In 1999 the Institute of Medicine (IOM) released a report titled "To Err Is Human," in which medical error was cited as the eighth leading cause of death in the United States (more than motor vehicle accidents, breast cancer, or AIDS), responsible for as many as 98,000 deaths annually [1]. The healthcare community was starting to become aware of the significance of organizational and human factors. In France, the Ministry of Health conducted a national survey on 'serious unwanted events related to healthcare delivery' in 2004 and 2009. It was found that in hospitals, 60% of such events could be connected to poor teamwork, especially 'insufficient supervision,' 'insufficient communication,' and 'lack of quality culture' [2].
Since then, many studies have examined the non-technical skills of caregivers [3]-[6] and have shown that poor communication and supervision were general precursors of unwanted events as in the French studies. These skills are especially crucial in ill-defined and rapidly evolving situations and when stakes are high. This is the case when a patient in the operating room starts desaturating, with no apparent reason, and when the first remediation actions show no improvement. The anesthesiologist, surgeon, and nurses must then share their perceptions of the situation, come up with interpretations, select the most plausible and take action before it is too late. In other words, the staff must address the questions "what is going on?" and "what should we do about it?", i.e. engage in sense-making processes.
Effective sense-making processes are the cornerstone of high reliability organizations [7]. The aim of this study was to validate a measure of sense-making in anesthesia in the operating room through the video analysis of high-fidelity simulation training exercises conducted at the LabForSIMS simulation center of Paris-Saclay Medical school between 2017 to June 2021.
We review the reliability and validity of themeasureanddiscusstheoreticalandmanagerialimplicationsforhigherreliabilityintrainingforreal-lifeoperations.