The Development of a Role-Playing Simulation to Investigate Coordination of an OR Master Schedale

The structure of many hospitals is team-based. Safety, efficiency, and performance depend on the ability of the organizations to support coordination and collaboration across teams, tasks, and resources. To develop adequate technologies to support these processes we need a deeper understanding of how different professionals manage multiple tasks and interruptions. The goal of this research is to simulate the coordination mechanisms and trajectories of hospital personnel as they move patients in and out of OR.In the complex hospital environment, there are at least three key types of trajectories: (a) patient trajectories , (b) resource trajectories, (c) staff trajectories. We developed a web-based role-playing game to simulate a master schedule in an OR.We ask three players to take on the role of charge nurse (CN), anesthesiologist in charge (AIC), and surgeon coordinator (SC) with the goal of attending toORscheduling dynamics, as they manage their individual trajectories and objectives in the face of interruptions.The tasks that each player is responsible for performing can be classified into three types: (1) Facilitating patient flow through the OR, (2) Coordinating the master schedule, and (3) Managing resources.Figure 1 depicts the flow of a patient through the system, and denotes the role of each player in this flow. Throughout the patient flow, various types of interruptions can occur(shown as lightning bolts). For example, a patient may fail to arrive at the appointed time, a surgeon could be late arriving for surgery, a surgery could take longer than expected, or the cleaning staff could be too busy to clean the operating room in time for the nextsurgery. These types of interruptions affect trajectories by requiring players to quickly converge on a problem that requires an immediate response.We expect that trajectories will be influenced in part by the type and frequency of interruptions encountered by the players. By superimposing the interruptions on the reconstructed trajectories, we will be able to discern how different types of interruptionsaffect trajectories and, ultimately, performance. Moreover, by manipulating the perceived importance of competing objectives, we can also observe how these perceptions moderatethe effect of interruptions on trajectories.The design of the game was guided by the following considerations:COLLABORATIVE COMPLEXITY: Collaborations should be sufficiently complex to reasonably represent a real OR unit, but simple enough to ensure that the game is playable.GAME TIME: The game should represent a full 8-hour shift of OR unit surgeries. Game time is, therefore, accelerated over real time by a factor of 8. This allows an 8-hour shift to be “played” in one hour of real time.EASE OF USE: We chose to use a Web-based interface to leverage players’ prior experience with Web technologies. This novel method of studying trajectories and interruptions will yield new insights into the processes that underlie collaborative work in critical environments.CONFLICT OF INTEREST: Authors indicated they have nothing to disclose.