A successful surgery is the result of the seamless collaboration among the surgical team. A cohesive team operates like a well-oiled machine, where every member is in harmony with one another. In the second installment of this two-part blog series, we delve into the mechanics of surgical teamwork, exploring a fresh perspective on the concept of "team familiarity." By dissecting its key components, can we harness the advantages of consistent and experienced teams to enhance patient outcomes?
The image below highlights how familiar teams contribute to smoother procedures.
## Benefits of Familiarity
In the operating room (OR), a core multidisciplinary team plays a crucial role in delivering each procedure, often working on a shift-based or specialty-based schedule. The shared history among individual team members forms what we call "familiarity." Teams that have worked together extensively—whether for months or even years—exhibit a high level of familiarity.
Research consistently shows that increased familiarity leads to better team performance and improved outcomes. A systematic review from the University of Chicago revealed that heightened familiarity strongly correlates with enhanced team performance, particularly in shortening operative times [1]. Additional benefits include reduced surgical errors, disruptions, lengths of stay, and reoperation rates, though these findings aren’t always consistent across studies [2, 3].
> *Increased familiarity is linked to better team performance, especially in reducing operative time.*
## Challenges to Consistency
Despite the evident advantages of familiar teams, hospital structures often present significant logistical hurdles in maintaining consistent and familiar teams. This frequently involves assembling unfamiliar professionals to fill shifts and uphold service continuity.
However, these challenges also open up opportunities for innovation. Could we isolate specific elements of team familiarity and integrate them into our current systems? Can technology assist in replicating these features to benefit everyone?
## Shared Mental Models
A literature review in the *AORN Journal* explained some of the benefits of team familiarity through the lens of a "shared mental model" [4]. Transactive memory theory in psychology suggests that as teams gain experience together, members develop confidence and understanding of each other's capabilities. This fosters clear responsibility assignments and enables team members to predict each other’s actions. Shared mental models are integral to teamwork and team-building exercises, underpinning practices like debriefings and huddles.
> *Familiar teams build a shared mental model based on knowledge of each other's skills, preferences, and experiences.*
By defining the characteristics of familiar teams, it may be feasible to "capture" their shared mental model so it can be viewed by outsiders or newcomers. Shared mental models resemble various IT technologies, such as data clouds and machine learning. In today's era of data sharing, can technology help us access and share a team's shared mental model? Could this allow us to emulate the superior attributes of team familiarity and apply them to everyday surgical practice?
## Team-Specific Knowledge
Surgical workflows, while rooted in consensus best practices, are often tailored to specific units, teams, or individual surgeons. Capturing a team's mental model starts with documenting these workflows for quick and intuitive access. Surgical "preference cards" serve as an example, listing the supplies a surgeon requires for each procedure.
Incision's *Assist* app takes this concept further by enabling OR teams to digitize their protocols, equipment, and unique working methods. Accessible via a custom mobile app, these resources are organized by specialty, procedure, and team. Incorporating multiple disciplines—surgery, perioperative nursing, surgical technology, and anesthesia—*Assist* mirrors real-world OR teams and provides instant access to both regular members and newcomers, including temporary and traveling staff.
## Anticipation and Alignment
A hallmark of familiar teams is the ability to anticipate each other's actions. For instance, a surgeon and scrub nurse who regularly collaborate usually have a solid grasp of how the other will behave during most surgeries. They understand what's needed at any given stage and what steps to take if something goes awry. This knowledge contributes to their shared mental model and facilitates faster, more efficient operations [5, 6].
Alignment between surgeons and scrub nurses also minimizes avoidable disruptions, such as those due to corrective actions or equipment shortages. In neurosurgery, teams reported fewer workflow disruptions in groups with high surgeon-scrub nurse familiarity [7]. Similarly, cardiac surgery teams that frequently work together experience fewer surgical flow disruptions, errors, and teamwork failures [8]. In urology, greater familiarity has been tied to fewer "inconvenience events" in robot-assisted prostatectomies [9].
> *Improved team member anticipation reduces disruptions, enhances alignment, and boosts efficiency.*
## Preferences and Preparedness
Understanding specific team members' preferences and work habits is another vital aspect of familiar teams. Variations in surgical practices are common even within the same unit or department. Established team members get accustomed to these nuances—"Dr. Stevens is left-handed and always uses nylon sutures to close..." However, staff usually don't know the preferences of unfamiliar surgeons, which can lead to delays, misalignments, and frustration.
In a multicenter study, 88% of staff using *Assist* reported feeling better prepared for their time in the OR [10]. This was especially noticeable for newcomers, allowing newer and more junior staff to scrub in and actively assist more effectively than before. Among the same group, 70% felt more familiar and confident with the instruments and equipment they encountered with specific teams and for particular surgeons.
> *Access to team-specific protocols and surgeon-specific workflows increases staff preparedness, confidence, and familiarity with standard equipment.*
## The Future of Surgical Teams?
With documented savings in time and efficiency, the advantages of familiar teams hold immense value for surgical managers and healthcare facilities. The cost of OR time varies widely, ranging from $36 to $150 per minute, or $2220 to $9000 per hour, depending on the location and setting [11, 12]. Shorter operative times, quicker preparation, and reduced case turnover times are likely to yield significant financial benefits.
Overcoming logistical obstacles to bring familiar staff together in daily rotas seems daunting. Yet, technology designed to capture and share the critical aspects of a team's mental model—including individual preferences and team-specific workflows—offers a novel solution to these logistical barriers. Solutions like *Assist* already demonstrate improvements in staff familiarity with equipment and protocols, boosting preparedness, confidence, and performance.
As we progress toward enhanced collaboration, de-siloing, and optimized information sharing, the future holds great promise for surgical teams. By dismantling the logistical and technological barriers, we are confident that the broad-ranging impacts of familiarity can be made accessible to all.
At Incision, we're committed to crafting blogs that spark conversations, foster teamwork, and educate in engaging ways. When we learn collectively, we grow together. Join the dialogue!
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