Background The World Health Organization (WHO) Surgical Safety Checklist is reported to reduce surgical morbidity and mortality, and is mandatory in the UK National Health Service. Hospital audit data show high compliance rates, but direct observation suggests that actual performance may be...

Background Teamwork training and system standardisation have both been proposed to reduce error and harm in surgery. Since the approaches differ markedly, there is potential for synergy between them. Methods Design: Controlled interrupted time series with a 3 month intervention and observation...

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...

Objectives To examine the effectiveness of a “systems” approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches. Setting A controlled before-after study using the orthopaedic trauma theatre of a...

Background: Standard operating procedures (SOPs) should improve safety in the operating theatre, but controlled studies evaluating the effect of staff-led implementation are needed. Methods: In a controlled interrupted time series, we evaluated three team process measures (compliance with WHO...

IMPORTANCE: Patient safety improvement interventions usually address either work systems or team culture. We do not know which is more effective, or whether combining approaches is beneficial. OBJECTIVE: To compare improvement in surgical team performance after interventions addressing teamwork...

Objectives To evaluate the effectiveness of aviation-style teamwork training in improving operating theatre team performance and clinical outcomes. Setting 3 operating theatres in a UK district general hospital, 1 acting as a control group and the other 2 as the intervention group. Participants...

Background: To investigate the effectiveness of combining teamwork training and lean process improvement, two distinct approaches to improving surgical safety. We conducted a controlled interrupted time series study in a specialist UK Orthopaedic hospital incorporating a plastic surgery team...