An experiment on the effects of interruptions on work trajectories and performance in critical environments’

Operating rooms are characterized by the interdependence of multiple professionals working on multiple tasks. The multiple agendas that drive various professionals mean that team goals are ill defined and conflicted. Emergencies, cancellations, unprepared or absent patients create continually dynamic conditions. These emergent needs can upset plans at any moment. Performance in these contexts depends not only on the professionalism of each team, but also on the ability to support coordination and collaboration across teams, tasks, and resources. Drawing on an ethnographic study of hospital work in an operating room (OR), we developed a web-based role-playing application of a master schedule. The goal 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 (e.g., the patient moves from admission, through testing, surgery, post-op, and discharge), (b) resource trajectories (e.g., the operating room is used for a series of surgeries through the day), and (c) staff trajectories (e.g., an MD participates in morning rounds, afternoon patient visits, discharge consultations, and the like). Although scheduling algorithms can be used as a starting point for coordination, the dynamic nature of medical work makes preset schedules untenable. Surgeries can last longer or shorter than anticipated, requiring on-the-fly adjustment of the surgical schedule. Patients can experience setbacks that affect their planned trajectory, and doctors, nurses and other staff can experience interruptions that affect their work trajectories.We developed a web-based role-playing game to simulate a master schedule in an OR, and to understand how different types of interruptions affect coordination, trajectories, and performance. In this game, 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 to OR scheduling dynamics, as they manage their individual trajectories and objectives in the face of interruptions. 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 next surgery. These types of interruptions affect trajectories by requiring players to quickly converge on a problem that requires an immediate response.