Developing observational measures of performance in surgical teams

Healey, Andrew

doi:10.1136/qhc.13.suppl_1.i33

Cited by 61 publications

(61 citation statements)

References 26 publications

(15 reference statements)

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“…These skills are neither formally taught, nor included in competence assessments. Training would be beneficial in improving the knowledge and coordination of effort among surgeons, anaesthetists, perfusionists and nursing staff , Helmreich 2000, Fletcher et al 2002, Healey et al 2004. A consequence of this training would be to provide surgical teams with an enhanced ability to identify sources of recurrent failure and develop strategies for their management and future reduction through pre-operative briefings and post-operative debriefings.…”

Section: Discussionmentioning

confidence: 98%

Identification of systems failures in successful paediatric cardiac surgery

et al. 2006

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Patient safety will benefit from an approach to human error that examines systemic causes, rather than blames individuals. This study describes a direct observation methodology, based on a threat and error model, prospectively to identify types and sources of systems failures in paediatric cardiac surgery. Of substantive interest were the range, frequency and types of failures that could be identified and whether minor failures could accumulate to form more serious events, as has been the case in other industries. Check lists, notes and video recordings were employed to observe 24 successful operations. A total of 366 failures were recorded. Coordination and communication problems, equipment problems, a relaxed safety culture, patient-related problems and perfusion-related problems were most frequent, with a smaller number of skill, knowledge and decision-making failures. Longer and more risky operations were likely to generate a greater number of minor failures than shorter and lower risk operations, and in seven higher-risk cases frequently occurring minor failures accumulated to threaten the safety of the patient. Non-technical errors were more prevalent than technical errors and task threats were the most prevalent systemic source of error. Adverse events in surgery are likely to be associated with a number of recurring and prospectively identifiable errors. These may be co-incident and cumulative human errors predisposed by threats embedded in the system, rather than due to individual incompetence or negligence. Prospectively identifying and reducing these recurrent failures would lead to improved surgical standards and enhanced patient safety.

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Section: Discussionmentioning

confidence: 98%

Identification of systems failures in successful paediatric cardiac surgery

et al. 2006

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“…Neither type of measure is necessarily better than the other measure; each measure demands a different design according to its purpose. The following is a description of an observational teamwork assessment in surgery (OTAS) designed to assess the performance of the entire interprofessional team in the operating theatre at the level of task and of behaviour (Healey et al, 2004). …”

Section: Measurement Specificity and System Scopementioning

confidence: 99%

“…For instance, the model applied to surgery (see Figure 1) states that surgery demands interprofessional teamwork. Surgical teams demand certain infrastructure, resources and competencies, collectively termed as team input factors (Healey et al, 2004).…”

Section: A Team Performance Modelmentioning

confidence: 99%

The complexity of measuring interprofessional teamwork in the operating theatre

Healey

Undre

Sevdalis

et al. 2006

Journal of Interprofessional Care

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Surgery depends on interprofessional teamwork, which is becoming increasingly specialized. If surgery is to become a highly reliable system, it must adapt and professionals must learn from, and share, tested models of interprofessional teamwork. Trainers also need valid measures of teamwork to assess individual and team performance. However, measurement and assessment of interprofessional teamwork is lacking and interprofessional team training is scarce in the surgical domain. This paper addresses the complexity of measuring interprofessional teamwork in the operating theatre. It focuses mainly on the design and properties of observational assessment tools. The report and analysis serves to inform the researcher or clinician of the issues to consider when designing or choosing from alternative measures of team performance for training or assessment.

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“…However, where technical competence is quality assured, shared 'nontechnical skills', such as interpersonal communications, are not, yet such skills have long been recognised as prerequisites for safe and effective performance (Fletcher et al 2002;Gawande 2009;Healey et al 2004;Helmreich and Schaefer 1994;Pronovost and Vohr 2010). Such 'shared' skills transcend professional boundaries.…”

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confidence: 98%

‘Achieving ensemble’: communication in orthopaedic surgical teams and the development of situation awareness—an observational study using live videotaped examples

Bleakley

Allard

Hobbs

2012

Adv in Health Sci Educ

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Focused dialogue, as good communication between practitioners, offers a condition of possibility for development of high levels of situation awareness in surgical teams. This has been termed "achieving ensemble". Situation awareness grasps what is happening in time and space with regard to one's own unfolding work in relation to that of colleagues, and is necessary to maintain patient safety throughout a surgical list. We refined a typology, initially developed for use in studying the dynamics of teams in aviation safety, of 10 kinds of communication within two broad areas: 'Reports', or authoritative acts of communication setting up a monological or authoritative climate; and 'Requests', or facilitative acts of communication setting up a dialogical or participatory climate. We systematically mapped how orthopaedic surgical teams use verbal communication through analysis of videotaped operations using the typology. We asked: 'do orthopaedic surgical teams set up the conditions of possibility for the emergence of situation awareness through effective communication?' We found that orthopaedic surgical teams tend to produce monological rather than dialogical climates. Dialogue increases with more complex cases, but in routine work, communication levels are depressed and one-way, influenced by surgeons working within a traditionally hierarchical and authoritative culture. We suggest that such a monological climate inhibits development of situation awareness and then compromises patient safety. The same teams, however, generate potentially rich educational climates through exchange of profession-specific knowledge and skills, and we suggest that where technical skill exchange is good, non-technical or interpersonal communication skill levels can follow.

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Developing observational measures of performance in surgical teams

Cited by 61 publications

References 26 publications

Identification of systems failures in successful paediatric cardiac surgery

Identification of systems failures in successful paediatric cardiac surgery

The complexity of measuring interprofessional teamwork in the operating theatre

‘Achieving ensemble’: communication in orthopaedic surgical teams and the development of situation awareness—an observational study using live videotaped examples

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