Patient care in the operating environment of modern hospitals is a complex, multidisciplinary, and multiprofessional task that requires teamwork. Due to the fact that teamwork provides the opportunity for pursuing multiple goals and performing multiple tasks, its central feature is coordination. Coordination requirements change when the task load changes or when non-routine events occur. In other industries, high performing teams have been described to adapt several aspects of their coordination process to the requirements of different task situations, e.g. use different coordination mechanisms such as plans and programs, leadership, and lateral team interaction. For anesthesia, however, there is very little empirical evidence which coordination behaviors help teams to maintain good clinical performance especially in the transition from a routine situation to the management of a non-routine or critical event. Anesthesia teams have to handle high risks with failures potentially endangering human lives, which poses high demands on performance. Their work is characterized by routine procedures and long lasting monitoring but in the same time also by rapidly shifting priorities, uncertainty, and complexity. The ability of teams to deal with uncertainty and rapidly changing conditions depends strongly on the team coordination.
The project addresses this question by focusing on the relationship of clinical performance (based on reaction times in detecting and managing non-routine events) with a team’s coordination process. We use different methods to record team behavior: two observation systems that have been developed to capture coordination processes in anesthesia teams and one rating system that has been developed to assess non-technical skills in anesthesia teams. Our analysis is based on data gathered during anesthesia inductions in the clinical setting as well as during simulated anesthesia inductions. The use of data from both settings will help us to ensure the ecological validity of our results as well as to investigate coordination behavior related to high clinical performance under various (simulated) task conditions with a higher degree of experimental control. This will allow for a rather comprehensive analysis of the relationship between coordination mechanisms, non-technical skills and clinical performance in anesthesia teams which is a central research need with important implications for team training. In addition, the integration of different methods will allow for a methodological comparison and lead to the development of an integrated, reliable methodology to assess coordination in anesthesia teams.