Improving Faculty's Ability to Speak Up to Others in the Operating Room

Study Overview
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Brief Summary
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Importance Team members speaking-up by raising concerns about inappropriate or unsafe actions of others within the team can have direct, immediate, and preventive effect on adverse outcomes. However, little is known about the hurdles and enablers of this behavior in healthcare, especially within the operating room setting. Objective 1. Determine if an educational workshop would improve speaking-up behaviors of practicing anesthesiologists when presented with realistically-simulated clinical situations. 2.Describe speaking-up behaviors addressed to a surgeon, a nurse, and a colleague. 3. Identify the self-reported hurdles and enablers for speaking-up in those situations encountered. Design Randomized controlled experiment of an educational workshop intervention on communication behaviors in a simulated case. Qualitative analysis of debriefing conversations following the simulated case. Setting Established academic simulation center Participants Seventy-one practicing anesthesiologists from four academic medical centers and one community hospital Intervention Fifty minute educational workshop on speaking-up that included rationale, conversational techniques, a rubric for speaking-up, and role-play.

Detailed Description
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Main Outcomes and Measures 1. Observed communication in a simulated case that included a surgeon falling asleep during surgery, inappropriate activation of a speakerphone by a nurse, and an incorrect treatment order by a colleague in response to a venous air embolism. 2. Transcribed conversation during a structured debriefing, analyzed for hurdles and enablers.

Official Title
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Improving Faculty's Ability to Speak Up to Others in the Operating Room: A Simulation Based Randomized Controlled Trial of an Educational Intervention

Conditions
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Faculty, Medical

Intervention / Treatment
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* Other: Educational Workshop on Speaking-Up
* Other: Unrelated Education (CPR)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Attending Anesthesiologist Exclusion Criteria: Prior exposure to test case
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Educational Workshop on Speaking-Up<br>Educational Workshop on Speaking-Up Before Simulated Case | Other: Educational Workshop on Speaking-Up<br>* Educational workshop including lecture, discussion, role-play Concepts include: 2-challenge rule, pairing advocacy and inquiry<br>|
| Sham Comparator: Unrelated Education<br>Unrelated Education (CPR) before simulated case (Educational Workshop on Speaking-up after case and debriefing) | Other: Unrelated Education (CPR)<br>* Unrelated Education (CPR workshop) including: lecture, discussion Topics covered: Cardiac Life Support algorithms, CPR, Medications<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Speaking-Up Behavior | Subjects were assessed by trained raters as to whether they spoke-up when safety related errors were made during a realistic simulation case. | Immediate | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Speaking-up Behaviors | Anesthesiologist subject's behavior in speaking-up to a surgeon, nurse, and colleague during a realistic simulation case were assessed descriptively. | Immediate | 
| Self-reported hurdles and enablers of speaking-up | A qualitative analysis of stated hurdles or enablers for speaking-up or not was conducted from video recordings of a post-case structured debriefing. | 1 hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Education, Curriculum, Anesthesiology, Operating Rooms