VILLARUZ, GRAYLE AYLWIN

NCD4
JOURNAL
SUMMARY:

This narrative synthesis explores the literature on challenging authority in the operating room (OR)
environment, focusing on the importance of effective communication between multidisciplinary care teams,
particularly during crisis situations. Effective communication is crucial for patient safety, and communication
breakdown can have severe consequences. Hierarchy, organizational culture, and education are often overlooked in
educational curriculum.

Crew Resource Management (CRM) originated from the observation of interactions between pilots in the
cockpit, where junior pilots tried to challenge the captain in high acuity situations but were ignored by senior team
members. CRM was designed to optimize training in non-technical skills to ensure flight safety, including the ability
to effectively challenge authority. These competencies are translatable to the OR environment, which resembles the
flight deck in many aspects.

Research on speaking up in the hierarchical environment of the OR is relatively new, with most research using
self-reporting methods and only recently has simulation been used to examine this concept. Qualitative research using
surveys and interviews offers insight into trainees' perception of hierarchy in the OR and perceived barriers and
enablers. Studies using simulation have revealed a significant educational gap in the training given to juniors around
effectively challenging authority.

Despite the importance of challenging authority and speaking up for patient safety, it remains a difficult task
for those of "low power" in the OR environment. Barriers to challenging authority include a hierarchical climate,
superior's interpersonal communication skill, gender differences, and a lack of adequate training in voicing concerns.
Enablers to speaking up include teaching interventions, evidence that speaking up results in meaningful changes, and
anonymized reporting mechanisms.

This narrative synthesis aims to explore the literature on challenging authority in the OR environment,
examining the identification of modifiable barriers, the effectiveness of educational interventions on the ability to
speak up, and enablers to challenging authority.

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findings of such study may also help shape help policy and contribute to global healthcare. It also helps
nurses advance their field, stay updated and offer better patient care.

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The research also provides insights into areas for improvement, allowing for the development of more
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profession and supporting the provision of the best possible nursing care.