• Eliciting Context-Mechanism-Outcome configurations: Experiences from a realist evaluation investigating the impact of robotic surgery on teamwork in the operating theatre

      Alvarado, Natasha; Honey, S.; Greenhalgh, J.; Pearman, A.; Dowding, D.; Cope, A.; Long, A.; Jayne, D.; Gill, A.; Kotze, A.; et al. (2017-10-01)
      This article recounts our experience of eliciting, cataloguing and prioritizing conjectured Context-Mechanism-Outcome configurations at the outset of a realist evaluation, to provide new insight into how Context-Mechanism-Outcome configurations can be generated and theorized. Our construction of Context-Mechanism-Outcome configurations centred on how, why and in what circumstances teamwork was impacted by robotic surgery, rather than how and why this technology improved surgical outcomes as intended. We found that, as well as offering resources, robotic surgery took away resources from the theatre team, by physically reconfiguring the operating theatre and redistributing the surgical task load, essentially changing the context in which teamwork was performed. We constructed Context-Mechanism-Outcome configurations that explain how teamwork mechanisms were both constrained by the contextual changes, and triggered in the new context through the use of informal strategies. We conclude by reflecting on our application of realist evaluation to understand the potential impacts of robotic surgery on teamwork.
    • Human factors in robotic assisted surgery: Lessons from studies 'in the Wild'

      Catchpole, K.; Bisantz, A.; Hallbeck, M.S.; Weigl, M.; Randell, Rebecca; Kossack, M.; Anger, J.T. (2019-07)
      This article reviews studies conducted “in the wild” that explore the “ironies of automation” in Robotic Assisted Surgery (RAS). Workload may be reduced for the surgeon, but increased for other team members, with postural stress relocated rather than reduced, and the introduction of a range of new challenges, for example, in the need to control multiple arms, with multiple instruments; and the increased demands of being physically separated from the team. Workflow disruptions were not compared with other surgeries; however, the prevalence of equipment and training disruptions differs from other types of surgeries. A consistent observation is that communication and coordination problems are relatively frequent, suggesting that the surgical team may need to be trained to use specific verbal and non-verbal cues during surgery. RAS also changes the necessary size of the operating room instrument cleaning processes. These studies demonstrate the value of clinically-based human factors engineers working alongside surgical teams to improve the delivery of RAS.