Hospitalised patients are most likely to suffer harm in the operating theatre. Non-technical and team skills have been identified, and are increasingly recognised, as critical to safety and efficiency in the operating theatre. Despite increasing awareness of the importance of these skills to patient safety, education, training and assessment is lacking. The overarching aim of this Thesis is to facilitate and accelerate the integration of these skills into the education, training, and assessment of operating theatre teams by addressing a number of challenges related to this endeavour.
An introduction to patient safety and the core non-technical and team skills that underpin expertise and safety in the operating theatre is presented, providing the theoretical basis for this work (Chapters 1 & 2). A systematic review on the impact of non-technical skills on technical performance in surgery is presented (Chapter 3), underlining the need to integrate these skills into the education, training and assessment of operating theatre teams. The empirical work of this Thesis is then reported. An observational study exploring stress and teamwork in the operating theatre is presented (Chapter 4), increasing our understanding of the factors that facilitate and impede teamwork in the operating theatre. To ensure the robust assessment of teamwork in the operating theatre, the formal content validation and refinement of the Observational Teamwork Assessment for Surgery (OTAS) tool is reported (Chapter 5). This is followed by an observational study exploring team performance at specific operative stages, as well as in multiport versus single incision laparoscopic surgery (Chapter 6). Chapters 7-8 report the development of guidelines, based on expert consensus, to train faculty in the assessment of non-technical and teamwork skills, an essential feat if non-technical and team skills are to be successfully integrated into the training and assessment of operating theatre teams. Chapter 9 reports the development, piloting and evaluation of a programme, based on the findings of Chapters 7-8, to train faculty to assess teamwork in the operating theatre. Finally, Chapter 10 provides a general discussion of the work presented in this Thesis, reflecting on the findings and the wider evidence base. Implications for clinical practice, patient safety and future research are explored.