Presentation
From Observation to Co-Creation: Engaging and Educating Frontline Teams Using SEIPS, HFIX, and FACES to Improve Robotic OR Communication
DescriptionMiscommunication in the operating room remains a critical threat to patient safety, particularly in robotic surgery where complexity and noise amplify communication challenges. Observational studies have documented an average of 3.2 miscommunication events per hour, underscoring the need for interventions that are both effective and sustainable. Traditional solutions such as sterile cockpit rules, standardized protocols, and single-event team training often fail because they overlook the dynamic nature of OR systems and exclude frontline staff from the design process. To address these limitations, we modified HFIX3 framework to integrate three human factors tools, SEIPS 2.0, HFIX, and FACES, into a cohesive methodology for ideating, evaluating, and prioritizing interventions with comprehensive input from frontline staff.
This study was embedded within an AHRQ R01 grant and employed a mixed-methods approach combining direct observation, structured interviews, and participatory design sessions. We observed 215 hours of robotic surgeries across multiple specialties using a validated Speech Interference instrument to document communication breakdowns. Post-case interviews supplemented these observations to capture contextual insights. Our research team consolidated all data and identified specific challenges and systems characteristics that contribute to miscommunication breakdowns in the robotic OR. Between March and September 2024, we conducted fifteen multidisciplinary meetings with OR staff. During these sessions, we presented syntheses of our findings and introduced SEIPS 2.0 as an educational tool to help staff analyze their work system. Participants then brainstormed interventions targeting problematic system characteristics. From 86 initial suggestions, the research team consolidated and truncated them into 34 actionable.
SEIPS 2.0 served as the foundation for decomposing the OR into six work system components, person(s), tasks, tools and technology, organization, internal environment, and external environment, ensuring that interventions addressed systemic rather than isolated factors. The Human Factors Interventions Matrix (HFIX) was adapted to map these interventions to SEIPS components, creating a visual representation of how each intervention interacts with system characteristics and enabling the identification of overlaps and gaps. Finally, the FACES framework operationalized stakeholder input into structured ratings of feasibility, acceptability, cost-effectiveness, effectiveness, and sustainability. A frontline rating team of seven OR staff and a research team rated each intervention using Likert scales, and the research team repeated the ratings. Ratings were converted into rankings using median ratings and their quartile coefficient of variation to prioritize interventions.
Our findings revealed significant differences in perceptions between frontline staff and the research team. Frontline staff favored team- and task-based interventions, such as addressing message receivers by name or role and installing intercom systems, while the research team prioritized technology-based solutions, such as sound checks during timeouts and improved monitor systems. Statistical analysis confirmed these differences, with rankings diverging significantly between groups. Notably, frontline engagement led to early adoption of multiple interventions before the research team requested them.
This study illustrates how integrating SEIPS, HFIX, and FACES creates a structured yet flexible process for addressing complex communication challenges in healthcare. By engaging frontline staff in ideation and evaluation, the framework enhances acceptability and sustainability while providing granular insight into intervention viability. Although the effectiveness of interventions remains to be tested longitudinally, this approach offers a replicable model for human-centered design in quality improvement. Future work will focus on implementing top-ranked interventions and assessing their impact on communication and patient safety outcomes.
This study was embedded within an AHRQ R01 grant and employed a mixed-methods approach combining direct observation, structured interviews, and participatory design sessions. We observed 215 hours of robotic surgeries across multiple specialties using a validated Speech Interference instrument to document communication breakdowns. Post-case interviews supplemented these observations to capture contextual insights. Our research team consolidated all data and identified specific challenges and systems characteristics that contribute to miscommunication breakdowns in the robotic OR. Between March and September 2024, we conducted fifteen multidisciplinary meetings with OR staff. During these sessions, we presented syntheses of our findings and introduced SEIPS 2.0 as an educational tool to help staff analyze their work system. Participants then brainstormed interventions targeting problematic system characteristics. From 86 initial suggestions, the research team consolidated and truncated them into 34 actionable.
SEIPS 2.0 served as the foundation for decomposing the OR into six work system components, person(s), tasks, tools and technology, organization, internal environment, and external environment, ensuring that interventions addressed systemic rather than isolated factors. The Human Factors Interventions Matrix (HFIX) was adapted to map these interventions to SEIPS components, creating a visual representation of how each intervention interacts with system characteristics and enabling the identification of overlaps and gaps. Finally, the FACES framework operationalized stakeholder input into structured ratings of feasibility, acceptability, cost-effectiveness, effectiveness, and sustainability. A frontline rating team of seven OR staff and a research team rated each intervention using Likert scales, and the research team repeated the ratings. Ratings were converted into rankings using median ratings and their quartile coefficient of variation to prioritize interventions.
Our findings revealed significant differences in perceptions between frontline staff and the research team. Frontline staff favored team- and task-based interventions, such as addressing message receivers by name or role and installing intercom systems, while the research team prioritized technology-based solutions, such as sound checks during timeouts and improved monitor systems. Statistical analysis confirmed these differences, with rankings diverging significantly between groups. Notably, frontline engagement led to early adoption of multiple interventions before the research team requested them.
This study illustrates how integrating SEIPS, HFIX, and FACES creates a structured yet flexible process for addressing complex communication challenges in healthcare. By engaging frontline staff in ideation and evaluation, the framework enhances acceptability and sustainability while providing granular insight into intervention viability. Although the effectiveness of interventions remains to be tested longitudinally, this approach offers a replicable model for human-centered design in quality improvement. Future work will focus on implementing top-ranked interventions and assessing their impact on communication and patient safety outcomes.
Authors
Hospitalist, Medical Director of Human Factors
Event Type
Oral Presentations
TimeTuesday, March 242:15pm - 2:37pm EDT
LocationMorgan
Simulation and Education