Peak performances by operating theatre teams: What makes care professionals resilient?
Working in an operating theatre takes nerves of steel. High pressure, stress and unexpected developments during operations ask a lot of care professionals. To put in a peak performance time and again, they need mental resilience. So what makes care professionals resilient? And what shape does leadership take in an operating theatre?
An interdisciplinary research team comprising Eduard Schmidt (assistant professor, Institute of Public Administration, FGGA, specialising in leadership), Yannick Balk (sports psychologist and assistant professor, University of Amsterdam), Marieke Adriaanse (professor, FSW/LUMC) and Jaap Hamming (surgeon and professor, LUMC) has received a 122,000-euro grant from Dutch health research organisation ZonMw for a research project on leadership, resilience and self-regulation in operating theatres. Schmidt and Balk will be doing the hands-on research and will start by attending operations at the LUMC (Leiden University Medical Center).
Performing in stressful situations
Little research has been carried out into collaboration in operating theatres, but the team is about to change that. Schmidt: ‘Medical research often focuses on clinical issues, but we’re more interested in finding out how people interact with each other. What is it that makes teams able to put in a peak performance time and again? Where do they find the strength to recover from setbacks and keep on going? For instance, when a patient’s losing too much blood. What do you do then and how does the team respond?’
Balk adds: ‘Our research has a positive angle. What’s going well and which skills form the basis of that? Dealing with stress and emotions, for example: How do you prepare for that? And what if you’ve slept badly? How do you ensure you can still perform? What makes for a resilient care professional and what can we and others learn from that?’
Eduard Schmidt: ‘We’ll look for several things in the observations: how people communicate with each other and how they handle discussions and feedback. It’ll also be interesting to see if people – and if so who? – dare to speak up when they have doubts. I think the best way to address this is by actually being present in the room.’
Observations in the operating theatre
For their research, the duo be donning PPE (personal protective equipment) and making observations in the operating theatre. Schmidt: ‘We’ll look for several things in the observations: how people communicate with each other and how they handle discussions and feedback. It’ll also be interesting to see if people – and if so who? – dare to speak up when they have doubts, and if so who? I think the best way to address this is by actually being present in the room. We’ll combine our observations of operations with interviews in which we’ll focus on all care professionals – not only surgeons but also operating assistants, anaesthesiologists and medical trainees – to make sure everybody’s voice is heard.’
The outcomes of this ‘action research’ will be used in follow-up research. Balk: ‘With the outcomes in mind, we’ll try to identify interesting follow-up questions and change our surveys accordingly. In this quantitative research, people will fill in short questionnaires at several intervals.’
Desired behaviours in the operating theatre
The project has met with enthusiasm at the LUMC. Changes in society also find their way into the operating theatre. Although surgeons obviously still bear the main responsibility for the operation, the input of the entire team is becoming increasingly important. Balk: ‘To be able to perform, the team needs to feel at ease. We all have prejudices about surgeons’ behaviour – direct, at the top of the hierarchy and dominant – but is that really true? It’s good to come together and discuss which behaviours in not only surgeons but also the other team members are needed for the team to perform best.’
The researchers hope to have a blueprint by this time next year that can be used in educational healthcare programmes to see which behaviours increase resilience in care professionals. Schmidt: ‘It’d be wonderful if it stopped people from reverting to directive and defensive behaviours when things get tough. Sharing knowledge and proposing small changes, such as breaking certain routines or getting used to certain habits, seems to be more efficient than sending everyone on leadership training.’
Text: Margriet van der Zee
Translation: Marleen van Koetsveld
Images: header Stockphoto, second photo: private collection Yannick Balk