Skip to main content
SpringerLink
Log in

The Science and Training of Expert Operating Room Teams

  • Chapter
  • First Online:
Comprehensive Healthcare Simulation: Surgery and Surgical Subspecialties

Part of the book series: Comprehensive Healthcare Simulation ((CHS))

Abstract

It is widely accepted that teamwork skills are critical to optimizing safety in the operating team. Failures in teamwork, rather than technical skills, are frequently identified as contributing factors in adverse events in the operating room. The fact that a team of experts do not simply merge to form an expert team, coupled with the fact the teamwork skills do not necessarily develop and perfect over time, has led to the development of many team training programs. The use of simulation to train teamwork skills has increased dramatically over the past decade. Drawing on the team science and surgical simulation literature, this chapter begins with a comprehensive overview of theoretical and conceptual underpinnings of effective teamwork (i.e., what distinguishes a high-performing team from a low-performing team). Next, methodologies to enhance team development and effectiveness are described and reviewed, followed by a summary of teamwork assessment tools that have been developed to measure the quality of OR teamwork. We discuss in detail a range of measurement issues including lack of standardization, psychometric quality, and rater trainer and provide “tips” on measuring and evaluating teamwork skills. A brief summary of the evidence regarding the effectiveness of team training in healthcare, surgery, and specifically multidisciplinary OR team training is presented. Finally, we highlight the challenges to widespread adoption, implementation, and sustainability of operating room simulation-based team training and identify a number of knowledge gaps that warrant future attention and exploration.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Patterson MD, Geis GL, Falcone RA, LeMaster T, Wears RL. In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf. 2013;22:468–77.

    Article  Google Scholar 

  2. Gardner AK, Ahmed RA, George RL, Frey JA. In situ simulation to assess workplace attitudes and effectiveness in a new facility. Simul Healthc. 2013;8:351–8.

    Article  Google Scholar 

  3. Bashford T, Reshamwalla S, McAuley J, Allen NH, McNatt Z, et al. Implementation of the WHO surgical safety checklist in an Ethiopian referral hospital. Patient Saf Surg. 2014;28:8–16.

    Google Scholar 

  4. Raemer DB, Kolbe M, Minehart RD, Rudolph JW, Pian-Smith MC. Improving anesthesiologists’ ability to speak up in the operating room: a randomized controlled experiment of a simulation-based intervention and a qualitative analysis of hurdles and enablers. Acad Med. 2016;4:530–9.

    Article  Google Scholar 

  5. Salas E, Rosen MA, Burke CS, Goodwin GF. The wisdom of collectives in organizations: an update of the teamwork competencies. In: Salas E, Goodwin GF, Burke CS, editors. Team effectiveness in complex organizations. New York: Taylor & Francis; 2009.

    Google Scholar 

  6. Salas E, Sims DE, Burke CS. Is there a “big five” in teamwork? Small Group Res. 2005;36:555–99.

    Article  Google Scholar 

  7. Gardner AK, Scott DJ. Concepts for developing expert surgical teams using simulation. Surg Clin North Am. 2015;95:717–28.

    Article  Google Scholar 

  8. Koschmann T, Dunnington G, Kim M. Team cognition and the accountabilities of the tool pass. In: Salas E, Fiore SM, Letsky MP, editors. Theories of team cognition: cross-disciplinary perspectives. New York: Taylor and Francis.

    Google Scholar 

  9. Klimoski R, Mohammed S. Team mental model: construct or metaphor? J Manage. 1994;20:403–37.

    Google Scholar 

  10. Smith-Jentsch KA, Mathieu JE, Kraiger K. Investigating linear and interactive effects of shared mental models on safety and efficiency in a field setting. J Appl Psyc. 2005;90:523–35.

    Article  Google Scholar 

  11. Wegner DM. Transactive memory: a contemporary analysis of the group mind. In: Mullen B, Goethals GR, editors. Theories of group behavior, New York: Springer-Verlag; 1986.

    Google Scholar 

  12. Liang DW, Moreland R, Argote L. Group versus individual training and group performance mediating factor of transactive memory. Personal Soc Psychol Bull. 1995;85:331–48.

    Google Scholar 

  13. Moreland RL, Argote L, Krishnan R. Socially shared cognition at work: transactive memory and group performance. In: Nye JL, Brower AM, editors. What’s social about social cognition? Research on socially shared cognition in small groups. Thousand Oaks: Sage; 1996.

    Google Scholar 

  14. Gardner AK, Ahmed RA. Transforming trauma teams through transactive memory: can simulation enhance performance? Simul Games. 2014;4:356–70.

    Article  Google Scholar 

  15. Endsley MR. Expertise and situation awareness. In: Ericsson KA, Charness P, Feltovich P, Hoffman R, editors. The Cambridge handbook of expertise and expert performance. New York: Cambridge University Press; 2006.

    Google Scholar 

  16. Hogan MP, Pace DE, Hapgood J, Boone DC. Use of human patient simulation and the situation awareness global assessment technique in practical trauma skills assessment. J Trauma. 2006;61:1047–52.

    Article  Google Scholar 

  17. Gardner AK, Kosemund M, Martinez J. Examining the feasibility and predictive validity of the SAGAT tool to assess situation awareness among medical trainees. Simul Healthc. 2017;12(1):17–21. https://doi.org/10.1097/SIH.0000000000000181.

  18. Webber SS. Leadership and trust facilitating cross-functional team success. J Manag Dev. 2002;21:201–14.

    Article  Google Scholar 

  19. Bandura A. Social foundations of thought and action. Englewood Cliffs: Prentice Hall; 1986.

    Google Scholar 

  20. Salas E, Dickinson TL, Converse SA, Tannenbaum SI. Toward an understanding of team performance and training. In: Swezy RW, Salas E, editors. Teams: their training and performance. Norwood: Ablex; 1992.

    Google Scholar 

  21. Cohen SG, Bailey DR. What makes teams work: group effectiveness research from the shop floor to the executive suite. J Manag. 1997;23:238–90.

    Google Scholar 

  22. Okhuysen GA, Bechky BA. Coordination in organizations: an integrative perspective. Acad Manag Ann. 2009;3:463–502.

    Article  Google Scholar 

  23. Kim S, Dunkin BJ, Paige JT, Eggerstedt JM, Nicholas C, Vassilliou MC, Spight DH, Pliego JF, Rush RM, Lau JN, Carpenter RO, Scott DJ. What is the future of training in surgery? Needs assessment of national stakeholders. Surgery. 2014;156:707–17.

    Article  Google Scholar 

  24. Rosen MA, Salas E, Wilson KA, et al. Measuring team performance in simulation-based training: adopting best practices for healthcare. Simul Healthc. 2008;3:33–41.

    Article  Google Scholar 

  25. Weaver SJ, Rosen MA, DiazGranados D, Lazzara EH, Lyons R, et al. Does teamwork improve performance in the operating room? A multilevel evaluation. Jt Comm J Qual Patient Saf. 2010;36:133–42.

    Article  Google Scholar 

  26. Scott DJ, Dunnington GL. The new ACS/APDS skills curriculum: moving the learning curve out of the operating room. J Gastrointest Surg. 2008;12:213–21.

    Article  Google Scholar 

  27. World Health Organization. Framework for action on interprofessional education and collaborative practice: a health professions networks, nursing, and midwifery, human resources for health. Geneva: World Health Organization; 2010.

    Google Scholar 

  28. Lockman JL, Ambardekar A, Deutsch ES. Optimizing education with in situ simulation. In: Palaganas JC, Maxworthy JC, Epps CA, Mancini ME, editors. Defining excellence in simulation programs. Philadelphia: Wolters Kluwer; 2015.

    Google Scholar 

  29. Raemer DB. Ignaz Semmelweis redux? Simul Healthc. 2014;9:153–5.

    Article  Google Scholar 

  30. Goldstein IL, Ford K. Training in organizations: needs assessment, development, and evaluation. Belmont: Wadsworth; 2002.

    Google Scholar 

  31. Yule S, Flin R, Maran N, Rowley D, Youngson G, Paterson-Brown S. Surgeons’ nontechnical skills in the operating room: reliability testing of the NOTSS behavior rating system. World J Surg. 2008;32:548–56.

    Article  Google Scholar 

  32. Mitchell L, Flin R, Yule S, Mitchell J, Coutts K, Youngson G. Development of a behavioural marker system for scrub practitioners' non-technical skills (SPLINTS system). J Eval Clin Pract. 2013;19(2):317–23.

    Article  Google Scholar 

  33. Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R. Anaesthetists’ nontechnical skills (ANTS): evaluation of a behavioral marking system. Br J Anaesth. 2003;90:580–8.

    Article  CAS  Google Scholar 

  34. Hull L, Arora S, Kassab E, et al. Observational teamwork assessment for surgery: content validation and tool refinement. J Am Coll Surg. 2011;212:234–43.

    Article  Google Scholar 

  35. Dietz AS, Pronovost PJ, Benson KN, Mendez-Tellez PA, Dwyer C, Wyskiel R, Rosen MA. A systematic review of behavioural marker systems in healthcare: what do we know about their attributes, validity and application? BMJ Qual Saf. 2014;23(12):1031–9.

    Article  Google Scholar 

  36. Sharma B, Mishra A, Aggarwal R, Grantcharov TP. Nontechnical skills assessment in surgery. Surg Oncol. 2011;20(3):169–77.

    Article  Google Scholar 

  37. Cumin D, Boyd MJ, Webster CS, Weller JM. A systematic review of simulation for multidisciplinary team training in operating rooms. Simul Healthc. 2013;8(3):171–9.

    Article  Google Scholar 

  38. Hull L, Arora S, Aggarwal R, Darzi A, Vincent C, Sevdalis N. The impact of nontechnical skills on technical performance in surgery: a systematic review. J Am Coll Surg. 2012;214(2):214–30.

    Article  Google Scholar 

  39. Gardner AK, Russo MA, Jabbour II, Kosemund M, Scott DJ. Frame of reference training for simulation-based intraoperative communication assessment. Am J Surg. 2016;212:548. https://doi.org/10.1016/j.amjsurg.2016.02.009.

    Article  PubMed  Google Scholar 

  40. Hull L, Arora S, Symons NR, Jalil R, Darzi A, Vincent C. Sevdalis N; Delphi expert consensus panel. Training faculty in nontechnical skill assessment: national guidelines on program requirements. Ann Surg. 2013;258(2):370–5.

    Article  Google Scholar 

  41. Krokos KJ, Baker DP, Alonso A, Day R. Assessing team processes in complex environments: challenges in transitioning research to practice. In: Salas E, Goodwin BCS, editors. Team effectiveness in complex organizations: Cross-disciplinary perspective and approaches. New York: Taylor & Francis/Routledge; 2009.

    Google Scholar 

  42. McCulloch P, Rathbone J, Catchpole K. Interventions to improve teamwork and communications among healthcare staff. Br J Surg. 2011;98(4):469–79.

    Article  CAS  Google Scholar 

  43. Neily J, Mills PD, Young-Xu Y, Carney BT, West P, Berger DH, Mazzia LM, Paull DE, Bagian JP. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304(15):1693–700.

    Article  CAS  Google Scholar 

  44. Young-Xu Y, Neily J, Mills PD, Carney BT, West P, Berger DH, Mazzia LM, Paull DE, Bagian JP. Association between implementation of a medical team training program and surgical morbidity. Arch Surg. 2011;46(12):1368–73.

    Article  Google Scholar 

  45. Eppich W, Howard V, Vozenilek J, Curran I. Simulation-based team training in healthcare. Simul Healthc. 2011;6(Suppl):S14–9. https://doi.org/10.1097/SIH.0b013e318229f550.

    Article  PubMed  Google Scholar 

  46. Korndorffer JR Jr, Arora S, Sevdalis N, Paige J, McClusky DA 3rd, Stefanidis D, PEGASUS Research Group. The American College of Surgeons/Association of Program Directors in surgery National Skills Curriculum: adoption rate, challenges and strategies for effective implementation into surgical residency programs. Surgery. 2013;154(1):13–20.

    Article  Google Scholar 

  47. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Admin Pol Ment Health. 2011;28:65–76.

    Article  Google Scholar 

  48. Stefanidis D, Sevdalis N, Paige J, Zevin B, Aggarwal R, Grantcharov T, Jones DB, Association for Surgical Education Simulation Committee. Simulation in surgery: what's needed next? Ann Surg. 2015;261(5):846–53.

    Article  Google Scholar 

  49. Waltz TJ, Powell BJ, Matthieu MM, et al. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the expert recommendations for implementing change (ERIC) study. Implement Sci. 2015;10:109.

    Article  Google Scholar 

  50. Powell BJ, Beidas RS, Lewis CC, et al. Methods to improve the selection and tailoring of implementation strategies. J Behav Health Serv Res. 2017;44(2):177–94.

    Article  Google Scholar 

  51. Tuckman BW. Developmental sequence in small groups. Psychol Bull. 1965;63(6):384–99.

    Article  CAS  Google Scholar 

  52. Mohammed S, Hamilton K, Lim A. The incorporation of time in team research: past, current, and future. In: Salas E, Goodwin BCS, editors. Team effectiveness in complex organizations: Cross-disciplinary perspective and approaches. New York: Taylor & Francis/Routledge; 2009.

    Google Scholar 

  53. Burke CS, Stagl KC, Salas E, Pierce L, Kendall DL. Understanding team adaptation: a conceptual analysis and model. J Appl Psychol. 2006;91:1189–207.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Health Professions, Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Aimee Gardner

  2. Department of Health Service and Population Research, King’s College London, London, UK

    Louise Hull

Authors
  1. Aimee Gardner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Louise Hull
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aimee Gardner .

Editor information

Editors and Affiliations

  1. Vice Chair of Education, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Dimitrios Stefanidis

  2. Vice Chair of Education, Department of Surgery, Stanford University, Stanford, CA, USA

    James R. Korndorffer Jr.

  3. Executive Director WISH and CREST, Department of Urology, University of Washington, Seattle, WA, USA

    Robert Sweet

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gardner, A., Hull, L. (2019). The Science and Training of Expert Operating Room Teams. In: Stefanidis, D., Korndorffer Jr., J., Sweet, R. (eds) Comprehensive Healthcare Simulation: Surgery and Surgical Subspecialties. Comprehensive Healthcare Simulation. Springer, Cham. https://doi.org/10.1007/978-3-319-98276-2_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98276-2_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98275-5

  • Online ISBN: 978-3-319-98276-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation