Attitudes to teamwork and safety in the operating theatre.

BACKGROUND A survey was undertaken to assess surgical team members' attitudes to safety and teamwork in the operating theatre. METHOD The Operating Room Management Attitudes Questionnaire (ORMAQ) measures attitudes to leadership, teamwork, stress and fatigue and error. A version of the ORMAQ was distributed to surgical teams in 17 hospitals in Scotland. A total of 352 responses were analysed, 138 from consultant surgeons, 93 from trainee surgeons and 121 from theatre nurses. RESULTS Respondents generally demonstrated positive attitudes to behaviours associated with effective teamwork and safety. Attitudes indicating a belief in personal invulnerability to stress and fatigue were evident in both nurses and surgeons. Consultant surgeons had more positive views on the quality of surgical leadership and communication in theatre than trainees and theatre nurses. While the ubiquity of human error was well recognised, attitudes to error management strategies (incident reporting, procedural compliance) suggest that they may not be fully functioning across hospitals. While theatre staff placed a clear priority on patient safety against other business objectives (e.g. waiting lists, cost cutting), not all of them felt that this was endorsed by their hospital management. CONCLUSIONS Attitude surveys can provide useful diagnostic information relating to behaviour and safety in surgical units. Discrepancies were found between the views of consultants compared with trainees and nurses, in relation to leadership and teamwork. While attitudes to safety were generally positive, there were several areas where theatre staff did not seem to appreciate the impact of psychological factors on technical performance.

[1]  Robert L. Helmreich,et al.  3 Human factors in the operating room: interpersonal determinants of safety, efficiency and morale , 1996 .

[2]  R. Reznick,et al.  Communication failures in the operating room: an observational classification of recurrent types and effects , 2004, Quality and Safety in Health Care.

[3]  R Flin,et al.  Anaesthetists' attitudes to teamwork and safety , 2003, Anaesthesia.

[4]  Sanjay A Pai.  Complications: A Surgeon's Notes on an Imperfect Science , 2002, BMJ : British Medical Journal.

[5]  David M Studdert,et al.  Analysis of errors reported by surgeons at three teaching hospitals. , 2003, Surgery.

[6]  Atul A. Gawande,et al.  Complications: A Surgeon's Notes on an Imperfect Science , 2002 .

[7]  Caprice K. Christian,et al.  A prospective study of patient safety in the operating room. , 2006, Surgery.

[8]  R. Helmreich,et al.  Culture at Work in Aviation and Medicine: National, Organizational and Professional Influences , 1998 .

[9]  Marilyn Sue Bogner,et al.  Human Error in Medicine , 1995 .

[10]  R. Kneebone.  Simulation in surgical training: educational issues and practical implications , 2003, Medical education.

[11]  Lorelei Lingard,et al.  Team Communications in the Operating Room: Talk Patterns, Sites of Tension, and Implications for Novices , 2002, Academic medicine : journal of the Association of American Medical Colleges.

[12]  Andy Conway Morris,et al.  Complications: a Surgeon's Notes on an Imperfect Science , 2003, BMJ.

[13]  A. Edmondson.  Speaking Up in the Operating Room: How Team Leaders Promote Learning in Interdisciplinary Action Teams , 2003 .

[14]  R. Flin,et al.  Identifying and training non-technical skills for teams in acute medicine , 2004, Quality and Safety in Health Care.

[15]  James T. Reason,et al.  Behavioural markers of surgical excellence , 2003 .

[16]  Robert L. Helmreich,et al.  Team performance in the operating room. , 1994 .

[17]  R. Stillman,et al.  The Scalpel's Edge: The Culture of Surgeons , 1999 .

[18]  G. Yukl,et al.  Leadership in Organizations , 1981 .

[19]  Kateri Jochum.  Teaming Up: Components of Safety Under High Risk , 2004 .

[20]  R Flin,et al.  Leadership for safety: industrial experience , 2004, Quality and Safety in Health Care.

[21]  Rhona Flin,et al.  Identifying and training non-technical skills of nuclear emergency response teams , 2004 .

[22]  R. Plowman,et al.  Adverse events in British hospitals , 2001 .

[23]  R. Helmreich,et al.  Surgery as team endeavour , 2000, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[24]  L. Rikkers.  Presidential address: Surgical leadership--lessons learned. , 2004, Surgery.

[25]  J. Sexton,et al.  Error, Stress, and Teamwork in Medicine and Aviation: Cross Sectional Surveys , 2001 .

[26]  Lynne Martin,et al.  Development of the NOTECHS (non-technical skills) system for assessing pilots’ CRM skills , 2018, Human Factors and Aerospace Safety.

[27]  R. Flin,et al.  Non-technical skills for surgeons in the operating room: a review of the literature. , 2006, Surgery.

[28]  C. Vincent,et al.  Adverse events in British hospitals: preliminary retrospective record review , 2001, BMJ : British Medical Journal.

[29]  Charles Vincent,et al.  Systems Approaches to Surgical Quality and Safety: From Concept to Measurement , 2004, Annals of surgery.

[30]  R. Helmreich,et al.  Safety in the operating theatre--part 1: interpersonal relationships and team performance. , 1995, Current anaesthesia and critical care.

[31]  M. Leonard,et al.  The human factor: the critical importance of effective teamwork and communication in providing safe care , 2004, Quality and Safety in Health Care.

[32]  J. Reason,et al.  Human factors and cardiac surgery: a multicenter study. , 2000, The Journal of thoracic and cardiovascular surgery.

[33]  Ara Darzi,et al.  A Human Factors Analysis of Technical and Team Skills Among Surgical Trainees During Procedural Simulations in a Simulated Operating Theatre , 2005, Annals of surgery.