Understanding the problems affecting the functioning of the J.D. Allen operating theatre

Date
2016
Authors
Gosai, Kamal Arunkumar
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Abstract
Background: In recent years, waiting periods for surgery have increased dramatically. This may significantly impact patient outcomes from a variety of surgical conditions. Delayed surgical procedures are often a symptom of the dysfunction of one or more of the diverse elements which interact in the work of an operating theatre (OT). Attempts to address the problems have often been limited to addressing single issues in a manner suggestive of a Newtonian linear understanding of cause and effect. Historically, this view has led to short term interventions with limited if not adverse outcomes. There is limited understanding of the systems which are at work in the OT in which doctors, nurses and support staff interact. Aim: The aim of this study was to take the first step towards understanding the nature of problems faced by various stakeholders who are directly involved with patients’ and their transit through the J.D. Allen OT at Chris Hani Baragwanath Academic Hospital (CHBAH). Methods: This study was conducted in the J.D. Allen OT at CHBAH, using a qualitative, contextual, exploratory, descriptive research design. Five focus group discussions were held with purposefully selected nurses, cleaners, porters, anaesthetists and surgeons. Data saturation was achieved and the data was analysed using thematic analysis, ensuring that trustworthiness was established. Results: Three main themes have emerged reflecting:  Broken relationships and not owning the workspace - participants highlighted poor communication and social interactions amongst different stakeholders which may result in a failure of teamwork towards the common goal of patient care. This was due to a lack of incentivisation and workplace morale.  The battle to get work done - reflects the complex nature of problems experienced including staff and equipment shortages which hinders efficient patient flow. Fatigue and burnout amongst staff is prevalent. A lack of leadership and accountability by management was also highlighted.  This exists within the context of the legacy of “Bara” - which highlights that the hospital has a history of being overburdened and is remarkably failing as it functions at the edge of chaos. Problems encountered by the OT team were thus complex in nature. Conclusion: There are many diverse elements which interact with each other and the system in unpredictable ways. The J.D. Allen OT has the features of a complex adaptive system (CAS).
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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Anaesthesiology Johannesburg 2016
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