Implementation of Resilience Engineering for Operating Room. Unveiling the Hidden Interactions among Multi-Professionals in a Surgical Team

Background: The implementation of resilience engineering for an operating room is difficult;however, its study would become important for the surgeon’s personal and surgical team in order to develop a new surgical safety management. An expert operator must perform an operation with his surgical team that includes an anesthetist, scrub nurse, and young assistant. However, there exist some gaps among these multi-professionals. Objective: From the viewpoint of an expert operator, to have an operation go well, we would describe how to reconcile their gaps. We will explain the gaps among the multi-professionals in a surgical team, such as hidden interactions between the operator and anesthetist, surgeon and scrub nurse, and expert operator and young assistant. Material and Methods: We assumed three types of interactions among the multi-professionals in the operating theater and we clarified how to bridge the gaps by revealing what the operator thinks, what the anesthetist thinks, what the scrub nurse thinks, and what the young assistant thinks in the surgical team, and by understanding how they perform during surgery. Outcomes: What the expert operator thinks and how he performs in surgery is summarized by the following three items: 1) safety is first, 2) achieving the operative purpose, and 3) fast surgery. We interviewed the surgical team members. In order for the surgery to go well, what the important thing is “safety first” for any surgical professionals. The sentence, “safety is first” is the magic words, such as “open sesame”. They can communicate with each other on the spot and build the team and system. To develop a strong and resilient surgical team, these four behaviors are important to improve the performance as a system: 1) sharing the same goal and same priority, 2) understanding gaps with clear verbal communication. Coming out from own professional boundaries (takotsubo), speaking in words, 3) all of us, having a strong will (iron heart), and learning anger management, and 4) improvising even in difficult situations. Conclusion: We would like to summarize the items learned from my three described scenes, which are 1) to develop a strong and resilient surgical team, 2) what we have to do, and how we have to perform, and 3) how we can develop a team and system.

Implementation of Resilience Engineering for Thoracic Surgery. Reconciling Work-as-Imagined and Work-as-Done

Background: The Work-As-Imagined (WAI) is a plan that is expected to be performed before surgery, and the Work-As-Done (WAD) is the result of work actually done. In order to perform safe and high-quality surgery for the individual surgeon, the surgical team, and hospital organization as a system, we have to reconcile the WAI and the WAD in resilience engineering for the real world of surgical healthcare. Objective: Based on the resilient healthcare theory, we would like to clarify the actual way of reconciling the WAI and WAD in surgery. Material and Methods: As a typical model of thoracic surgery, we use a lobectomy case for lung cancer. We describe a surgeon’s WAI and WAD, and we explain the anticipating, monitoring, responding, and learning based on the resilient healthcare theory. We reveal the gaps between the WAI and WAD during an operation, we consider the surgeon’s thinking and actual performance, and we describe the actual way of reconciling the WAI and WAD for the surgeon and surgical team. Outcomes: We described three scenes in the operating room, which are 1) by individual surgeon: adjustment for intrathoracic adhesion;2) by surgical team: adjustment for pulmonary artery bleeding;and 3) by surgical team with multi-professionals in the operating room: adjustment for life threatening pulmonary artery critical bleeding. Conclusion: In order to implement a resilient healthcare theory in everyday surgical work, it is important that 1) learning of incidents and the experience of doing well for unexpected events as lessons, and 2) constructing a circulation mechanism of anticipating, monitoring, responding, and learning.

Quantification of disaster resilience in civil engineering:A review

Resistance to unexpected disasters and rapid post-disaster recovery(i.e.,disaster resilience)of cities are extremely necessary owing to the concentrated risk of urbanization.Resilience quantification can adequately reflect the capacity of a city to withstand disasters.Many existing studies have focused on and proposed several frameworks on the quantitative measures of disaster resilience,and the corresponding research objects include different types of disasters(e.g.,earthquake,hurricane,flood,and fire),various domains(e.g.,engineering,social,and economic),and multiple levels(e.g.,city,community,and building).Among these research objects,studies on seismic resilience in civil engineering are relatively comprehensive.Specifically,studies on resilience in civil engineering have paid significant attention to the dynamics of engineering facilities and the engineering-related social and economic functions,including city-scale engineering,social,and economic functionalities,and essential functionalities of building,transportation,lifeline,and nonphysical subsystems of a city.Consequently,based on the review of resilience studies carried out in recent years,the framework and specifications for the quantification of disaster resilience of civil engineering systems subjected to earthquakes and other unexpected disasters are elaborated.Methods of disaster resilience assessment of cities and the corresponding subsystems are discussed.Furthermore,several case studies are reviewed,and resilience limit-state analyses of communities and buildings are performed.