A-TEAM: Targets for training, feedback and assessment of all OR members' teamwork

Safer Surgery: Analysing Behaviour in the Operating Theatre

Volumn , Issue , 2009, Pages 129-150

  Wallin, Carl Johan ^a,b   Hedman, Leif ^c,d   Meurling, Lisbet ^d   Felländer Tsai, Li ^d,e  

^a KAROLINSKA UNIVERSITY HOSPITAL   (Sweden)

^b Division of Advanced Patient Simulation Centre for Advanced Medical Simulation at Karolinska   (Sweden)

^c UMEÅ UNIVERSITY   (Sweden)

^d KAROLINSKA INSTITUTE   (Sweden)

^e Centre for Advanced Medical Simulation   (Sweden)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 84878274269     PISSN: None     EISSN: None     Source Type: Book    
DOI: None     Document Type: Chapter

References (78)

1. ™: Strategies and Tools to Enhance Performance and Patient Safety. Available from: [last accessed September 2008].
2. Ahlberg, G., Enochsson, L., Gallagher, A.G., Hedman, L., Hogman, C., McClusky, D.A. 3rd, Ramel, S., Smith, C.D.andArvidsson, D. (2007) Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. American Journal of Surgery 193 (6), 797-804.
3. Avolio, B.J. (2007) Promoting more integrative strategies for leadership theory-building. American Psychologist 62 (1), 25-33.
4. Baddeley, A.D. and Hitch, G.J. (1974) Working memory. In G.A. Bower (ed.), Recent Advances in Learning and Motivation (pp. 47-90). New York: Academic Press.
5. Baddeley, A.D. and Logie, R.H. (1999) Working memory: The multicomponent model. In A. Miyake and P. Shah (eds) Models of Working Memory: Mechanisms of Active Maintenance and Executive Control (pp. 22-61). New York: Cambridge University Press.
6. Baker, D.P., Gustafson, S., Beaubien, J., Salas, E. and Barach, P. (2005a) Medical team training programs in health care. Advances in Patient Safety vol. 4, Agency for Healthcare Research and Quality, Rockville, MD. Available from: [accessed September 2008].
7. Baker, D.P., Gustafson, S., Beaubien, J., Salas, E. and Barach, P. (2005b) Medical teamwork and patient safety: The evidence-based relation. Literature Review. AHRQ Publication No. 05-0053, April 2005. Agency for Healthcare Research and Quality, Rockville, MD. Available from: [accessed September 2008].
8. Brannick, M.T. and Prince, C. (1997) An overview of team performance measurement. In M.T. Brannick, E. Salas and C. Prince (eds) Team Performance Assessment and Measurement (pp. 3-16). Mahwah: Lawrence Erlbaum Associates.
9. Burke, C.S., Salas, E., Wilson-Donnelly, K. and Priest, H. (2004) How to turn a team of experts into an expert medical team: Guidance from the aviation and military communities. Quality and Safety in Health Care 13 (Suppl. 1), i96-104.
10. Burke, C.S., Stagl, K.C., Klein, C., Goodwin, G.F., Salas, E. and Halpin, S.M. (2006) What type of leadership behaviors are functional in teams? A meta-analysis. The Leadership Quarterly 17, 288-307.
11. Cannon-Bowers, J. and Salas, E. (1997) A framework for developing team performance measures in training. In M.T. Brannick, E. Salas, C. Prince (eds) Team Performance Assessment and Measurement (pp. 45-62). Mahwah, NJ: Lawrence Erlbaum Associates.
12. Carthey, J., de Leval, M.R., Wright, D.J., Farewell, V.T., Reason, J.T. and all UK paediatric cardiac centres (2003) Behavioural markers of surgical excellence. Safety Science 41 (5), 409-25.
13. Catchpole, K.R., Giddings, A.E., Wilkinson, M., Hirst, G., Dale, T. and de Leval, M.R. (2007) Improving patient safety by identifying latent failures in successful operations. Surgery 142 (1), 102-10.
14. Cooper, S. and Wakelam, A. (1999) Leadership of resuscitation teams: 'Lighthouse Leadership'. Resuscitation 42 (1), 27-45.
15. Cowan, N. (2005) Working Memory Capacity. New York, NY: Psychology Press.
16. de Fockert, J.W., Rees, G., Frith, C.D. and Lavie N. (2001) The role of working memory in visual selective attention. Science 291, 1803-806.
17. Dickinson, T.L. and McIntyre, R.M. (1997) A conceptual framework for teamwork measurement. In M.T. Brannick, E. Salas and C. Prince (eds) Team Performance Assessment and Measurement, (pp. 19-43). Mahwah: Lawrence Erlbaum Associates.
18. Enochsson, L., Isaksson, B., Tour, R., Kjellin, A., Hedman, L., Wredmark, T. and Tsai-Felländer, L. (2004) Visuospatial skills and computer game experience influence the performance of virtual endoscopy. Journal of Gastrointestinal Surgery 8(7), 876-82; discussion 882.
19. Entin, E.E. and Serfaty, D. (1999) Adaptive team coordination. Human Factors 41, 312-25.
20. Fletcher, G., Flin. R., McGeorge, P., Glavin, R., Maran. N. and Patey, R. (2003) Anaesthetists' Non-Technical Skills (ANTS): Evaluation of a behavioural marker system. British Journal of Anaesthesia 90 (5), 580-8.
21. Flin. R., Martin, L., Goeters, K.M., Hormann, H.J., Amalberti, R., Valot, C. and Nijhuis, H. (2003) Development of the NOTECHS (non-technical skills) system for assessing pilots' CRM skills. Human Factors and Aerospace Safety 3 (2), 97-119.
22. Flin. R., Glavin, R., Maran. N. and Patey, R. (2004a) Anaesthetists' Non-technical Skills (ANTS) System Handbook v1.0. Available from: < http://www.abdn.ac.uk/iprc/ants/> [accessed March 2009].
23. Flin. R. and Maran. N. (2004b) Identifying and training non-technical skills for teams in acute medicine. Quality and Safety in Health Care 13 (Suppl. 1), i80-4.
24. Flin. R., Rowley. D., Paterson-Brown. S. and Maran. N.(2006) The Non-technical Skills for Surgeons (NOTSS) System Handbook v1.2. Available from:
25. Frankel, A., Gardner, R., Maynard, L. and Kelly, A. (2007) Using the Communication and Teamwork Skills (CATS) Assessment to measure health care team performance teamwork and communication. The Joint Commission Journal on Quality and Patient Safety 33 (9), 549-58.
26. Gaba, D.M. (1992) Dynamic decision-making in anaesthesiology: Cognitive models and training approaches. In D.A. Evans and V.L. Patel (eds) Advanced Models of Cognition for Medical Training and Practice. Berlin: Springer.
27. Gaba, D.M., Fish, K.J. and Howard, S.K. (1994) Crisis Resource Management in Anesthesia. New York: Churchill Livingstone.
28. Gawande, A.A., Zinner, M.J., Studdert, D.M. and Brennan, T.A. (2003) Analysis of errors reported by surgeons at three teaching hospitals. Surgery 133 (6), 614-21.
29. Grantcharov, T.P., Kristiansen, V.B., Bendix, J., Bardram, L., Rosenberg, J. and Funch-Jensen, P. (2004) Randomized clinical trial of virtual reality simulation for laparoscopic skills training. British Journal of Surgery 91 (2), 146-50.
30. Healey, A.N., Undre, S. and Vincent, C.A. (2004) Developing observational measures of performance in surgical teams. Quality and Safety in Health Care 13 (Suppl. 1), i33-40.
31. Hedman, L., Ström, P., Andersson, P., Kjellin, A., Wredmark, T. and Felländer-Tsai, L. (2006) High-level visual-spatial ability for novices correlates with performance in a visual-spatial complex surgical simulator task. Surgical Endoscopy 20 (8), 1275-80.
32. Hedman, L., Klingberg, T., Enochsson, L., Kjellin, A. and Felländer-Tsai, L. (2007) Visual working memory influences the performance in virtual image-guided surgical intervention. Surgical Endoscopy 21 (11), 2044-50.
33. Helmreich, R.L., Merritt, A.C. and Wilhelm, J.A. (1999) The evolution of Crew Resource Management training in commercial aviation. International Journal of Aviation Psychology 9 (1), 19-32.
34. House, R.J. and Aditya, R.N. (1997) The social scientific study of leadership: Quo vadis? Journal of Management 23 (3), 409-73.
35. Howard, S.K., Gaba, D.M., Fish, K.J., Yang, G. and Sarnquist, F.H. (1992) Anesthesia crisis resource management training: Teaching anesthesiologists to handle critical incidents. Aviation, Space & Environmental Medicine 63 (9), 763-70.
36. Kim, J., Neilipovitz, D., Cardinal P., Chiu, M. and Clinch, J. (2006) A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa critical care medicine, high-fidelity simulation, and crisis resource management I study. Critical Care Medicine 35 (8), 2167-74.
37. Klein, K.J., Ziegert, J.C., Knight, A.P. and Xiao, Y. (2006) Dynamic delegation: Hierarchical, shared and deindividualized leadership in extreme action teams. Administrative Science Quarterly 51, 590-621.
38. Kohn, L.T., Corrigan, J.M. and Donaldson, M.S. (eds) (2000) To Err is Human; Building a Safer Health System. Washington DC: National Academy Press.
39. Kolga Schlickum, M., Hedman, L., Enochsson, L., Kjellin, A. and Felländer-Tsai, L. (2008) Transfer of systematic computer game training in surgical novices on performance in virtual reality image guided surgical simulators. Studies in Health Technology and Informatics 132, 210-15.
40. Kozlowski, S.W.J. and Bell, B.S. (2002) Work groups and teams in organizations. In W.C. Borman, D.G. Ilgen and R.J. Klimoski (eds) Comprehensive Handbook of Psychology vol. 12: Industrial and Organizational Psychology (pp. 333-75). New York: Wiley.
41. Lingard, L., Reznick, R., Espin, S., Regehr, G. and DeVito, I. (2002) Team communications in the operating room: Talk patterns, sites of tension, and implications for novices. Academic Medicine 77 (3), 232-7.
42. Lingard, L., Espin S., Whyte, S., Regehr, G., Baker, G.R., Reznick, R., Bohnen, J., Orser, B., Doran, D. and Grober, E. (2004a) Communication failures in the operating room: An observational classification of recurrent types and effects. Quality and Safety in Health Care 13, 330-4.
43. Lingard, L., Garwood, S. and Poenaru, D. (2004b) Tensions influencing operating room team function: Does institutional context make a difference? Medical Education 38 (7), 691-9.
44. Lipshitz, R. (2005) There is more to seeing than meets the eyeball: The art of science and observation. In H. Montgomery, R. Lipshitz, B. Brehmer (eds) How Professionals make Decisions (pp. 365-78). Mahwah, NJ: Lawrence Erlbaum Associates.
45. Manser, T. (2009) Teamwork and patient safety in dynamic domains of healthcare: A review of the literature. Acta Anaesth Scand 53 (2), 143-51.
46. Marsch, S.C., Tschan, F., Semmer, N., Spychiger, M., Breuer, M. and Hunziker, P.R. (2005) Performance of first responders in simulated cardiac arrests. Critical Care Medicine 33 (5), 963-7.
47. McGuire, J. (2000) Cognitive-Behavioural Approaches. An Introduction to Theory and Research. Available from: [accessed September 2008].
48. Miyake, A., Friedman, N.P., Rettinger, D.A., Shah, P. and Hegarty, M. (2001) How are visuospatial working memory, executive functioning, and spatial abilities related? A latent variable analysis. Journal of Experimental Psychology: General 130, 621-40.
49. Miller, G.A. (1956) The magical number seven, plus or minus two: Some limits on our capacity for processing information. Psychological Review 63, 81-97.
50. Moorthy, K., Munz, Y., Adams, S., Pandey, V. and Darzi, A. (2005) A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre. Annals of Surgery 242 (5), 631-9.
51. Moorthy, K., Munz, Y., Forrest, D., Pandey, V., Undre, S., Vincent, C. and Darzi, A. (2006) Surgical crisis management skills training and assessment: A simulation-based approach to enhancing operating room performance. Annals of Surgery 244 (1), 139-47.
52. Morey, J.C., Simon, R., Jay, G.D., Wears, R.L., Salisbury, M., Dukes, K.A. and Berns, S.D. (2002) Error reduction and performance improvement in the emergency department through formal teamwork training: Evaluation results of the MedTeams project. Health Services Research 37 (6), 1553-81.
53. Morgan, P. J., Pittini, R., Regehr, G., Marrs, C. and Haley, M.F. (2007) Evaluating team work in a simulated obstetric environment. Anesthesiology 106 (5), 907-15.
54. Murray, W.B. and Foster, P.A. (2000) Crisis resource management among strangers: Principles of organizing a multidisciplinary group for crisis resource management. Journal of Clinical Anesthesia 12 (8), 633-8.
55. Musselman, L.J., MacRae, H.M., Reznick, R.K. and Lingard, L.A. (2005) You learn better under the gun': Intimidation and harassment in surgical education. Medical Education 39 (9), 926-34.
56. Ostergaard, H.T., Ostergaard, D. and Lippert, A. (2004) Implementation of team training in medical education in Denmark. Quality and Safety in Health Care 13 (Suppl 1), i91-5.
57. Ottestad, E., Boulet, J.R. and Lighthall, G.K. (2007) Evaluating the management of septic shock using patient simulation. Critical Care Medicine 35 (3), 769-75.
58. Reznek, M., Smith-Coggins, R., Howard, S., Kiran, K., Harter, P., Sowb, Y., Gaba, D. and Krummel, T. (2003) Emergency medicine crisis resource management (EMCRM): Pilot study of a simulation-based crisis management course for emergency medicine. Academic Emergency Medicine 10 (4), 386-9.
59. Rosen, M.A., Salas, E., Wilson, K.A., King, H.B., Salisbury, M., Augenstein J.S., Robinson, D.W. and Birnbach, D.J. (2008) Measuring team performance in simulation-based training: Adopting best practices for healthcare. Simulation in Healthcare 3 (1), 33-41.
60. Roth, E.M. and Patterson, E.S. (2005) Using observational study as a tool for discovery: Uncovering cognitive and collaborative demands and adaptive strategies. In H. Montgomery, R. Lipshitz and B. Brehmer (eds) How Professionals make Decisions (pp. 379-93). Mahwah, NJ: Lawrence Erlbaum Associates.
61. Salas, E., Prince, C., Bowers C.A., Stout, R.J., Oser, L. and Cannon-Bowers, J.A. (1999) A methodology for enhancing crew resource management training. Human Factors 41 (1), 161-72.
62. Salas, E., Stagl, K.C. and Burke, C.S. (2004) 25 years of team effectiveness in organizations: Research themes and emerging needs. In C.L. Cooper and I.T. Robertson (eds) International Review of Industrial and Organizational Psychology (pp. 47-91). New York: John Wiley & Sons.
63. Seymour, N.E., Gallagher, A.G., Roman, S.A., O'Brien, M.K., Bansal, V.K., Andersen, D.K. and Satava, R.M. (2002) Virtual reality training improves operating room performance: Results of a randomized, double-blinded study. Annals of Surgery 236 (4), 458-63.
64. Shapiro, M.J., Morey, J.C., Small, S.D., Langford, V., Kaylor, C.J., Jagminas, L., Suner, S., Salisbury, M.L. and Simon, R., Jay, G.D. (2004) Simulation based teamwork training for emergency department staff: Does it improve clinical team performance when added to an existing didactic teamwork curriculum? Quality and Safety in Health Care 13(6), 417-21.
65. Shiliang Chang, Waid, E., Martinec, D.V., Zheng, B., Swanstrom, L.L. (2008) Verbal communication improves laparoscopic team performance. Surgical Innovation 15 (2), 143-7.
66. Small, S.D., Wuerz, R.C., Simon, R., Shapiro, N., Conn, A. and Setnik, G. (1999) Demonstration of high-fidelity simulation team training for emergency medicine. Academic Emergency Medicine 6(4), 312-23.
67. St. Pierre, M., Hofinger, G. and Buerschaper, C. (2008) Crisis Management in Acute Care Settings: Human Factors and Team Psychology in a High Stakes Environment. Berlin: Springer.
68. Thomas, E.J., Sexton, J.B. and Helmreich, R.L. (2004) Translating teamwork behaviours from aviation to healthcare: Development of behavioural markers for neonatal resuscitation. Quality and Safety in Health Care 13 (Suppl 1), i57-64.
69. Tschan, F., Semmer, N.K., Gautschi, D., Hunziker, P., Spychiger, M. and Marsch, S. (2006) Leading to recovery: Group performance and coordinative activities in medical emergency driven groups. Human Performance 19 (3), 277-304.
70. Undre, S., Sevdalis, N., Healey, A.N., Darzi, A. and Vincent, C.A. (2007) Observational teamwork assessment for surgery (OTAS): Refinement and application in urological surgery. World Journal of Surgery 31 (7), 1373-81.
71. Van Vugt, M. (2006) Evolutionary origins of leadership and followership. Personality and Social Psychology Review 10 (4), 354-71.
72. Van Vugt, M., Hogan, R. and Kaiser, R.B. (2008) Leadership, followership, and evolution: Some lessons from the past. American Psychologist 63 (3), 182-96.
73. Veterans Affairs National Center for Patient Safety (2004) Medical Team Training. Available from: [accessed September 2008].
74. Wallin, C.J., Meurling, L., Hedman, L., Hedegård, J. and Felländer-Tsai, L. (2007) Target-focused medical emergency team training using a human patient simulator: Effects on behaviour and attitude. Medical Education 41 (2), 173-80.
75. Weick, K.E. (1968) Systematic observational methods. In G. Lindzey and E. Aronson (eds), Handbook of Social Psychology, Vol. 2, 2nd edition (pp. 357-451). Reading, MA: Addison Wesley.
76. Wiegmann, D.A., ElBardissi, A.W., Dearani, J.A., Daly, R.C., Sundt, T.M. 3rd (2007) Disruptions in surgical flow and their relationship to surgical errors: An exploratory investigation. Surgery 142 (5), 658-65.
77. Yule, S. Flin. R., Maran. N., Rowley. D., Youngson. G., Paterson-Brown. S. (2008) Surgeon's non-technical skills in the operating room: Reliability testing of the NOTSS behaviour rating system. World Journal of Surgery, 32 (4), 548-56.
78. Ziegert, J.C. (2004) A unified theory of team leadership: Towards a comprehensive understanding of leading teams. Paper presented at the 19th Annual Conference of the Society for Industrial and Organizational Psychology, Chicago, IL.