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Make a choice prof dr JKG Wietasch M.J. van der Laan D.A. Dongelmans Jop Groeneweg

Project properties

Title	The Impact of Performance Variability in Safety in Healthcare
Keywords	surgery Safety team
Researchers	prof dr JKG Wietasch M.J. van der Laan D.A. Dongelmans Jop Groeneweg
Type of project	MD/PhD programme
Nature of the research	The total project consists of three fases; - systematic evaluation of the current impact of performance variability of team performance in healthcare - developbent of an improvement bundle of interventions - implementatation and evaluation of the interventions
Fields of study	anesthesiology surgery intensive care

Background / introduction

Beyond doubt stress and fatigue have impact on clinical performance and personal health. Our stress response’ and is governed by a complex interplay of nervous, endocrine, and immunological mechanisms. Fatigue is more intricately linked to three main factors: the work demands of the task at hand; the effort required to sustain performance; and the degree of controllability over the work conditions, which includes the perception of control over the work conditions and the opportunity to execute tasks in various ways. Under conditions of low control, prolonged efforts to maintain performance and the associated high invested effort lead to an adaptive mode of strain (effort with distress) as well as feelings of fatigue. Fatigue could therefore better be conceptualized as a state resulting from the extended use of high-effort control strategies, rather than a mere lack of energy. In situations of high demand and low control, individuals may react in different ways as the tasks progresses. Firstly, over time, their performance levels may decline as attention wanes, and they may begin to explore alternative, more rewarding possibilities. Secondly, individuals may adjust their goal aspirations for the current task, enabling them to maintain current effort levels while accepting a reduction in performance. Lastly, individuals may choose to increase their level of effort invested, thereby safeguarding task goals. In the fast-paced and high-stress enviorment like high performance teams in healthcare, the impact of stress and fatigue on performance has been topic of interest. The lack of consensus on the effects of fatigue might underestimate fatigue as cause of physician impairment. Notably, reports indicate that surgeon can be fatigued up to 50% of their time awake, underscoring the importance of evaluating the potential impact of fatigue on performance to ensure a high quality of care.

Research question / problem definition
How can we improve personal and team performance and protect patient safety in high risk high demand settings in healthcare

References

1: Bos K, van der Laan MJ, Groeneweg J, Kamps GJ, Legemate DA, Leistikow I, Dongelmans DA. Grading recommendations for enhanced patient safety in sentinel event analysis: the recommendation improvement matrix. BMJ Open Qual. 2024 Apr 16;13(2):e002592. doi: 10.1136/bmjoq-2023-002592. PMID: 38626939. 2: Reijmerink IM, van der Laan MJ, Wietasch JKG, Hooft L, Cnossen F. Impact of fatigue in surgeons on performance and patient outcome: systematic review. Br J Surg. 2024 Jan 3;111(1):znad397. doi: 10.1093/bjs/znad397. PMID: 38097353; PMCID: PMC10771255. 3: Lentz CM, De Lind Van Wijngaarden RAF, Willeboordse F, Hooft L, van der Laan MJ. Dedicated teams to optimize quality and safety of surgery: A systematic review. Int J Qual Health Care. 2022 Oct 27;34(4):mzac078. doi: 10.1093/intqhc/mzac078. PMID: 36299250; PMCID: PMC9606443. 4: Koelemay MJW, van der Laan MJ. Opereren van abdominaal aorta aneurysma kan nog veiliger [Safer surgery for abdominal aortic aneurysm]. Ned Tijdschr Geneeskd. 2022 Jul 28;166:D6918. Dutch. PMID: 35899751. 5: Reijmerink IM, Bos K, Leistikow IP, Groeneweg J, Cnossen F, Dongelmans DA, van der Laan MJ. Performance variability in perioperative sentinel events: report on a nationwide data set. Br J Surg. 2022 Jun 14;109(7):573-575. doi: 10.1093/bjs/znac067. PMID: 35373247; PMCID: PMC10364676.