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• W4382765669 abstract "Various operating theatre tools have been introduced in the wake of growing evidence that preventable error is overrepresented in surgery.1 A common thread amongst surgical preventative errors relate to teamwork and decision making.2 One such tool intended to address preventable error is the multi-disciplinary team briefing (MDTB)—also known as ‘huddles’, ‘pre-list briefings’ and ‘perioperative briefings’. An MDTB is a short meeting that occurs before the surgical list commences and involves all medical staff working in a particular theatre.3 Although variations exist across individuals, specialties, hospitals and health services, an evidence-based five-step model of MDTB suggests they should include five elements: introductions, list overview, case-specific details, questions, and a summary of changes.4-6 A practical exemplar of this process is provided in Civil.4 MDTBs differ from the WHO team time out (WHOTTO) and other pre-case briefings in both timing and scope. The WHOTTO occurs when the patient is in theatre and is concerned solely with that patient. In contrast, the MDTB occurs before any patients arrive and addresses the whole list. Whereas the WHOTTO is primarily concerned with safety, the MDTB establishes a shared understanding of the list, role clarity, and effective communication patterns.3 Despite evidence of the utility of MDTBs in supporting critical outcomes including patient safety, safety climate, surgical efficiency, and staff engagement, MDTB uptake across Australian and New Zealand is variable.4, 5, 7 Barriers to MDTB implementation are many and complex; however, a primary barrier remains individual resistance.6 Such resistance often rests in the view that MDTBs are unnecessary intrusions that take up valuable operating time8 and may be compounded by the fact that much of the empirical evidence as to their effectiveness is reported in medical education and nursing journals that surgeons may not read regularly. Poor uptake may also signal a lack of understanding as to why MDTBs work which may help bridge the evidence-practice gap. When performed well, two ways in which MDTBs result in improved perioperative outcomes are the demonstration of dynamic leadership and supporting teamwork. The importance of dynamic leadership has been stressed by many researchers.9-11 Dynamic leadership is defined by the effective oscillation between task-specific leadership and leadership that supports team functioning.9 MDTBs can help surgeons lead dynamically by creating opportunities to set out a clear plan for the list and specific patients (task-specific) while also affording team members opportunities to contribute and proactively coordinate (team functioning). Demonstrations of leader humility, a characteristic of great leaders,12 can enhance dynamic leadership. Integral to leader humility is the appreciation of others' strengths, acknowledging one's own fallibility and a desire to learn—all of which may help surgical teams effectively meet dynamic requirements.9, 11 By actively engaging all team members in MDTBs, surgeons can signal their humility, harness the strengths of others, and model teachability. When MDTBs are conducted well, they afford team members ongoing opportunities to contribute, highlight staff strengths, and involve the integration of suggestions that help the team achieve optimal outcomes.3, 5, 6 MDTBs can also support teamwork which is essential because teamwork deficiencies as a significant contributor to surgical error with serious consequences.1, 9, 13 Effective teamwork, particularly in high-stakes and dynamic contexts, is largely characterized by psychological safety, role clarity and mutual performance monitoring and backing up.14 Psychological safety reflects the extent to which individuals perceive there to be interpersonal risk associated with speaking up about potential issues or threats.15 MDTBs can help create psychological safety, particularly amongst teams that may not have worked together before. Specifically, the simple act of introducing oneself can increase the propensity for team members to speak up later and support inter-professional communication. Furthermore, MDTBs can establish norms of civility that can support effective teamwork. In addition to speaking up, psychological safety is also negatively related to psychological silence—the deliberate act of not speaking up despite seeing something (potentially) wrong.15 A recent meta-analysis found a strong positive correlation between silence and adverse incidents.16 Role clarification constitute critical pieces of information communicated during the MDTB review of cases step. For example, surgeons should indicate who will be the primary and assisting surgeon for each case, and nursing staff should identify who will be scrub and circulating. Role clarity may also provide useful during slowing down moments that occur during difficult dissections or complex procedures. During these cognitively demanding moments, the surgeon's attention is focused on the task and their situation awareness is decreased. Identifying who will be involved and when such slowing down moments will occur can help the team support the surgeon by reducing environmental distractions and increasing their own awareness of the broader surgical context such as blood loss and other potential hazards. Open access publishing facilitated by The University of Western Australia, as part of the Wiley - The University of Western Australia agreement via the Council of Australian University Librarians. A. F. Stewart Flemming: Conceptualization; writing – original draft; writing – review and editing. Joseph Alexander Carpini: Writing – review and editing." @default.
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• W4382765669 date "2023-05-09" @default.
• W4382765669 modified "2023-09-26" @default.
• W4382765669 title "Why multi‐disciplinary team briefings work" @default.
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• W4382765669 doi "https://doi.org/10.1111/ans.18515" @default.
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