Capítulo 2: Propuesta de sistema para la integración de Archivos Históricos que
2.1 Características del sistema SAHISWEB
2.1.1 Modelado del sistema
As discussed in Chapter 1, the surgical team’s non-‐technical skills are the generic behavioural skills that strengthen the team member’s technical ability to perform the task. These include; leadership and management skills, team work and cooperation, problem solving and decision making, situation awareness, and communications and interactions skills. To be able to collect data on these non-‐technical skills, a specifically designed scale called the Oxford NOTECHS II was used.
The Oxford non-technical skills scale II
(Oxford NOTECHS II)4.3.8.4
Several methods have been developed for measuring non-‐technical skills in the operating theatre, some focused on whole team performance such as OTAS [273], Oxford NOTECHS [47], OSTAS [274], and EPOC [275], while others focused on sub-‐team performance such as ANTS [276], NOTSS [277] and SPLINTS [278]. The one used in the current study, Oxford NOTECHs II scale, has its origins in the aviation industry. It was developed from an earlier version [47] which in turn was based on scales developed for use in cockpit crew teamwork training and assessments. Adaptations, that ensured its successful usability in the operating theatres, were made based on a process involving task analyses and input from a safety expert panel that included human factors scientists, anaesthetists, different speciality surgeons, and aviation training experts [47, 279].
The Oxford NOTECHS II has been structured along the four behavioural dimensions: leadership and management (L&M); teamwork and cooperation (T&C); problem
solving and decision-‐making (PS & DM); and situation awareness (SA). A list of behavioural markers was used to aid the observers in identifying the relevant
Table 4-‐3: Oxford NOTECHS II behavioural markers [47]
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/ deviates with team approval/ demonstrates desire to achieve high standards
Planning and
preparation Team participation in planning/ plan is shared/ understanding confirmed/ projects/ changes in consultation
Workload
management Distributes tasks/ monitors/ reviews/ tasks are 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 post treatment review
Situation awareness
Notice Considers all team elements/ asks for or shares information/
aware of available of 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
Based on intra-‐operative observation, a score from 1-‐8 is awarded to each of the sub-‐ team (Surgeon’s team, Anaesthetist’s team, Nursing Scrub team) on each of the behavioural dimensions. Because surgical teams are expected to maintain an effective level of safety during surgery, a baseline score of six was used to anchor the
observations. If sub-‐teams consistently maintained an effective level of safety and teamwork, this score remained unchanged. Any change in behaviour that would either enhance or degrade safety levels would be reflected on the score. Behavioural
markers were incorporated to aid the observers in the assessment process [47] . The scores are anchored to the categories in Table 4-‐4.
Table 4-‐4: Oxford NOTECHs II scoring paradigm [269]
Score Consistency Behavioural descriptors
1 Consistent Behaviour compromises patient safety and effective
team work
2 Inconsistent
3 Consistent Behaviour in other conditions could directly compromise
patient safety and effective team work
4 Inconsistent
5 Inconsistent Behaviour maintains an effective level of patient safety
and teamwork
6 Consistent
7 Inconsistent Behaviour enhances patient safety and effective
teamwork
8 Consistent
Another aspect of the Oxford NOTECHS II scale is the ability to assess the whole
operating team as a unit as well as the sub-‐teams described earlier. The sub-‐scores can reflect each sub-‐teams’ non-‐technical skills separate to the other members of the team within the whole operating theatres [47].
The primary measure for the purposes of this study is the whole team score (Team’s Oxford NOTECHS II score). A sub-‐analyses are conducted with sub-‐teams’ scores and the combined surgical and scrub sub-‐teams Oxford NOTECHS II scores only. This is made on the assumption that the anaesthetic team’s input, although clearly essential as part of an operating team towards patient safety as a whole, is less influential in achieving better alignment following TKA given their lack of direct input technically towards this surgical goal.
To assess for observational competency and Oxford NOTECHs II reliability amongst observers, independent dual observations of elective orthopaedic operations across multiple sites were conducted. The observers, both individually and in pairs,
performed observations on 20 cases with an expert observer. Inter-‐rater agreement of overall and sub-‐team Oxford NOTECHs II scores were evaluated using the rWG(J) test [280].