ESRC IMPACTS ESRC IMPACTS


espite significant progress in the development of new surgical techniques and equipment, the ‘human element’ of surgery such as surgeons, anaesthetists


For further ESRC Impact Case Studies visit www.esrc.ac.uk/impacts-and-findings/ features-casestudies/case-studies/index.aspx


The human element D


New research from an ESRC studentship scientifically measures the team behaviour of operating theatre staff and links it to patient outcomes


and nursing personnel has been neglected. A research team of psychologists and doctors


led by Dr Nick Sevdalis, experimental psychologist and Senior Lecturer at Imperial College London’s Clinical Safety Research Unit (directed by Professor Charles Vincent, a clinical psychologist), has devised a tool to offer a scientific yet practical assessment of teamwork within the complex and often stressful environment of an operating theatre. The Observational Teamwork Assessment for


Surgery (OTAS) tool assesses 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 behaviourally anchored scale. Taken together, these behaviours provide an index of the quality of inter- professional teamwork in the Operating Theatre. OTAS is scientifically robust yet clinically


feasible. It’s also acceptable to the populations it is aimed at – operating theatre professionals – and is carried out within healthcare settings, thus continuously testing and refining the external validity of conceptual models and metrics in the ‘real’ world of surgery. The research has allowed a truly multidisciplinary research group to be maintained over a number of years within the Clinical Safety Research Unit of Imperial College, in which psychologist researchers (Doctoral students, research assistants, and post-doctoral research associates) are working alongside clinical researchers applying robust psychological science to important clinical problems. Traditionally, psychological research of this type was not published in mainstream surgical or other clinical journals and the clinical field was entirely unaware of the possibilities for robust assessment and training interventions that can arise from applied psychological research. However, this new research has featured in major peer-reviewed clinical outlets (eg, Annals of Surgery), becoming an acceptable research avenue for both clinical and psychology-trained researchers.


This research was the first to scientifically assess how well or poorly a team functions in operating theatres, and to link team-functioning with care processes and patient outcomes. By measuring team behaviour in these settings the research has paved the way for the vigorous evaluation of the effectiveness of national policy interventions – such as the national roll-out of the Surgical Safety Checklist (www.safesurgery.org.uk) – ultimately contributing to improved patient outcomes. n


Key findings


n 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 (www.safesurgery.org.uk)


n 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


n The OTAS tool can be used in general surgical, urological and vascular procedures as well as in simulated procedures (for research or training); it can be used reliably by two (or more) trained blinded observers; and it can be used both by psychologists and clinical observers (eg, surgeons)


n A training programme of approximately 20 hours for new OTAS assessors has been developed and validated by Dr Sevdalis’ team


n OTAS has formed the basis for the development of similar measurement instruments that have been developed for multidisciplinary cancer teams and also for resuscitation teams


n It has been independently translated in Italian and re-validated for use in operating theatres in Italy and in German- and Spanish-speaking countries through an established network of research collaborators


i Dr Nick Sevdalis, Senior Lecturer, Department of Surgery & Cancer,


Imperial College, London Email n.sevdalis@imperial.ac.uk Web www1.imperial.ac.uk/medicine/about/institutes/ patientsafetyservicequality/cpssq_publications/resources_tools/otas This research was funded by the National Institute for Health Research, the EPSRC, the BUPA Foundation, the American Association for Surgical Education, the London Deanery and a joint ESRC/MRC Research Studentship award


AUTUMN 2011 SOCIETY NOW 13


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