“Are you happy?” Collaborative decision making in the operating theatre

Decision making has become a key term in the endeavours of health professionals, patients, policy makers and researchers to describe clinical work and explain its outcomes. In this talk for the Social Science Research Forum, Queen Mary University, 27 March 2012, I explore how decisions are made in the operating theatre. I will report the initial findings of a detailed analysis of talk during 12 laparoscopic gall bladder removal operations. The focus will be on who says what to whom prior to the cutting of the cystic duct and the cystic artery. This is a critical moment in the operation as there is a risk of incorrect identification; the structures to be cut look like the main structures from which they branch off and which should not be damaged. Our analysis shows that in this data set the decision to cut the structures thought to be the cystic duct and cystic artery was always made in collaboration, irrespective of whether it was a consultant or a registrar who was operating. By asking, eg, “Are you happy?” the ‘operating’ surgeons sought confirmation from their (senior) colleagues prior to making the cuts. I will discuss the implications of this form of collaborative decision making, and place them in relation to current discourses, in the NHS and in society at large, about participation, sharing, agency, responsibility, and transparency.

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