Resilience through interpretive practice – A study of robotic surgery

• Published in: Safety science Vol. 108; pp. 113 - 128
• Main Authors: Wahlström, Mikael, Seppänen, Laura, Norros, Leena, Aaltonen, Iina, Riikonen, Jarno
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01.10.2018; Elsevier BV
• Subjects: Adaptation; Cancer; Cancer therapies; Cancer treatment; Cognitive ability; Field study; Medical personnel; Resilience; Robotic surgery; Sensory feedback; Situational demands; Surgeons; Surgical techniques; Work environment; Work practices; Robotic surgery; Situational demands; Cancer treatment; Resilience; Work practices; Field study
• ISSN: 0925-7535; 1879-1042
• DOI: 10.1016/j.ssci.2018.04.010

•Explains how interpretation provides system resilience.•Provides a model describing adaptation to situational demands.•Identifies challenges and contradictions within radical prostatectomy.•Describes implicit work practices for promoting patient health.•An ethnographic description of robotic surgery. The paper provides an ethnographic description of robotic surgery, along with task and work-domain analyses of it, with focus on surgeons’ adaptation to situational demands. Thereby, the study conducted ties in with the discussions on resilience and interpretive practice, theoretical approaches that consider human capability and improvisation in activity as sources of safety. The study methods include observations of operations, video analyses, interviews and self-confrontation sessions (i.e., surgeons commenting on video samples of their own work). The results are summarised in a conceptual model encompassing the basic elements that enable robotic surgery as an activity: manual, perceptual, social, and cognitive aspects are covered at three hierarchical levels, from strategies and planning to routinised techniques. Uncertainties and complexities that render adaptation challenging are elaborated upon. Robotic surgery could be considered a complex form of navigation since where anticipatory interaction with the environment is needed – the surgeon creates the landscape where the operation takes place, and tissues are identified and separated by palpation, albeit without tactile feedback, and with careful consideration of the patient’s health. In this challenging environment conflictual aims are to be addressed: minimal damage should be induced while one removes the cancer. The findings suggest that resilient activity is manifested in an interpretive human–environment connection wherein appropriate generic principles and aims guide more specific work actions; a hierarchy in adaptation to situational demands can therefore be identified as the specific actions, usually based on relatively fixed routines, vary and adapt in line with higher-level principles.