Advertisement

World Journal of Surgery

, Volume 30, Issue 10, pp 1774–1783 | Cite as

Observational Assessment of Surgical Teamwork: A Feasibility Study

  • Shabnam UndreEmail author
  • Andrew N. Healey
  • Ara Darzi
  • Charles A. Vincent
ORIGINAL SCIENTIFIC REPORTS

Abstract

Background

Teamwork is fundamental to effective surgery, yet there are currently no measures of teamwork to guide training, evaluate team interventions or assess the impact of teamwork on outcomes. We report the first steps in the development of an observational assessment of teamwork and preliminary findings.

Method

We observed 50 operations in general surgery from a single operating theater using a measure of teamwork specifically developed for use in the operating theater. The OTAS (Observational Teamwork Assessment for Surgery) comprises a procedural task checklist centered on the patient, equipment and communications tasks and ratings on team behavior constructs, namely: communication, co-operation, co-ordination, shared-leadership and monitoring.

Results

Ratings of overall team performance were reasonably high, though variable, but there was evidence that clinically significant steps were being missed which at the very least eroded safety margins. There was, for instance, a frequent failure to check both surgical and anesthetic equipment and a failure to confirm the procedure verbally, patient notes were missing in about one-eighth of the cases and delays or changes occurred in over two-thirds of the cases.

Conclusions

This study takes an initial step towards developing measures of team performance in surgery that are defined in relation to tasks and behaviors of the team. The observational method of assessment is feasible and can provide a wealth of potentially valuable research data. However, for these measures to be used for formal assessment, more research is needed to make them robust and standardized.

Keywords

Behavior Rating Task Completion Team Performance Task List Communication Task 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

We thank the BUPA foundation and the Department of Health: Patient Safety Research Programme for funding this work. We are grateful to Dr. Nick Sevdalis for his contribution to the revision of this manuscript. We would also like to thank our Surgical, Anaesthetic and Nursing Colleagues for their support and co-operation in this study.

References

  1. 1.
    Vincent C, Moorthy K, Sarker SK, Chang A, Darzi AW. Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg 2004;239:475–482PubMedCrossRefGoogle Scholar
  2. 2.
    Calland JF, Guerlain S, Adams RB, Tribble CG, Foley E, Chekan EG. A systems approach to surgical safety. Surg Endosc 2002;16:1005–1014PubMedCrossRefGoogle Scholar
  3. 3.
    Undre S, Sevdalis N, Healey AN, Darzi A, Vincent C. Teamwork in the operating theatre: cohesion or confusion? J Eval Clin Pract 2006 12:182–189. Google Scholar
  4. 4.
    Fletcher GC, McGeorge P, Flin RH, Glavin RJ, Maran NJ. The role of non-technical skills in anaesthesia: a review of current literature. Br J Anaesth 2002;88:418–429PubMedCrossRefGoogle Scholar
  5. 5.
    Millward LJ, Jeffries N. The team survey: a tool for health care team development. [Miscellaneous Article]. J Adv Nurs 2001;35:276–287PubMedCrossRefGoogle Scholar
  6. 6.
    Baldwin PJ, Paisley AM, Brown SP. Consultant surgeons’ opinion of the skills required of basic surgical trainees. Br J Surg 1999;86:1078–1082PubMedCrossRefGoogle Scholar
  7. 7.
    Lang NP, Rowland-Morin PA, Coe NP. Identification of communication apprehension in medical students starting a surgery rotation. Am J Surg 1998;176:41–45PubMedCrossRefGoogle Scholar
  8. 8.
    Hawryluck LA, Espin SL, Garwood KC, Evans CA, Lingard LA. Pulling together and pushing apart: tides of tension in the ICU team. Acad Med 2002;77[Suppl10]:S73–S76PubMedCrossRefGoogle Scholar
  9. 9.
    Lingard L, Reznick R, DeVito I, Espin S. Forming professional identities on the health care team: discursive constructions of the ‚other’ in the operating room. Med Educ 2002;36:728–734PubMedCrossRefGoogle Scholar
  10. 10.
    Thomas EJ, Sexton JB, Helmreich RL. Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med 2003;31:956–959PubMedCrossRefGoogle Scholar
  11. 11.
    Grommes P. Contributing to coherence: an empirical study of OR team communication. In: Minnick-Fox M, Williams A, Kaser E, editors. Proceedings of the 24th Penn Linguistics Colloquium. Univ Penn Working Papers Linguistics 2000;7:1, 87–98Google Scholar
  12. 12.
    Morey JC, Simon R, Jay GD, Wears RL, Salisbury M, Dukes KA, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 2002;37:1553–1581PubMedCrossRefGoogle Scholar
  13. 13.
    Helmreich RL, Foushee HC. Why crew resource management? Empirical and theoretical basis of human factors training in aviation. In: Weiner EL, Kanki BG, Helmreich RL, editors. Cockpit Resource Management. New York, Academic, 1993:3–45Google Scholar
  14. 14.
    West M, Borrill C, Unsworth K. Team effectiveness in organisations. In: Cooper CL, Robertson IT, editors. International Review of Industrial Organisational Psychology, vol 13. Chichester, Wiley, 1998:1–48Google Scholar
  15. 15.
    Cohen S, Bailey D. What makes teams work: group effectiveness research from the shop floor to the executive suite. J Manage 1997;23:239–290CrossRefGoogle Scholar
  16. 16.
    Gladstein D. Groups in context: a model of group task effectiveness. Adm Sci Q 1984;29:499–517CrossRefGoogle Scholar
  17. 17.
    Guzzo RA, Shea GP. Group performance and intergroup relations in organisations. In: Dunnette MD, Hough LM, editors. Handbook of Industrial and Organisational Psychology. Palo Alto: Consultant Psychological Press, 1992:269–313Google Scholar
  18. 18.
    Stewart GL, Barrick MR. Team structure and performance: assessing the mediating role of intrateam process and the moderating role of task type. Acad Manage J 2000; 43:135–148.Google Scholar
  19. 19.
    Carthey J, de Leval MR, Reason JT. The human factor in cardiac surgery: errors and near misses in a high technology medical domain. Ann Thorac Surg 2001;72:300–305PubMedCrossRefGoogle Scholar
  20. 20.
    Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, et al. Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 2004;13:330–334PubMedCrossRefGoogle Scholar
  21. 21.
    Dickinson T L, McIntyre RM.. A conceptual framework for teamwork measurement. In: Brannick MT, Salas E, Prince C editors, Team performance assessment and measurement, theory, methods, and applications . Mahwah: Lawrence Erlbaum Associates 1997:19-43.Google Scholar
  22. 22.
    Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R. Anaesthetists’ non-technical skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth 2003;90:580–588PubMedCrossRefGoogle Scholar
  23. 23.
    Healey AN, Undre S, Vincent CA. Developing observational measures of performance in surgical teams. Qual Saf Health Care 2004;13[Suppl 1]:i33–i40PubMedCrossRefGoogle Scholar
  24. 24.
    de Leval MR, Carthey J, Wright DJ, Farewell VT, Reason JT. Human factors and cardiac surgery: a multicenter study. J Thorac Cardiovasc Surg 2000;119:661–672PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Shabnam Undre
    • 1
    • 2
    Email author
  • Andrew N. Healey
    • 1
  • Ara Darzi
    • 1
  • Charles A. Vincent
    • 1
  1. 1.Clinical Safety Research Unit, Department of Surgical Oncology and Technology, Imperial College University of LondonLondonUK
  2. 2.Clinical Safety Research Unit, Department of Surgical Oncology and Technology, Imperial College University of London, 10th FloorSt. Mary’s Hospital QEQM BuildingLondonUK

Personalised recommendations