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A Multicenter Trial of Aviation-Style Training for Surgical Teams

Catchpole, Ken R. PhD; Dale, Trevor J. FRAes; Hirst, D. Guy FRAes; Smith, J. Phillip FRAes; Giddings, Tony A.E.B. FRCS

doi: 10.1097/PTS.0b013e3181f100ea
Original Articles

Aims: This study measured the effect of aviation-style team training on 3 surgical teams from different specialties. It focused on team working and communication, particularly briefing, time-out, and debriefing, and sought to understand how improvements in team skills could be implemented in a broad range of naturalistic surgical environments to improve safety, quality, and efficiency.

Method: Surgical teams performing maxillofacial, vascular, and neurosurgery were studied during 112 operations: 51 before and 61 after intervention. Human factors experts delivered the training of up to 2 days in the classroom followed by 6 days of coaching in theater for each team. Trained observers measured teamwork using the Oxford NOTECHS and the frequency of preoperative briefings, preincision time-outs, and postoperative debriefings. The Safety Attitudes Questionnaire and ethnographic observations were used to provide contextual details.

Results: There were significantly more time-outs (χ2 = 18.17, P < 0.001), briefings (χ2 = 8.62, P = 0.004), and debriefings (χ2 = 8.58, P = 0.004) after the intervention. The NOTECHS scores showed an interaction between site and intervention (F 2,106 = 7.57, P = 0.001). The Safety Attitudes Questionnaire and ethnographic observations helped understand these differences.

Conclusions: Aviation-style teamwork training can increase compliance and team performance, but this was influenced by the attitude and collaboration of key individuals, and the effect was reduced by significant latent failures. This study demonstrates the need to improve organizational and personal management factors in the National Health Service if training in patient safety is to be effective and sustained. It also shows the influence of working conditions on clinical studies of quality improvement.

From the *University of Oxford; †Atrainability Ltd, Surrey; ‡Brilliant Development Ltd, Bucks; and §Royal College of Surgeons of England, London, UK.

Correspondence: Ken R. Catchpole, Quality Reliability Safety and Teamwork Unit, Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, OX3 9DU, UK (e-mail:

The authors thank the Health Foundation and the Department of Health for the funding to support the project. Dr Catchpole was partly supported by a Leverhulme Trust early career fellowship and by the Nuffield Department of Surgery.

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