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The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre
  1. A Mishra,
  2. K Catchpole,
  3. P McCulloch
  1. Quality, Reliability, Safety and Teamwork Unit, Nuffield Department of Surgery, University of Oxford, Oxford, UK
  1. Mr A Mishra, Nuffield Department of Surgery, The John Radcliffe, Headington, Oxford OX3 9DU, UK; mishra007{at}


Introduction: The frequency of adverse events in the operating theatre has been linked to the quality of teamwork and communication. Developing suitable measures of teamwork may play a role in reducing errors in surgery. This study reports on the development and evaluation of a method for measuring operating-theatre teamwork quality.

Methods: The Oxford Non-Technical Skills (NOTECHS) scale was developed from an aviation instrument for assessment of non-technical skills. Consultation with experts and task analysis led to modifications reflecting the complexities of the theatre teamwork, particularly the coexistence of three subteams (surgeons, anaesthetists and nurses). The scale was then evaluated using teams performing laparoscopic cholecystectomy (n = 65) before and after teamwork training. Attitudes to teamwork and surgical error rates were assessed by questionnaire and direct observation methods, and used to assess the reliability and validity of the Oxford NOTECHS scale.

Results: The interobserver reliability was excellent in 24 operations independently assessed by two observers (Rwg = 0.99), confirmed by a third observer in 11 cases (Rwg = 0.99). Validity was demonstrated through improved scores after teamwork training (t = −3.019, p = 0.005), concurrent with improved attitudes to teamwork after training; inverse correlation between NOTECHS scores and surgical errors (ρ = −0.267, p = 0.046); strong inverse correlation between surgical subteam score and surgical errors (ρ = −0.412, n = 65, p = 0.001); and strong correlation with teamwork scores from an alternative system (n = 5, r = 0.886, p = 0.046)

Conclusion: The Oxford NOTECHS scale appears to be a reliable and valid instrument for assessing teamwork in the operating theatre, and is ready for further application.

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  • Competing interests: None.

  • Funding: This study was funded by the BUPA Foundation.

  • Ethics approval: Ethical approval was obtained from the Milton Keynes local research ethics committee (study no. 04/Q1603/35 amendment 2).

  • Patient consent: Obtained.

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