title: Assessing the similarity of mental models of operating room team members and implications for patient safety: a prospective, replicated study.
abstract: BACKGROUND
  Patient safety depends on effective teamwork. The similarity of team members' mental models - or their shared understanding-regarding clinical tasks is likely to influence the effectiveness of teamwork. Mental models have not been measured in the complex, high-acuity environment of the operating room (OR), where professionals of different backgrounds must work together to achieve the best surgical outcome for each patient. Therefore, we aimed to explore the similarity of mental models of task sequence and of responsibility for task within multidisciplinary OR teams.
  
  
  METHODS
  We developed a computer-based card sorting tool (Momento) to capture the information on mental models in 20 six-person surgical teams, each comprised of three subteams (anaesthesia, surgery, and nursing) for two simulated laparotomies. Team members sorted 20 cards depicting key tasks according to when in the procedure each task should be performed, and which subteam was primarily responsible for each task. Within each OR team and subteam, we conducted pairwise comparisons of scores to arrive at mean similarity scores for each task.
  
  
  RESULTS
  Mean similarity score for task sequence was 87 % (range 57-97 %). Mean score for responsibility for task was 70 % (range = 38-100 %), but for half of the tasks was only 51 % (range = 38-69 %). Participants believed their own subteam was primarily responsible for approximately half the tasks in each procedure.
  
  
  CONCLUSIONS
  We found differences in the mental models of some OR team members about responsibility for and order of certain tasks in an emergency laparotomy. Momento is a tool that could help elucidate and better align the mental models of OR team members about surgical procedures and thereby improve teamwork and outcomes for patients.
authors: Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. i.nakarada-kordic@auckland.ac.nz.
authors: Ivana
authors: I
authors: Nakarada-Kordic
authors: Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.|Auckland City Hospital, Auckland, New Zealand.
authors: Jennifer M
authors: JM
authors: Weller
authors: Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
authors: Craig S
authors: CS
authors: Webster
authors: Department of Anaesthesiology, School of Medicine, University of Auckland, Auckland, New Zealand.
authors: David
authors: D
authors: Cumin
authors: Department of Medicine, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand.
authors: Christopher
authors: C
authors: Frampton
authors: , Wellington, New Zealand.
authors: Matt
authors: M
authors: Boyd
authors: Auckland City Hospital, Auckland, New Zealand.|Department of Anaesthesiology, School of Medicine, University of Auckland, Auckland, New Zealand.
authors: Alan F
authors: AF
authors: Merry
mesh_terms: D000758:Anesthesia / Q000592:standards* / Q000639:trends; D001315:Australia; D057189:Checklist / Q000592:standards* / Q000639:trends; D003299:Cooperative Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D009520:New Zealand; D009873:Operating Rooms; D010348:Patient Care Team / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000592:standards*; D013514:Surgical Procedures, Operative / Q000592:standards* / Q000639:trends; D013647:Task Performance and Analysis
keywords: Multidisciplinary teamwork; Operating room teams; Patient safety; Shared mental models