Selected sections and domains from the Checklist Performance and Surgical Teamwork Tools
| Item | Definition | Criteria/examples of excellent behaviours | Examples of poor behaviours |
|---|---|---|---|
| Buy-in | Acceptance and commitment by individuals to the performance of the checklist | Team members stop all other activities and conversation and appear to be interested while the checklist is performed | Team members continue other activities or conversation while performing the checklist, or exhibit poor buy-in behaviour (eg, non-participation, speed reading, or rolling eyes) |
| Clinical leadership | Exerting control or playing a decision-making role in a patient's clinical care. Any member of the team may demonstrate clinical leadership in the course of a surgical procedure | Surgical team members share clinical responsibilities while managing a patient's hypotension. Team members are open to suggestions from every member of the team. Physicians actively participate in patient care prior to incision, and maintain a positive tone throughout the operation | Surgical team members ignore requests from other team members when managing a patient's condition. Staff members do not offer the opportunity to others to provide suggestions or actively discourage suggestions. Physicians are not present prior to incision, or if present, are engaged in unrelated activities. Physicians set a negative tone for the case by disregarding the opinions of other team members |
| Communication | Team communication refers to the way information is shared among surgical team members. | Verbal communication is easy to understand and clearly directed at individuals. Team members’ names are frequently used to ensure that the correct person receives the information. Key information is shared as it becomes available. Both speakers and recipients make visual or spoken efforts to confirm that important information was received | Verbal communication is inaudible or mumbled, or other team members need to clarify requests. Key information is not shared among team members in a timely fashion. No attempt is made by speakers or receivers to confirm that important information was received |
| Coordination | Coordination refers to team members working together to accomplish technical tasks | Team members are eager to help one another, and plan for patient care together. Team members pay close attention to the operation and are able to engage in a discussion of its progress. When the patient condition changes, the team works together to adapt to the situation. Interactions occur in a coordinated and cooperative fashion | The actions of team members are completely disconnected. Team members do not pay attention, or fail to update each other on the progress of the case. Plans are not updated or discussed when the patient condition changes. Emergence from anaesthesia is not well timed with the end of the surgical portion of the operation |
| Respect | Respect refers to the ways in which team members treat or show regard for one another | Team members are called by their names, even if it requires asking them for their names again. No one is ever referred to by their role. When there is a problem or confusion, team members provide instruction as needed. Team members are apologetic when errors are discovered and appear genuinely interested in learning from their error. When an error occurs, errors are addressed in a calm and respectful fashion, without accusations or condescending remarks. | Team members are called by their roles instead of by name. When mistakes occur, no attempt is made to use the error as an occasion for learning or to encourage team members to speak up with questions or concerns in the future. Instead, errors are pointed out with condescension or raised voices. Team members respond angrily or rudely when an error or mistake is pointed out |
| Assertiveness | Assertiveness refers to team members’ willingness to speak up in order to communicate or ask for help | Team members make certain that their concerns are heard and understood by other team members. Team members help each other when they are busy | When team members are ignored, they do not follow-up and ensure that their concerns are addressed. Team members who appear to be extremely overloaded and busy fail to ask for help |