What makes surgical teams more productive?

Emmanouil Avgerinos, Ioannis Fragkos and Yufei Huang explain that for surgical teams, shared experiences and hierarchical structures matter more than you think

Healthcare service is often the central focus of many governments and agencies. While a lot of attention has been devoted to developing new technologies and medicines for diagnosis and treatment, the management of healthcare services has often been neglected. We believe that better management can increase productivity in healthcare service, which can result in improved patient care quality, reduced cost and waiting time for the patients.

Surgery operations as an example

The creation of efficient surgery teams constitutes a highly challenging task for hospital management. Specifically, such teams are assembled in order to perform a specific operation and then dissolve, and their members may work again with each other in the future as part of another team. A key characteristic therefore of these teams that could potentially affect their productivity is how familiar is each team member with each other as individuals within the same team may have different levels of past shared experiences among themselves.

While it has been shown that team familiarity, in general, can improve productivity by reducing the operation’s completion times, different types of team familiarity can have different effects on team productivity. Specifically, within a surgical team, there are different levels of hierarchy which can affect the impact of familiarity among individuals on team productivity. Team familiarity can, for instance, develop among surgeons, among non-surgeons or across surgeons and non-surgeons within the same team.

As surgeons tend to have the highest status within an operating team, the relationships between them and non-surgeons could be quite formal and hierarchical. Unlike these hierarchical relationships, the ones among members of the same level of the hierarchy are likely to be more casual. Interactions and communication between two individuals from the same hierarchical level are more meaningful, which makes their relationship generally stronger.  As such, motivational states, like cohesion, are more likely to develop among these team members, which can lead to higher productivity. Hence horizontal team familiarity seems to be more impactful than hierarchical one for a surgery team.

The unspoken power of shared experiences

The effect of past shared experiences on productivity may also depend on the context within these experiences were obtained. Specifically, team Familiarity gained from past unsuccessful operations may promote more surgical productivity than familiarity gained from past successful cases. Failures can change the way individuals communicate and process information, making their interactions more meaningful and impactful as they try to identify as a group the source of failure in order to avoid it next time they perform a similar task. In addition, past failures can make individuals more motivated and willing to engage in a relationship as part of the team. This can in turn, promote the development of cohesiveness among team members which may lead to increased productivity the next time they perform the previously unsuccessful operation.

The real-world evidence

Using cardiac surgeries dataset from a European hospital, we tested these hypotheses and got significant managerial results. Our findings indicate that if the surgery team is assembled wisely by considering past shared experiences among the team, increased team familiarity among the team’s surgeons can reduce the duration of an operation up to 18.37 minutes. Similarly, team familiarity gained from past unsuccessful operations can lead to a decrease of up to 6.5 minutes for a future operation. Using the same resources, hospital managers can therefore apply more efficient team composition strategies and achieve to increase the number of operations within a week which can, in turn, reduce the waiting time of patients needing such a surgery.

Similar strategies can also be applied with caution in other settings where teams experience similar communication and coordination challenges and are characterised by different hierarchical levels, such as aircraft crews. Given the similarities these two settings are sharing like standardised protocols and checklist systems, our results may be successfully transferred to aviation team allocation policies.

By Emmanouil Avgerinos, IE Business School, IE University; Ioannis Fragkos at Rotterdam School of Management, Erasmus University; and Yufei Huang at Trinity Business School, Trinity College Dublin.