Observational Teamwork Assessment for Surgery (OTAS)

Project summary

Background

In recent years, the importance of teamwork skills has gained widespread recognition as a critical element of high quality, safe surgical care. Several studies have been published in the literature, and there is now extensive evidence that poorer teamwork in the operating theatre is related to worse patient outcomes, whereas effective team performance is related to better patient outcomes, including morbidity and mortality. The Observational Teamwork Assessment for Surgery (OTAS) is an assessment instrument which can be used to evaluate the quality of teamwork in clinical and simulated perioperative settings.

What can OTAS be used for?

OTAS has several potential uses. Suggested examples are listed below.

OTAS in clinical practice

OTAS can be used by clinical trainers or team leaders (senior members of the operating theatre team) to structure and provide comprehensive feedback/ debriefing to operating theatre teams on their teamwork. In addition, OTAS can be used as a guide for theatre teams. As OTAS contains a comprehensive list of ‘exemplar behaviours’ that indicate effective teamwork, teams can use the instrument to identify best practices which they can adopt.

OTAS as an assessment instrument

OTAS can be used as an assessment instrument to quantify the quality of teamwork in clinical and simulated settings. The 45 behavioural ratings that OTAS can generate for a procedure (see OTAS form in this booklet) provide a comprehensive overview of the quality of teamwork for each case. Such detail can be used to identify what the team is doing well and where there are gaps requiring improvement. In addition, OTAS can be used by healthcare managers to audit and improve the quality of teamwork in the operating theatre.

OTAS as a research instrument

OTAS can be used to empirically quantify whether an intervention designed to improve teamwork is effective in doing so and to study teamwork in the perioperative setting. For example, OTAS can be used to analyse the relationship between the quality of teamwork and other safety or quality metrics (e.g. clinical outcomes, compliance with perioperative best practices, and so on).

Case study

The Economic and Social Research Council (ESRC) recently published an OTAS Impact Case Study (PDF) ‌on teamwork in surgery and OTAS. 

Downloads

The Observational Teamwork Assessment for Surgery tool is available upon request (contact details below).  *OTAS has been translated into Italian, German, Turkish and Spanish*  

The Observational Teamwork Assessment for Surgery (OTAS) User Training Manual is free to download:

• OTAS User Training Manual (English) (PDF)
• OTAS User Training Manual (German) (PDF)
• OTAS User Training Manual (Turkish) (PDF)
• OTAS User Training Manual (Spanish) (PDF)  

The Observational Teamwork Assessment for Surgery (OTAS) Team Feedback and Debriefing Form is free to download:

• OTAS Feedback and Debriefing Form (PDF)

Outputs

Selected bibliography

• Amaya Arias AC, Barajas R, Eslava-Schmalbach JH, Wheelock A, Gaitán Duarte H, Hull L, Sevdalis N. Translation, cultural adaptation and content re-validation of the observational teamwork assessment for surgery tool. Int J Surg 2014; 2(12):1390-402. Pubmed
• Passauer-Baierl S, Chiapponi C,  Bruns CJ, Weigl M. Teamwork in the Operating Theatre: The German Observational Teamwork Assessment for Surgery (OTAS-D) and its First Application in Germany. Zentralbl Chir 2014;139(6):648-56. Pubmed
• Healey AN, Undre S, Sevdalis N, Koutantji M, Vincent CA. The complexity of measuring interprofessional teamwork in the operating theatre. Journal of Interprofessional Care 2006;20:485-95. Pubmed
• Undre S, Healey AN, Darzi A, Vincent CA. Observational assessment of surgical teamwork: a feasibility study. World Journal of Surgery. 2006 Oct;30(10):1774-83. Pubmed
• Undre S, Sevdalis N, Healey AN, Vincent CA. The Observational Teamwork Assessment for Surgery (OTAS): Refinement and application in urological surgery. World Journal of Surgery 2007;31:1373-81. Pubmed
• Sevdalis N, Lyons M, Healey AN, Undre S, Darzi A, Vincent CA. Observational Teamwork Assessment for Surgery: Construct validation with expert vs. novice raters. Annals of Surgery 2009;249:1047-51. Pubmed
• Hull L, Arora S, Kassab E, Sevdalis N. Observational Teamwork Assessment for Surgery: Content Validation and Tool Refinement. Journal of American College of Surgeon 2011: 212(2):234-243.e5 Pubmed
• Undre S, Sevdalis N, Vincent CA. Observing and assessing surgical teams:The Observational Teamwork Assessment for Surgery© (OTAS)©. In R Flin, L Mitchell (Eds.) Safer Surgery: Analyzing Behaviour in the Operating Theatre (pp. 83-102; Ch. 6).Ashgate. 2009. A comprehensive overview of OTAS development and testing in theatres.
• Vincent C. Teams create safety. In C Vincent Patient Safety – 2nd edition (Ch 18). Elsevier, 2010.
• Vincent C, Moorthy K, Sarker SK, Chang A, Darzi AW. Systems approaches to surgical quality and safety: from concept to measurement. Annals of Surgery 2004; 239: 475-482. Pubmed (The background to the importance of teamworking and nontechnical factors in surgery, which led to OTAS development)