Abstract:
The similarity of team members’ mental models regarding clinical tasks is likely to influence teamwork effectiveness. There are currently a number of approaches to measuring similarity. However, they have not been applied in the complex environment of the operating room (OR), where professionals of different backgrounds must work together to achieve optimal outcomes for patients. This thesis had three objectives: 1) to develop a new empirical method for assessing the similarity of mental models in surgery, focusing on laparotomy; 2) to begin the process of validation of the new approach; and 3) to demonstrate how the new approach could be used in clinical practice. The first objective was achieved by developing a software application (Momento) to sort key tasks in order to capture the information on mental models regarding task sequence and responsibility. Momento was developed through an iterative process including literature review, exploratory observation and expert opinion. The second objective was achieved by examining the specific assumptions underlying the validity of the Momento approach. Twenty six-person OR teams, each comprising three subteams (anaesthesia, surgery and nursing) completed Momento prior to two simulated emergency laparotomies. Participants sorted 20 cards depicting key tasks, according to when in the procedure each task should be performed, and which subteam was primarily responsible for each task. The following assumptions were tested: a) similarity scores for mental models would be positively related to team familiarity scores or how familiar team members are with each other; b) similarity scores for mental models would be greater within OR subteams than between members of different subteams; c) different statistical measures used to calculate the similarity scores would yield similar results. The data provided support for all but the first validity assumption. The third objective was achieved by separately analysing data for each key task. Differences were identified in team members’ mental models for specific tasks for both responsibility and the order in which they should be performed. This may have implications for teamwork and patient safety. The Momento approach could help elucidate and align the mental models of OR team members and potentially improve teamwork and patient outcomes.