Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)

Legacy Department

Industrial Engineering

Committee Chair/Advisor

Rivera-Rodriguez, Antonia J

Committee Member

Gramopadhye, Anand K

Committee Member

Greenstein, Joel S

Committee Member

Taaffe, Kevin M

Committee Member

Shappell, Scott A

Committee Member

Abernathy III, James H


Disruptions are common occurrences in a variety of healthcare settings and early research has shown that they are likely contributors to medical errors. For this reason, healthcare researchers have focused on studying and understanding the nature of Surgical Flow Disruptions (SFDs) to increase patient safety and quality of care within the operating room (OR). Many researchers have used simplistic taxonomies to collect and categorize the types of SFD that occur within the OR. Others have gone further to study SFD recovery and have link unrecovered and recovered SFD to minor and major adverse events experienced by patients. This dissertation, focused on cardiovascular surgeries, has expanded on both of these areas of research. First, the use of the Realizing Improved Patient Care through Human-centered Operating Room Design (RIPCHORD) taxonomy was validated by observing 11 cardiovascular surgeries and collected data surrounding SFDs and their recovery. SFDs were coded into the taxonomy with a 99.994% agreement. Second, three types of SFD recovery (individual, team, or none) were predicted based upon interactions between each RIPCHORD main taxonomy category and operational phase of surgery. By predicting the proportions of individual, team, and no recovery for when and what types of SFDs occur, an organizational or second-order problem solving approach occurs and the potential for targeting interventions to minimize SFDs and SFD recovery. Removing unorganized behavior from the operating room solves the root cause behind SFDs and offers structured teamwork to promote SFD recovery.



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