“One size” doesn't “fit all”: Understanding variability in anesthesia work practices

Objectives: This work examines the variability in how different anesthesia providers approach patient care to provide insight into the source and necessity of variations in practice, the implications of different individual preferences, and the subsequent consequences on approaches to safety that emphasize standardization. Methods: Vignette-based interviews were performed with 18 anesthesia providers to elicit the cognitive processes and strategies that they utilize as they progress through a case. A qualitative data analysis of the transcripts was performed to illuminate the variability in their processes of managing the case. Results: Participants employed converging strategies consistent with prior literature. However, divergence occurs in the application of those strategies; there is variability in participants’ information seeking strategies, problem anticipation, and resulting actions. In some instances, this divergence was minor, representing natural preferences that would inevitably converge in the management of the case. In other instances, this divergence represented major deviations that would not converge throughout the management of the case. Conclusions: The differences in how anesthesia providers approach their work, as identified in this study, call into question whether ‘standardization’ is always the best approach to improve safety in anesthesia. Whatever the cause of variations in individual strategies, when developing new approaches, the variability in anesthesia information seeking, goal setting and anticipation needs to be reflected in policies, practices, protocols, and training. This work reinforces the idea that it is the humans in the system, with their flexibility and expertise, who are the primary source of everyday safety.