World Journal of Surgery

, Volume 31, Issue 7, pp 1373–1381 | Cite as

Observational Teamwork Assessment for Surgery (OTAS): Refinement and Application in Urological Surgery

  • Shabnam UndreEmail author
  • Nick Sevdalis
  • Andrew N. Healey
  • Ara Darzi
  • Charles A. Vincent



Teamwork in surgical teams is at the forefront of good practice guidelines and empirical research as an important aspect of safe surgery. We have developed a comprehensive assessment for teamwork in surgery—the Observational Teamwork Assessment for Surgery (OTAS)—and we have tested it for general surgical procedures. The aim of the research reported here was to extend the assessment to urology procedures.


After refining the original assessment, we used it to observe 50 urology procedures. The OTAS comprises a procedural task checklist that assesses patient, equipment/provisions, and communication tasks as well as ratings on five team behavior constructs (communication, cooperation, coordination, leadership, and monitoring). Teamwork was assessed separately in the surgical, anesthesia, and nursing subteams in the operating theater. We also assessed the reliability of the behavioral scoring.


Regarding task completion, a number of communication and equipment/provisions tasks were not routinely performed during the operations we observed. Regarding teamwork-related behaviors, adequate reliability was obtained in the scoring of behaviors. Anesthetists and nurses obtained their lowest scores on communication. Surgeons’ scores revealed a more complex pattern. In addition to low scores on communication, surgeons’ teamwork behaviors appeared to deteriorate as the procedures were finishing.


Our findings suggest that OTAS is applicable to various branches of surgery. Separate assessment of the subteams in the operating theater provides useful information that can be used to build targeted teamwork training aiming to improve surgical patients’ safety and outcomes.


Operating Theater Surgical Team Behavioral Rating 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.



The authors thank the BUPA Foundation and the Department of Health: Patient Safety Research Programme for funding this work and the British Academy for supporting the presentation of some of the work at the 26th International Congress of Applied Psychology (Athens, July 2006).


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Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Shabnam Undre
    • 1
    Email author
  • Nick Sevdalis
    • 1
    • 2
  • Andrew N. Healey
    • 1
  • Ara Darzi
    • 3
  • Charles A. Vincent
    • 1
  1. 1.Clinical Safety Research Unit, Department of Bio-Surgery and Surgical TechnologyImperial CollegeLondonUK
  2. 2.National Patient Safety AgencyLondonUK
  3. 3.Department of Bio-Surgery and Surgical TechnologyImperial CollegeLondonUK

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