Making the OR work: a socio-material study of ergonomics in the operating room

INTRODUCTION: Poor operating room (OR) ergonomics pose risk of injury to OR staff, worsening patient outcomes and threatening workforce wellness and sustainability. How OR staff navigate ergonomic barriers in the interdisciplinary team environment was examined in this qualitative study. METHODS: Semi-structured, open-ended interviews of surgeons, anaesthesiologists and OR nurses were conducted at single institution using a socio-material approach with interview-to-the-double. Transcripts were coded by two independent researchers. Themes in the data were outlined using the System Engineering Initiative for Patient Safety (SEIPS) framework. RESULTS: Five major themes were identified. First, physical environment issues creating cognitive and physical frictions, such as tripping hazards and improper room layouts. Second, influence of social positionality, with hierarchy by role and experience and social dynamics leading to differential capacity to adjust. Third, team collaboration, with lack of interdisciplinary work and communication and high staff turnover. Fourth, burden of self-initiated work arounds, outlining conflict between system/organizational issues but individual solutions. Fifth, institutional support, with lack of leadership engagement. Participants suggested solutions including accommodations to foster a collaborative approach to managing discomfort in the OR, and new team communication tools. CONCLUSIONS: Ergonomic barriers were described within the work system of the SEIPS framework. Social positionality and differential levels of agency, as well as lack of team collaboration and misperceptions of others' roles, were central to ergonomic challenges. Conflicts between problems lying with the system/organization, but solution being left to individuals, were also central to challenges to optimal OR ergonomics.