Advertisement

Hierarchical task analysis for identification of interrelationships between ergonomic, external disruption, and internal disruption in complex laparoscopic procedures

  • Latif Al-HakimEmail author
  • Ming Wang
  • Jiaquan Xiao
  • Dennis Gyomber
  • Shomik Sengupta
Article

Abstract

Background

Traditionally, hierarchical task analysis (HTA) in surgery examines observable disruption in a predefined set of tasks as performed, rather than examining the ergonomics requirements, which may predispose surgical teams to act erroneously. This research aims to address this gap in the literature. It develops a HTA protocol taking into consideration surgical team actions, observable external disruption, internal disruption, and ergonomic goals required for safer conducting procedures. Laparoscopic radical prostatectomy (LRP) is selected as a case.

Methods

This research involved observations inside operating rooms (ORs) of three large teaching hospitals in Australia and China. Two rounds of observations are conducted: observations for developing HTA, and observations after presenting the developed HTA among surgical teams. The traditional HTA format is expanded to include two additional columns: technical considerations and ergonomics considerations. Two groups are formed from the observed LRPs. LRPs in the first group were conducted with no regard to the specified ergonomic goals and associated ergonomic features, and the second are conducted with the surgical teams attempting to follow specified ergonomic goals and features as prescribed in HTA. Careful attempt is required to select procedures such that the total operative times for both groups are approximately equal (± 5%).

Results

Between March 2016 and November 2017, a total of 29 LRPs were observed, and a HTA developed. The results reveal significant reduction (43%) in the total external disruptive events and approximately 58% reduction in the internal disruptive events in LRPs conducted with HTA requirements.

Conclusions

The developed HTA appears to have some utility, but needs evaluation in larger studies. It can potentially be used as a training aid, and as a checklist for evaluating surgical performance.

Keywords

Disruption Ergonomic requirements Hierarchical task analysis Laparoscopic radical prostatectomy Performance appraisal, training aid 

Notes

Acknowledgements

We would like to acknowledge the support of Professor Xiaoying Zhou, Deputy President, and Ms Mingli Yang, Director of International Affair Office at the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. The authors appreciate the work of Mr Todd Manning, Department of Anatomy and Developmental Biology, Monash University, Australia, for editing the first draft of the manuscript. The authors would like to acknowledge the effort of Mr. Kapil Sethi, Urological Surgical Fellow at the Austin Hospital, Melbourne Australia, for organising several observations.

Compliance with ethical standards

Disclosures

The authors Latif Al-Hakim, Ming Wang, Jiaquan Xiao, Dennis Gyomber, and Shomik Sengupta have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2018_6656_MOESM1_ESM.docx (38 kb)
Supplementary material 1 (DOCX 37 KB)

References

  1. 1.
    Salvendy G (2012) Handbook of human factors and ergonomics. Wiley, New YorkCrossRefGoogle Scholar
  2. 2.
    Carayon P (2011) Handbook of human factors and ergonomics in health care and patient safety. CRC Press, Boca RatonGoogle Scholar
  3. 3.
    Stanton NA, Hedge A, Brookhuis K, Salas E, Hendrick HW (2004) Handbook of human factors and ergonomics methods. CRC Press, Boca RatonCrossRefGoogle Scholar
  4. 4.
    Rose J, Bearman C (2012) Making effective use of task analysis to identify human factors issues in new rail technology. Appl Ergon 43:614–624CrossRefGoogle Scholar
  5. 5.
    Lane R, Stanton N, Harrison D (2006) Applying hierarchical task analysis to medication administration errors. Appl Ergon 37:669–679CrossRefGoogle Scholar
  6. 6.
    Stanton N (2006) Hierarchical task analysis: Development, applications, and extensions. Appl Ergon 37:55–79CrossRefGoogle Scholar
  7. 7.
    Phipps D, Meakin G, Beatty P, Nsoedo C, Parker D (2008) Human factor in anaesthesia practice: insights from a task analysis. Br J Anaesth 100:333–343CrossRefGoogle Scholar
  8. 8.
    Joice P, Hanna GB, Cuschieri A (1998) Error enacted during endoscopic surgery: a human reliability analysis. Appl Ergon 29:409–414CrossRefGoogle Scholar
  9. 9.
    Al-Hakim L, Maiping T, Sevdalis N (2014) Applying hierarchical task analysis to improving the patient positioning for direct lateral interbody fusion in spinal surgery. Appl Ergon 45:955–966CrossRefGoogle Scholar
  10. 10.
    Al-Hakim L, Maiping T, Watanachote MD, Sengupta S (2015) Human error identification tool for laparoscopic surgery: motion economy perspective. Appl Ergon 50:113–125CrossRefGoogle Scholar
  11. 11.
    Sarker SK, Chang A, Albrani T, Vincent C (2008) Constructing hierarchical task analysis in surgery. Surg Endosc 22:107–111CrossRefGoogle Scholar
  12. 12.
    Sarker S, Hutchinson R, Chang A, Vincent C, Darzi A (2006) Self-appraisal hierarchical task analysis of expert surgeons performing laparoscopic surgery. Surg Endosc 20:636–640CrossRefGoogle Scholar
  13. 13.
    Sarker SK, Delaney C (2011) Feasibility of self-appraisal in assessing operative performance in advanced laparoscopic colorectal surgery. Colorectal Dis 13:805–810CrossRefGoogle Scholar
  14. 14.
    Peyre SE, Peyre CG, Hagen JA, Sullivan ME, Lipham JC, DeMeester SR, Peters JH, DeMeester TR (2009) Laparoscopic Nissen fundoplication assessment: task analysis as a model for the development of a procedural checklist. Surg Endosc 23:1227–1232CrossRefGoogle Scholar
  15. 15.
    Kohn LT, Corrigan JM, Donaldson MS (2000) To err is human: building a safer health system. A report of the Committee on Quality of Health Care in America, Institute of Medicine. National Academy Press, Washington, DCGoogle Scholar
  16. 16.
    Al-Hakim L, Sengupta S, Xiao J (2017) Ergonomics perspective for identifying and reducing internal operative flow disruption for laparoscopic urological surgery. Surg Endosc 31:5043–5056CrossRefGoogle Scholar
  17. 17.
    Wiegmann DA, ElBardissi AW, Dearani JA, Daly RC, Sundt TM (2007) Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation. Surgery 142:658–665CrossRefGoogle Scholar
  18. 18.
    Etchells E, O’Neill C, Bernstein M (2003) Patient safety in surgery: error detection and prevention. World J Surg 27:936–941CrossRefGoogle Scholar
  19. 19.
    Shepherd A (2010) HTA as a framework for task analysis. Ergonomics 41:1537–1552CrossRefGoogle Scholar
  20. 20.
    Al-Hakim L (2011) The impact of preventable disruption on the operative time for minimally invasive surgery. Surg Endosc 25:3385–3392CrossRefGoogle Scholar
  21. 21.
    Vereczkei A, Feussner H, Negele T, Fritzsche F, Seitz T, Bubb H, Horvath OP (2004) Ergonomic assessment of the static stress confronted by surgeons during laparoscopic cholechstectomy. Surg Endosc 18:1118–1122CrossRefGoogle Scholar
  22. 22.
    Sevdalis N, Wong HW, Arora S, Nagpal K, Healey A, Hanna GB, Vincent CA (2012) Quantitative analysis of intraoperative communication in open and laparoscopic surgery. Surg Endosc 26:2931–2938CrossRefGoogle Scholar
  23. 23.
    Annett J, Cunningham D, MathiasJones P (2000) A method for measuring team skills. Ergonomics 43:1076–1094CrossRefGoogle Scholar
  24. 24.
    Acton SA, Reinach SJ (2003) Hierarchical task analysis for teams: devleoping a method to charcterize railroad yard switching. In: Human Factors and Ergonomics Society MeetingGoogle Scholar
  25. 25.
    Berguer R (1999) Surgery and ergonomics. Arch Surg 134:1011–1016CrossRefGoogle Scholar
  26. 26.
    Ronstrom C, Hallbeck S, Lowndes B, Chrouser KL (2018) Surgical ergonomics. Surgeons as educators. Springer, New York, pp 387–417CrossRefGoogle Scholar
  27. 27.
    van Veelen MA, Kazemier G, Koopman J, Goossens RH, Meijer DW (2002) Assessment of the ergonomically optimal operating surface height for laparoscopic surgery. J Laparoendosc Adv Surg Tech 12:47–52CrossRefGoogle Scholar
  28. 28.
    Luttmann A, Jäger M, Sökeland J (2009) Ergonomic assessment of the posture of surgeons performing endoscopic transurethral resections in urology. J Occup Med Toxicol 4::26CrossRefGoogle Scholar
  29. 29.
    Barnes RM (1998) Motion and time study design and measurement of works. Chapman and Hall, LondonGoogle Scholar
  30. 30.
    Rosner B, Glynn RJ, Lee ML (2006) The Wilcoxon signed rank test for paired comparisons of clustered data. Biometrics 62:185–192CrossRefGoogle Scholar
  31. 31.
    Gwet KL (2014) Handbook of inter-rater reliability: the definitive guide to measuring the extent of agreement among raters. Advanced Analytics, LLC, Montgomery VillageGoogle Scholar
  32. 32.
    Hair JF Jr, Wolfinbarger M, Money AH, Samouel P, Page MJ (2015) Essentials of business research methods. Routledge, New YorkCrossRefGoogle Scholar
  33. 33.
    Wauben LS, van Veelen MA, Gossot D, Gossens RH (2006) Application of ergonomics guidelines during minimally invasive surgery: a questionnaire survey of 284 surgeons. Surg Endosc Other Interv Tech 20(8):1268–1274CrossRefGoogle Scholar
  34. 34.
    Bove P, Lacovelli V (2011) Laparoscopic radical prostatectomy. In: Meinhold-Heerlein I (ed) Laparoscopy: an interdisciplinary approach. InTech, Coroatia, pp 21–44Google Scholar
  35. 35.
    Chen WM, Cheng CL, Ou YC, Yang CK, Chen CS (2010) New use of Foley catheter for exposing the urethral stump during vesicourethral anastomosis in laparoscopic radical prostatectomy. Urology 76:1109–1110CrossRefGoogle Scholar
  36. 36.
    Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV (2003) Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology 61:699–702CrossRefGoogle Scholar
  37. 37.
    Thomas MJ, Petrilli RM (2006) Crew familiarity: operational experience, non-technical performance, and error management. Aviat Space Environ Med 77:41Google Scholar
  38. 38.
    Al-Hakim L, Arora S, Sevdalis N (2016) Impact of disruptions on anaesthetic workflow during anaesthesia induction and patient positioning. Eur J Anaesthesiol 33:581–587CrossRefGoogle Scholar
  39. 39.
    Kao L, Thomas E (2008) Navigating towards improved surgical safety using aviation-based strategies. J Surg Res 145:327–335CrossRefGoogle Scholar
  40. 40.
    van Det MJ, Meijerink WJ, Hoff C, Totte ER, Pierie JP (2009) Optimal ergonomics for laparoscopic surgery in minimally inasive surgery suites: a review and guidelines. Surg Endosc 23:1279–1285CrossRefGoogle Scholar
  41. 41.
    Persoon MC, Broos HJ, Witjes JA, Hendrikx AJ, Scherpbier AJ (2011) The effect of distractions in the operating room during endourological procedures. Surg Endosc 25:437–443CrossRefGoogle Scholar
  42. 42.
    Al-Hakim L, Sevdalis N, Arora S et al (2012) On surgical disruption rating, expected operation time or actual wasted time—some comments on Gillepsie. BMJ Quality Safety 21::532CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Service Science and Operations ManagementZhejiang UniversityHangzhouChina
  2. 2.Division of Information Technology and Mathematical SciencesUniversity of South AustraliaAdelaideAustralia
  3. 3.Department of UrologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
  4. 4.Urology UnitAustin HospitalHeidelbergAustralia
  5. 5.Austin Department of SurgeryUniversity of MelbourneMelbourneAustralia
  6. 6.Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
  7. 7.Epworth HealthcareEast MelbourneAustralia

Personalised recommendations