Learning and teaching negotiation and conflict resolution skills to enhance patient safety in the OR

Awardees: Sharon Muret-Wagstaff (HMS), Richard Whyte (HMS), Brett A. Simon (HMS), James K. Sebenius (HBS)

Summary: Awardees plan to enable learners to apply principles of negotiation and conflict resolution in the high-stakes operating room environment, with the ultimate goal of improving medical teamwork and patient safety.

“We took a model that’s been used successfully at the Business School and in the Law School’s Program on Negotiation and adapted it to medicine . . . we had 40 interdisciplinary faculty . . . all working together to learn new skills.” —Sharon Muret-Wagstaff

Resolving conflicts to improve patient safety

Communication breakdowns often are at the core when adverse events occur in medicine. HILT grant awardees designed and implemented a five-session series of workshops, “Negotiation and Conflict Resolution to Enhance Operating Room Safety,” for faculty from the HMS Department of Anaesthesia and Department of Surgery as well as operating room nurses to address this challenge. The sessions took place in the simulated operating room at Beth Israel Deaconess Medical Center. Sharon Muret-Wagstaff and Richard Whyte of Harvard Medical School facilitated the simulations and discussions, and collaborated with Jim Sebenius, Gordon Donaldson Professor of Business Administration, to incorporate his research in negotiation and conflict resolution into the curriculum. “Jim’s framework represents a very deep model for resolving conflicts – it’s not just in the moment, but a study of the entire process from set-up and design to problem-solving tactics,” explained Muret-Wagstaff.

In researching this project, Muret-Wagstaff and her team discovered that the topic of negotiation and conflict resolution is rarely addressed in the medical literature, but widely studied in other disciplines. The demand was certainly evident: they conducted a needs assessment among faculty to determine the most desired issues for development – “negotiation and conflict resolution” was identified as the second most desired topic among more than 20 choices. Importantly, they embedded the program into an existing infrastructure, offering the workshops during regularly scheduled Tuesday morning faculty development sessions (rather than offering a stand-alone program). The enthusiasm was evident in attendance, according to Muret-Wagstaff: “You don’t need to show up before work at 6:45 a.m., but the room was always packed.” They deliberately targeted faculty over residents as a starting point, noting that surgery and anesthesia faculty members serve as role models and teach residents daily in the operating rooms (although they heard from many residents who wished they were able to participate).

The team designed the scenario simulations and curriculum from scratch, as there was no existing model in medicine. Muret-Wagstaff emphasized the benefit of bringing together surgeons, anesthesiologists, and nurses, professionals who otherwise are afforded little time together for these types of interdisciplinary discussions in the fast-paced, high-risk operating room environment. They based their scenario designs on observations of real operating rooms, as well as interviews with surgeons and nurses. Examples included: a post-operative scene in the surgical intensive care unit where the anesthesiologist and the surgeon have two different ideas about the treatment plan and are debating it live in front of the patients’ family; and a pre-operative scene outside of the operating room where the surgeon is scrubbed and ready to begin, but there is confusion because while their check-box system indicated the equipment is ready, the nurses have not yet finished counting the instruments. Participating faculty reported that seeing these scenarios unfold in the simulated operating room and debriefing them using Sebenius’ framework was quite effective; before the workshops ended, many had already begun using approaches learned in the course in the operating room.

Muret-Wagstaff stressed that the benefits of participating in the grant program extended far beyond the project work itself. Through various grant-related events, she and her team made connections with faculty and staff across schools and departments that augmented their project but also spurred additional projects, including a scholarly writing seminar for medical school faculty led by another HILT grantee, Tom Jehn. She found the process extremely helpful in making these connections because “academically and geographically we’re separated and have too few opportunities to collaborate across disciplines.” While their project was completed with little deviation from the original plan, she noted that it is difficult to find funding for educational research. “We never could have pulled this off without the HILT grant.”

Going forward, this HMS/HBS collaboration has created curricular materials and videos that can be adapted to virtually any physician education group and training level, and a manuscript is in preparation. Muret-Wagstaff could envision scaling up these negotiation and conflict resolution simulations to more departments within HMS, at other area medical schools, and potentially nationally.