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Dealing with unforeseen complexity in the OR: the role of heedful interrelating in medical teams

Highly complex operations such as paediatric cardiac surgery operations are characterised by many non-routine events. This study looked in detail at 40 paediatric cardiac cases in order to study how a highly competent team deals with the unforeseen complexity arising during these cases. A multi-method approach was used, employing questionnaires and direct team observations. Our results show that this particular team relied to a large extent on explicit coordination processes in order to deal with non-routine events. Non-routine events were strong predictors of explicit coordination processes, even when we controlled for the duration of the operation. Most non-routine events were noticed and dealt with through routine procedures. For dealing with the remaining difficult problems, processes such as heedful interrelating are required.