Operating theatres are very private workplaces. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. Behavioural scientists have been encouraged by clinicians to bring research techniques used in other industries into the operating theatre in order to study the behaviour of surgeons, nurses and anaesthetists. Safer Surgery presents one of the first collections of studies designed to understand the factors influencing safe and efficient surgical, anaesthetic and nursing practice.
The book is written by psychologists, surgeons and anaesthetists, whose contributions combine to offer readers the latest research techniques and findings from some of the leading investigators in this field. It is designed for practitioners and researchers interested in understanding the behaviour of operating theatre team members, with a view to enhancing both training and practice. The material is also suitable for those studying behaviour in other areas of healthcare or in high-risk work settings.
The aims of the book are to:
a) present the latest research on the behaviour of operating theatre teams
b) describe the techniques being used by psychologists and clinicians to study surgeons, anaesthetists and theatre nurses' task performance
c) outline the safety implications of the research to date.
Foreword, Charles Vincent; Preface, George Youngson; Introduction, Rhona Flin and Lucy Mitchell; Part I Tools for Measuring Behaviour in the Operating Theatre: Development and evaluation of the NOTSS behaviour rating system for intraoperative surgery (2003–2008), Steven Yule, Rhona Flin, Nikki Maran, David Rowley, George Youngson, John Duncan and Simon Paterson-Brown; Competence evaluation in orthopaedics – a ''bottom up'' approach, David Pitts and David Rowley; Implementing the assessment of surgical skills and non-technical behaviours in the operating room, Joy Marriott, Helen Purdie, Jim Crossley and Jonathan Beard; Scrub practitioners’ list of intra-operative non-technicalskills – SPLINTS, Lucy Mitchell and Rhona Flin; Observing and assessing surgical teams: the Observational Teamwork Assessment for Surgery (OTAS), Shabnam Undre, Nick Sevdalis and Charles Vincent; Rating operating theatre teams – surgical NOTECHS, Ami Mishra, Ken Catchpole, Guy Hirst, Trevor Dale and Peter McCulloch; RATE: a customizable, portable hardware/software system for analyzing and teaching human performance in the operating room, Stephanie Guerlain and J. Forrest Calland; A-TEAM: targets for training, feedback and assessment of all OR members'' teamwork, Carl-Johan Wallin, Leif Hedman, Lisbet Meurling and Li Felländer-Tsai; Introducing TOPplus in the operating theatre, Connie Dekker-van Doorn, Linda Wauben, Benno Bonke, Geert Kazemier, Jan Klein, Bianca Balvert, Bart Vrouenraets, Robbert Huijsman and Johan Lange. Part II Observational Studies of Anaesthetists: Integrating non-technical skills into anaesthetists'' workplace-based assessment tools, Ronnie Glavin and Rona Patey; Using ANTS for workplace assessment, Jodi Graham, Emma Giles and Graham Hocking; Measuring coordination behaviour in anaesthesia teams during induction of general anaesthetics, Michaela Kolbe, Barbara Künzle, Enikö Zala-Mezö, Johannes Wacker and Gudela Grote; Identifying characteristics of effective teamwork in complex medical work environments: adaptive crew coordination in anaesthesia, Tanja Manser, Steven K. Howard and David M. Gaba; Teams, talk and transitions in anaesthetic practice, Andrew Smith, Catherine Pope, Dawn Goodwin and Maggie Mort. Part III Observation of Theatre Teams: An empiric study of surgical team behaviours, patient outcomes, and a programme based on its results, Eric Thomas, Karen Mazzocco, Suzanne Graham; Diana Petitti, Kenneth Fong, Doug Bonacum, John Brookey, Robert Lasky and Bryan Sexton; Counting silence: complexities in the evaluation of team communication, Lorelei Lingard, Sarah Whyte, Glenn Regehr and Fauzia Gardezi; Observing team problem solving and communication in critical incidents, Gesine Hofinger and Cornelius Buerschaper; Observing failures in successful orthopaedic surgery, Ken Catchpole; Remembering to do things later and resuming interrupted tasks: prospective memory and patient safety, Peter Dieckmann, Marlene Dyrløv Madsen, Silke Reddersen, Marcus Rall and Theo Wehner; Surgical decision-making: a multimodal approach, Nick Sevdalis, Rosamond Jacklin and Charles Vincent; Simulator-based evaluation of clinical guidelines in acute medicine, Christoph Eich, Michael Müller, Andrea Nickut and Arnd Timmermann; Measuring the impact of time pressure on team task performance, Colin F. Mackenzie, Shelley A. Jeffcott and Yan Xiao; Distractions and interruptions in the operating room, Nick Sevdalis, Sonal Arora, Shabnam Undre and Charles Vincent. Part IV Discussions: Putting behavioural markers to work: developing and evaluating safety training in healthcare settings, David Musson; Commentary and clinical perspective, Paul Uhlig; Behaviour in the operating theatre: a clinical perspective, Nikki Maran and Simon Paterson-Brown; Index.
About the Editor:
Rhona Flin (BSc, PhD Psychology) is Professor of Applied Psychology at the University of Aberdeen. She is a Chartered Psychologist, a Fellow of the British Psychological Society and the Royal Society of Edinburgh. She directs a team of psychologists working with high-risk industries on research and consultancy projects concerned with the management of safety and emergency response. www.abdn.ac.uk/iprc
She is currently leading the Scottish Patient Safety Research Network and has been working with anaesthetists and surgeons since 1999. Her books include Sitting in the Hot Seat: Leaders and Teams for Critical Incident Management (Wiley, 1996), Managing the Offshore Installation Workforce (edited with Slaven, PennWell Books, 1996), Decision Making Under Stress (edited with Salas, Strub & Martin, Ashgate, 1997), Incident Command: Tales from the Hot Seat (edited with Arbuthnot, Ashgate 2002) and Safety at the Sharp End: A Guide to Non-Technical Skills (with O'Connor & Crichton, Ashgate, 2008).
Lucy Mitchell (MA, MRes Psychology) is a Research Assistant at the Industrial Psychology Research Centre at the University of Aberdeen. She is currently developing a framework for assessing and training operating theatre scrub practitioners' non-technical skills and is also working towards a PhD in this area. She is a former police officer and has previously investigated the decision-making skills of police firearms officers. Home page: www.abdn.ac.uk/iprc/staff/details/l.mitchell
'The expectation of improved performance in the operating room by the public, healthcare managers and funders leads to a need to understand and measure performance of surgical teams. This book provides an up-to-date overview of surgical performance research from across the globe. The use of this work to assess both non-technical and technical skills of operating teams will undoubtedly drive changes beneficial to patients.' - Bruce Barraclough, President, International Society for Quality in Health Care
'It is increasingly recognised that adverse events in the operating theatre arise from poor teamwork and poor communications, or deficiencies in our systems. It is also acknowledged that modern day surgery is increasingly complex and beyond the gift of any one professional or professional group to deliver and assure. The delivery of safer surgery depends on high performing teams who understand and recognise the interdependencies of their roles and contribution. This fascinating text, edited by Flin and Mitchell, brings together the work of leading researchers from medicine, psychology and safety critical industries, to expose the culture, professional hierarchies and behaviours endemic to our operating theatres. In this unique collection, each chapter highlights behavioural studies and educational approaches to develop professionals' non-technical skills and enhance safety in the theatre environment. Human error and systems failure contribute to "never" events and what we know to be avoidable harm; this text makes a valuable contribution to our understanding of what must change in our health systems and how we prepare future professionals to improve surgical safety.' - Jane Reid, President, International Federation of Perioperative Nurses, UK
'Despite a traditional focus heavily directed toward technical expertise, surgeons are increasingly aware of the impact of non-operative factors on patient outcomes. This book helps open the door to a field of study new to physicians; a body of knowledge critical to our development of the non-technical skills necessary for surgical success in an increasingly complex medical environment.' - Thoralf M. Sundt, M.D., Mayo Clinic, USA
'Authored by the "who's who" of social science researchers and clinicians,
this book is all about the a, b and c's of the operating theatre: actions, behaviours
and cultures – what they are, how to study
them, and how to make them safer for surgical patients.' - J M Davies, Professor of Anesthesia, University of Calgary Foothills Medical Centre, Canada