The human element of surgery
A new tool assessing the quality of team-related behaviours of the core members of an operating theatre team has been mandated for national use by the National Patient Safety Agency and implemented in several other countries.
Despite significant progress in the development of new surgical techniques and equipment, the 'human element' of surgery such as surgeons, anaesthetists, and nursing personnel has been neglected.
A research team of psychologists and doctors led by Dr Nick Sevdalis at Imperial College London's Clinical Safety Research Unit devised the Observational Teamwork Assessment for Surgery (OTAS) tool to assess the quality of team-related behaviours of the core members of an operating theatre team. The tool captures five team-related behaviours - communication, co-ordination, co-operation, situation awareness and leadership - each one of which is rated on a seven-point scale, providing an index of the quality of teamwork.
The research, part-funded by a joint ESRC/Medical Research Council Research Studentship grant, is the first to scientifically assess how well or poorly a team functions in operating theatres, and link team functioning with care processes and patient outcomes. Psychological research of this type had not been published previously in mainstream surgical or other clinical journals, and the clinical field was previously unaware of the possibilities of robust assessment and training interventions from applied psychological research.
Dr Sevdalis has also been modelling surgical risk estimation and choice of surgical procedure by expert and novice surgeons. A method to provide individualised feedback on decision-making has been exploited successfully by the Royal College of Surgeons.
- OTAS is being used to evaluate the effectiveness of one of the largest national quality improvement projects in surgical care in England and Wales – the Surgical Safety Checklist
- The Checklist, which was originally developed by the World Health Organisation, became national policy and was mandated for national use by the National Patient Safety Agency in January 2009
- OTAS has been independently translated in Italian and revalidated for use in operating theatres in Italy and in German- and Spanish-speaking countries through an established network of research collaborators
- A training programme of approximately 20 hours for new OTAS assessors has been developed and validated by Dr Sevdalis' team
- OTAS has formed the basis for the development of similar measurement instruments that have been developed for multidisciplinary cancer teams and for resuscitation teams.