Teamwork Assessment Tools in Modern Surgical Practice: A Systematic Review

Table 4

Oxford Nontechnical Skills (NOTECHS) scoring system, Mishra et al. (2009) [16].

(a)

Leadership and management
Leadership	Involves/reflects on suggestions/visible/accessible/inspires/motivates/coaches
Maintenance of standards	Subscribes to standards/monitors compliance to standards/intervenes if deviation occurs/deviates with team approval/demonstrates desire to achieve high standards
Planning and preparation	Team participation in planning/plan shared/understanding confirmed/projects/changes in consultation
Workload management	Distributes tasks/monitors/reviews/tasks prioritised/allots adequate time/responds to stress
Authority and assertiveness	Advocates position/values team input/takes control/persistent/appropriate assertiveness
Teamwork and cooperation
Team building/maintaining	Relaxed/supportive/open/inclusive/polite/friendly/use of humour/does not compete
Support of others	Helps others/offers assistance/gives feedback
Understanding team needs	Listens to others/recognises ability of team/condition of others considered/gives personal feedback
Conflict solving	Keeps calm in conflicts/suggests conflict solutions/concentrates on what is right
Problem-solving and decision-making
Definition and diagnosis	Uses all resources/analytical decision-making/reviews factors with team
Option generation	Suggests alternative options/asks for options/reviews outcomes/confirms options
Risk assessment	Estimates risks/considers risk in terms of team capabilities/estimates patient outcome
Outcome review	Reviews outcomes/reviews new options/objective, constructive, and timely reviews/makes time for review/seeks feedback from others/conducts posttreatment review
Situation awareness
Notice	Considers all team elements/asks for or shares information/aware of available resources/encourages vigilance/checks and reports changes in team/requests reports/updates
Understand	Knows capabilities/cross-checks above/shares mental models/speaks up when unsure/updates other team members/discusses team constraints
Think ahead	Identifies future problems/discusses contingencies/anticipates requirements
Below standard = 1	Behaviour directly compromises patient safety and effective teamwork
Basic standard = 2	Behaviour in other conditions could directly compromise patient safety and effective teamwork
Standard = 3	Behaviour maintains an effective level of patient safety and teamwork
Excellent = 4	Behaviour enhances patient safety and teamwork, a model for all other teams

(b) Nontechnical Skills (NOTECHS) subteam modifiers

	Surgical subteam	Anaesthetic subteam	Nursing subteam
Leadership and management
Positive modifiers	(i) Raises team morale	(i) Takes control when required	(i) Scrub provides clear instructions to circulating nurse(s)
	(ii) Intervenes if deviation occurs	(ii) Demonstrates desire for high standard	(ii) Senior nurse makes sure protocols are followed
	(iii) Prioritises tasks	(iii) Appropriately distributes tasks between rest of team	(iii) Speaks up when unhappy
Negative modifiers	(i) Deflates or fails to motivate team	(i) Does not take control when required	Senior nurse does not support juniors
	(ii) Does not attempt to build cohesion	(ii) Does not set standards
		(iii) Inappropriate task distribution
Teamwork and cooperation
Positive modifiers	(i) Open	(i) Supportive of other subteams	(i) Nurses cooperate and support each other well
	(ii) Appropriate use of abilities within team	(ii) Appreciates functions of other subteams	(ii) Senior nurse covers for junior scrub
	(iii) Supportive of other subteams when necessary
Negative modifiers	(i) Aggressive in conflicts	(i) Remains idle when problems arise	Poor coordination between equipment needs and those provided
	(ii) Does not appreciate others’ abilities	(ii) Functions separately from other subteams
Problem-solving and decision-making
Positive modifiers	(i) Demonstrates generation of options	(i) Participates in solving problems	(i) Takes an active part in decision-making
	(ii) Open discussion and agreement over anatomy	(ii) Raises suggestions	(ii) Suggests solutions to problems, for example, alternative equipment
	(iii) Incorporates other subteam issues
Negative modifiers	(i) Decisions made unsystematically	Does not consider anaesthetic options when faced with problem	Blames the surgeons when faced with problems
	(ii) Does not utilise team where it may benefit
Situation awareness
Specific to subteams
Positive modifiers	Periodically gathers awareness of surroundings	Anticipates surgical and process needs	Anticipates equipment needs
Negative modifiers	Is fixated on operative field	Is not present at important stages of the operation or for long periods of time	Absent at stages when needed to provide service
For all subteams
Positive modifiers	(i) Patient: has awareness of patient condition/comorbidity
	(ii) Procedure: appreciates stage of operation
	(iii) People: who is present in theatre, what skills they have, and what they are doing