Coordinating Clinical Teams

Abstract

Patient safety errors account for over 400,000 preventable deaths annually in US in hospitals alone, 70% of which are caused by team communication breakdowns, stemming from hierarchical structures and asymmetrical power dynamics between physicians, nurses, patients, and others. Nurses are uniquely positioned to identify and prevent these errors, but they are often penalized for speaking up, particularly when physicians are responsible. Nevertheless, empowering nurses and building strong interdisciplinary teams can lead to improved patient safety and outcomes. Thus, our group has been developing a series of intelligent systems that support teaming in safety critical settings, Robot-Centric Team Support System (RoboTSS), and recently developed a group detection and tracking system for collaborative robots. In this paper, we explore how RoboTSS can be used to empower nurses in interprofessional team settings, through a three month long, collaborative design process with nurses across five US-based hospitals. The main findings and contributions of this paper are as follows. First, we found that participants envisioned using a robotic crash cart to guide resuscitation procedures to improve efficiency and reduce errors. Second, nurses discussed how RoboTSS can generate choreography for efficient spatial reconfigurations in co-located clinical teams, which is particularly important in time-sensitive situations such as resuscitation. Third, we found that nurses want to use RoboTSS to "stop the line," and disrupt power dynamics by policing unsafe physician behavior, such as avoiding safety protocols using a robotic crash cart. Fourth, nurses envisioned using our system to support real-time error identification, such as breaking the sterile field, and then communicating those errors to physicians, to relieve them of responsibility. Finally, based on our findings, we propose robot design implications that capture how nurses envision utilizing RoboTSS. We hope this work promotes further exploration in how to design technology to challenge authority in asymmetrical power relationships, particularly in healthcare, as strong teams save lives.