Safer Surgery part 1 pot

Safer Surgery
Edited by
Rhona Flin and Lucy Mitchell
Analysing Behaviour in the Operating Theatre
SAFER SURGERY
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Safer Surgery
Analysing Behaviour in the Operating Theatre
RHONA FLIN
University of Aberdeen, UK
&
LUCY MITCHELL
University of Aberdeen, UK
© Rhona Flin and Lucy Mitchell 2009
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system or transmitted in any form or by any means, electronic, mechanical, photocopying,
recording or otherwise without the prior permission of the publisher.
Rhona Flin and Lucy Mitchell have asserted their moral right under the Copyright, Designs
and Patents Act, 1988, to be identied as the authors of this work.
Published by
Ashgate Publishing Limited Ashgate Publishing Company
Wey Court East Suite 420
Union Road 101 Cherry Street
Farnham Burlington
Surrey, GU9 7PT VT 05401-4405
England USA
www.ashgate.com
British Library Cataloguing in Publication Data
Safer surgery : analysing behaviour in the operating
theatre.
1. Surgical errors Prevention. 2. Operating room

personnel Psychology. 3. Operating room
personnel Evaluation. 4. Teams in the workplace.
5. Surgical errors.
I. Flin, Rhona H. II. Mitchell, Lucy.
617.9-dc22
ISBN: 978-0-7546-7536-5 (hbk); 978-0-7546-9577-6 (ebk.II)
Library of Congress Cataloging-in-Publication Data
Safer surgery : analysing behaviour in the operating theatre / [edited] by
Rhona Flin and
Lucy Mitchell.
p. cm.

Includes bibliographical references and index.
ISBN 978-0-7546-7536-5
1. Surgical errors Prevention. 2. Surgery. 3. Operating rooms. I. Flin, Rhona H. II.
Mitchell, Lucy.
[DNLM: 1. Medical Errors prevention & control. 2. Surgical Procedures, Operative-
-methods. 3. Accident Prevention. 4. Interprofessional Relations. 5. Operating Rooms.
WO 500 S128 2009]

RD27.85.S24 2009
617 dc22
2009004030
Contents
List of Figures ix
List of Tables xi
Notes on Contributors xiii
Foreword by Charles Vincent xxiii
Preface by George Youngson xxv
1 Introduction 1

Rhona Flin and Lucy Mitchell
PART I TOOLS FOR MEASURING BEHAVIOUR IN THE
OPERATING THEATRE
2 Development and Evaluation of the NOTSS Behaviour Rating
System for Intraoperative Surgery (2003–2008) 7
Steven Yule, Rhona Flin, Nikki Maran, David Rowley,
George Youngson, John Duncan and Simon Paterson-Brown
3 Competence Evaluation in Orthopaedics – A ‘Bottom-up’
Approach 27
David Pitts and David Rowley
4 Implementing the Assessment of Surgical Skills and
Non-Technical Behaviours in the Operating Room 47
Joy Marriott, Helen Purdie, Jim Crossley and Jonathan Beard
5 Scrub Practitioners’ List of Intra-Operative Non-Technical
Skills – SPLINTS 67
Lucy Mitchell and Rhona Flin
6 Observing and Assessing Surgical Teams:The Observational
Teamwork Assessment for Surgery
©
(OTAS)
©
83
Shabnam Undre, Nick Sevdalis and Charles Vincent
7 Rating Operating Theatre Teams – Surgical NOTECHS 103
Ami Mishra, Ken Catchpole, Guy Hirst, Trevor Dale and
Peter McCulloch
Safer Surgery
vi
8 RATE: A Customizable, Portable Hardware/Software System
for Analysing and Teaching Human Performance in the

Operating Room 117
Stephanie Guerlain and J. Forrest Calland
9 A-TEAM: Targets for Training, Feedback and Assessment of
all OR Members’ Teamwork 129
Carl-Johan Wallin, Leif Hedman, Lisbet Meurling and
Li Felländer-Tsai
10 Introducing TOPplus in the Operating Theatre 151
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 ANAESTHETICS
11 Integrating Non-Technical Skills into Anaesthetists’
Workplace-based Assessment Tools 175
Ronnie Glavin and Rona Patey
12 Using ANTS for Workplace Assessment 189
Jodi Graham, Emma Giles and Graham Hocking
13 Measuring Coordination Behaviour in Anaesthesia Teams
During Induction of General Anaesthetics 203
Michaela Kolbe, Barbara Künzle, Enikö Zala-Mezö, Johannes
Wacker and Gudela Grote
14 Identifying Characteristics of Effective Teamwork in Complex
Medical Work Environments: Adaptive Crew Coordination
in Anaesthesia 223
Tanja Manser, Steven K. Howard and David M. Gaba
15 Teams, Talk and Transitions in Anaesthetic Practice 241
Andrew Smith, Catherine Pope, Dawn Goodwin and
Maggie Mort
PART III OBSERVATION OF THEATRE TEAMS
16 An Empiric Study of Surgical Team Behaviours, Patient
Outcomes, and a Programme Based on its Results 261

Eric Thomas, Karen Mazzocco, Suzanne Graham, Diana Petitti,
Kenneth Fong, Doug Bonacum, John Brookey, Robert Lasky and
Bryan Sexton
Contents
vii
17 Counting Silence: Complexities in the Evaluation of Team
Communication 283
Lorelei Lingard, Sarah Whyte, Glenn Regehr and Fauzia Gardezi
18 Observing Team Problem Solving and Communication in
Critical Incidents 301
Gesine Honger and Cornelius Buerschaper
19 Observing Failures in Successful Orthopaedic Surgery 321
Ken Catchpole
20 Remembering To Do Things Later and Resuming Interrupted
Tasks: Prospective Memory and Patient Safety 339
Peter Dieckmann, Marlene Dyrløv Madsen, Silke Reddersen,
Marcus Rall and Theo Wehner
21 Surgical Decision-Making: A Multimodal Approach 353
Nick Sevdalis, Rosamond Jacklin and Charles Vincent
22 Simulator-Based Evaluation of Clinical Guidelines in
Acute Medicine 371
Christoph Eich, Michael Müller, Andrea Nickut and Arnd
Timmermann
23 Measuring the Impact of Time Pressure on Team Task
Performance 385
Colin F. Mackenzie, Shelly A. Jeffcott and Yan Xiao
24 Distractions and Interruptions in the Operating Room 405
Nick Sevdalis, Sonal Arora, Shabnam Undre and Charles Vincent
PART IV DISCUSSIONS
25 Putting Behavioural Markers to Work: Developing and

Evaluating Safety Training in Healthcare Settings 423
David Musson
26 Commentary and Clinical Perspective 437
Paul Uhlig
27 Behaviour in the Operating Theatre: A Clinical Perspective 445
Nikki Maran and Simon Paterson-Brown
Index 451
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List of Figures
Figure 2.1 Developing the NOTSS system 10
Figure 2.2 NOTSS skills taxonomy v1.2 17
Figure 2.3 Completed NOTSS rating form 19
Figure 3.1 Total hip replacement PBA T&O curriculum 32
Figure 4.1 Flowchart of the study implementation 52
Figure 7.1 Escalation model of surgical error 104
Figure 7.2 Relationship between minor failures and ranked
non-technical skills performance in paediatric cardiac
surgery 107
Figure 7.3 Mechanisms of surgical failure 108
Figure 7.4 Oxford NOTECHS scores against OTAS scores for
5 LCs 111
Figure 8.1 The RATE software 124
Figure 8.2 The RATE event-marking software 125
Figure 9.1 A schematic presentation of a structured team decision-
making process 133
Figure 10.1 Causes for latent failures leading to adverse events 152
Figure 10.2 TOPplus poster, rst version tested during pilot 159
Figure 10.3 Questions asked by team members as indicated on
the poster 161
Figure 10.4 Answers given by the team members as indicated on

the poster 162
Figure 10.5 Final version of the poster 167
Figure 11.1 Mini CEX trainee assessment, Victoria Inrmary 184
Figure 11.2 Mini CEX competency descriptors 185
Figure 12.1 Intraclass correlations calculated for each component of
ANTS 196
Figure 13.1 A taxonomy of explicit and implicit team coordination
and heedful interrelating behaviour 210
Figure 14.1 Conceptual framework of adaptive collaborative
practice 226
Figure 14.2 Overview of the observation system for coordination
behaviour in anaesthesia crews 229
Figure 14.3 System for data recording: FIT-system (left) and template
with observation codes including ‘buttons’ for members
of the operating room team (right) 230