title: Oxford NOTECHS II: a modified theatre team non-technical skills scoring system.
abstract: BACKGROUND
  We previously developed and validated the Oxford NOTECHS rating system for evaluating the non-technical skills of an entire operating theatre team. Experience with the scale identified the need for greater discrimination between levels of performance within the normal range. We report here the development of a modified scale (Oxford NOTECHS II) to facilitate this. The new measure uses an eight-point instead of a four point scale to measure each dimension of non-technical skills, and begins with a default rating of 6 for each element. We evaluated this new scale in 297 operations at five NHS sites in four surgical specialities. Measures of theatre process reliability (glitch count) and compliance with the WHO surgical safety checklist were scored contemporaneously, and relationships with NOTECHS II scores explored.
  
  
  RESULTS
  Mean team Oxford NOTECHS II scores was 73.39 (range 37-92). The means for surgical, anaesthetic and nursing sub-teams were 24.61 (IQR 23, 27); 24.22 (IQR 23, 26) and 24.55 (IQR 23, 26). Oxford NOTECHS II showed good inter-rater reliability between human factors and clinical observers in each of the four domains. Teams with high WHO compliance had higher mean Oxford NOTECHS II scores (74.5) than those with low compliance (71.1) (p = 0.010). We observed only a weak correlation between Oxford NOTECHS II scores and glitch count; r = -0.26 (95% CI -0.36 to -0.15). Oxford NOTECHS II scores did not vary significantly between 5 different hospital sites, but a significant difference was seen between specialities (p = 0.001).
  
  
  CONCLUSIONS
  Oxford NOTECHS II provides good discrimination between teams while retaining reliability and correlation with other measures of teamwork performance, and is not confounded by technical performance. It is therefore suitable for combined use with a technical performance scale to provide a global description of operating theatre team performance.
authors.affiliation: Quality, Reliability, Safety and Teamwork Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Eleanor R
authors.initials: ER
authors.lastname: Robertson
authors.affiliation: Warwick Orthopaedics, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hadi
authors.affiliation: Quality, Reliability, Safety and Teamwork Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Morgan
authors.affiliation: Warwick Orthopaedics, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors.forename: Sharon P
authors.initials: SP
authors.lastname: Pickering
authors.affiliation: Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.
authors.forename: Gary
authors.initials: G
authors.lastname: Collins
authors.affiliation: Saïd Business School, University of Oxford, Oxford, United Kingdom.
authors.forename: Steve
authors.initials: S
authors.lastname: New
authors.forename: Damian
authors.initials: D
authors.lastname: Griffin
authors.affiliation: Warwick Orthopaedics, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors.forename: Damien
authors.initials: D
authors.lastname: Griffin
authors.affiliation: Quality, Reliability, Safety and Teamwork Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: McCulloch
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
authors.forename: Ken C
authors.initials: KC
authors.lastname: Catchpole
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001519:Behavior; D002983:Clinical Competence; D006801:Humans; D008875:Middle Aged; D009873:Operating Rooms; D012107:Research Design