Team Work and Conflict During Elective Procedures in English National Health Service Operating Theatres
Multidisciplinary team working has been proposed as the means by which effective service delivery and organisation can be achieved within the operating theatre. Enhanced interprofessional communication, focus on a common goal, and valuing the contributions of team members have all been identified, within the professional literature, as elements of team working through which this objective could be realised. However, equal recognition has been given to reports of conflict and aggression experienced between professional groups within operating theatres. This thesis sets out to explore the relationship between these two phenomena in the context of the operating theatre, and explains the findings in an explanatory model of operating theatre work. The research was undertaken as a two part mixed method study. The first phase consisted of a survey of 391 operating department personnel, including surgeons, anaesthetists, nurses and operating department practitioners, employed in National Health Service operating departments in England. The survey gathered perceptions of conflict within and between staff groups, to identify the main sources of conflict, and the main protagonists. The results of the survey demonstrated the existence of the conflict related to changes in order of the operating list, and overrunning of the allotted operating time. The main professional groups involved were senior surgeons, and the nurses and operating department practitioners. Little variation was seen within the national sample. The second phase of the study consisted of ethnography within operating departments on two sites, supported by informal interviews with nurses, operating department practitioners, surgeons and anaesthetists. Field notes and interview data were analysed using Adaptive Theory through which new data and existing theory were utilised in an inductive process of theory generation. The findings reveal that working practices in the operating theatres did not conform fully to any existing model of team working. This thesis proposes that the persistent emphasis on multidisciplinary team working in the policy literature derives from a functionalist analysis of conflict. At a theoretical level the persistence of conflict can be explained via an analysis of the theoretical limitations of the functionalist model. Overcoming conflict requires a critique of functionalist solutions proposed in the literature and the application of alternative theoretical perspectives more attuned to addressing the underlying tensions inherent in the organisation of theatre work.
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