-being. Additionally, this study explored how staff in different roles (i.e., CRNA, nurse, physician, etc.) experienced these concepts. The survey was adapted from a questionnaire that explore the so-called "resilient capabilities" (anticipate, monitor, respond, and learn) as they apply to a team and an additional 18 questions that explore individual resilience. Additionally, this survey was used to collect basic demographic information, explore team communication, and gauge participant burnout and well-being. Following the survey, focus groups were then used to understand the challenges of and potential solutions to the physical environment of the ORs and how this impacts staff stress and satisfaction.
Results: Survey responses were examined by OR and by profession. Mean scores were calculated for each of the four areas of team resilience (anticipate, monitor, respond, and learn), overall team resilience, team communication and relationship, and individual resilience.
The group of participants that worked in more than one OR tended to exhibit lower team resilience than those who worked in only one OR. Those who worked in OR-3, however, tended to have the highest scores in team resilience. When examining the overall team resilience scores compared to individual resilience score and relationship and communication score, results indicate that those worked in more than one OR had the lowest scores in individual resilience and the second lowest score in relationship and communication. Also, even though those who work in OR-3 rated their individual resilience quite low, they had the highest relationship and communication score and team resilience score. These trends were also found in the well-being data. Participants who worked in more than one OR had the lowest feelings of joy while those who worked in OR-3 had the highest sense of belonging and the lowest feelings of burnout.
These same survey aspects differed between professions in the ORs. In terms of team resilience, those who were classified as “other” tended to have the highest score in each area of team resilience. Physicians, however, tended to have the lowest scores in each area of team resilience. When comparing overall team resilience, individual resilience, and team relationship and communication scores, nurses rated their relationship and communication with their team the highest but had the lowest individual resilience scores and the second lowest team resilience scores. CRNAs, conversely, had the lowest relationship and communication score while demonstrating the second highest individual and team resilience scores. Those categorized as "other" consistently rated each category highly. In terms of well-being, physicians had the highest sense of belonging but also noted higher burnout and the lowest amount of joy. CRNAs and nurses appear to have the best overall well-being: both groups had higher levels of belonging and joy without a large sense of burnout.
The focus groups highlighted factors that positively and negatively affect resilience, as well as coping mechanisms for stress. Participants noted that factors such as working with the same team, familiarity with coworkers, and case briefings positively influenced resilience. Conversely, the distant location of the staff lounge and locker rooms, staff turnover, and inadequate staffing were indicated as negative influences on resilience. Focus group participants mentioned coping strategies such as engaging in discussions with coworkers, having access to natural lighting, and decompressing by discussing and venting about their experiences.
Conclusions: Previous research has demonstrated the interplay between the built environment, resilience, and burnout. However, much less is known about how these concepts interact within the healthcare system, specifically operating rooms. This study set out to examine the impact of diverse operating room environments on resilience and well-being of staff and how resilience and well-being differ between those in different roles.
The first key finding from this study is that the layout and modernization of the OR space appears to affect both team and individual resilience, communication, and well-being. Participants in OR-3, the most recently renovated OR studied, demonstrated the highest mean overall team resilience score and the highest potential for team resilience in anticipation, learning, and monitoring. Additionally, this group scored the highest in communication. However, they had lower scores in response and individual resilience. Despite lower individual resilience scores, the results suggest that the changes made in OR-3 contribute to improved team resilience and enhanced communication. In terms of well-being, individuals working in OR-3 reported a strong sense of belonging and a low level of burnout, indicating positive effects of the modernized OR environment.
Another crucial finding corroborates earlier research indicating that working in multiple teams can negatively impact individual and team performance. Participants working across multiple ORs scored lower in both individual and team resilience compared to those working in a single OR. This group also experienced lower levels of joy and communication, underlining the importance of consistent team dynamics and effective briefings, especially when the OR comprises clinicians not always present in that specific OR.
Furthermore, this study highlighted distinct experiences of resilience, communication, and well-being based on different roles within the OR. Participants classified as "other" (not CRNA, nurse, or physician) tended to have the highest scores in each resilience category and the highest overall team resilience score. In contrast, physicians consistently demonstrated the lowest scores in team resilience categories and the second lowest overall team resilience score. CRNAs had the lowest communication score but ranked second highest in individual and team resilience scores. Surprisingly, physicians reported the greatest sense of belonging alongside the lowest levels of joy.
The incorporation of focus groups alongside the survey allowed for deeper exploration of potential causes behind differences observed among OR teams and roles. Participants provided valuable suggestions for infrastructure improvements both within and outside the OR, as well as shared strategies to minimize stress. The need for clinicians to work in multiple ORs highlighted the necessity of reinforcing pre-operation briefings to bolster both individual and team resilience. This study has shown that it is possible to identify the inconveniences originating from the built environment, expose the expertise, creativity and dedication shown by clinicians to overcome these burdens, and develop solutions to improve resilience.
Event Type
Poster Presentation
TimeMonday, March 254:45pm - 6:15pm CDT
LocationSalon C
Digital Health
Simulation and Education
Hospital Environments
Medical and Drug Delivery Devices
Patient Safety Research and Initiatives