Article Text

Download PDFPDF

The effect of teamwork training on team performance and clinical outcome in elective orthopaedic surgery: a controlled interrupted time series study
  1. Lauren Morgan1,
  2. Mohammed Hadi2,
  3. Sharon Pickering2,
  4. Eleanor Robertson1,
  5. Damian Griffin2,
  6. Gary Collins3,
  7. Oliver Rivero-Arias4,5,
  8. Ken Catchpole6,
  9. Peter McCulloch1,
  10. Steve New7
  1. 1Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
  2. 2Warwick Medical School, University of Coventry and Warwick, Warwick, UK
  3. 3Centre for Statistics in Medicine, University of Oxford, Oxford, UK
  4. 4Nuffield Department of Population Health, University of Oxford, Oxford, UK
  5. 5Red de Investigación de Servicios Sanitarios en Cronicidad (REDISSEC), Spain
  6. 6Cedars-Sinai Medical Centre, Los Angeles, California, USA
  7. 7Saïd Business School, University of Oxford, Oxford, UK
  1. Correspondence to Dr Peter G McCulloch; peter.mcculloch{at}


Objectives To evaluate the effectiveness of aviation-style teamwork training in improving operating theatre team performance and clinical outcomes.

Setting 3 operating theatres in a UK district general hospital, 1 acting as a control group and the other 2 as the intervention group.

Participants 72 operations (37 intervention, 35 control) were observed in full by 2 trained observers during two 3-month observation periods, before and after the intervention period.

Interventions A 1-day teamwork training course for all staff, followed by 6 weeks of weekly in-service coaching to embed learning.

Primary and secondary outcome measures We measured team non-technical skills using Oxford NOTECHS II, (evaluating the whole team and the surgical, anaesthetic and nursing subteams, and evaluated technical performance using the Glitch count. We evaluated compliance with the WHO checklist by recording whether time-out (T/O) and sign-out (S/O) were attempted, and whether T/O was fully complied with. We recorded complications, re-admissions and duration of hospital stay using hospital administrative data. We compared the before–after change in the intervention and control groups using 2-way analysis of variance (ANOVA) and regression modelling.

Results Mean NOTECHS II score increased significantly from 71.6 to 75.4 in the active group but remained static in the control group (p=0.047). Among staff subgroups, the nursing score increased significantly (p=0.006), but the anaesthetic and surgical scores did not. The attempt rate for WHO T/O procedures increased significantly in both active and control groups, but full compliance with T/O improved only in the active group (p=0.003). Mean glitch rate was unchanged in the control group but increased significantly (7.2–10.2/h, p=0.002) in the active group.

Conclusions Teamwork training was associated with improved non-technical skills in theatre teams but also with a rise in operative glitches.

  • Quality improvement
  • Patient safety

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

View Full Text

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.