Communication and Teamwork Skills (CATS) Assessment

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Submitted by National Center... on Oct 7, 2016 - 5:05pm CDT

Frankel, A.
Gardner, R.
Maynard, L.
Kelly, A.

The CATS was designed to measure communication and team skills of health care providers in an onsite (in situ) tool. Specifically, the tool measures situational awareness, coordination, communication, and cooperation.  Observers rate 21 behaviors based on crisis resource management behavioral-based markers.  A preliminary study observed healthcare workers in gastric bypass surgery, interdisciplinary rounds, and cesarean sections.  The results are meant to provide rapid cycle feedback from a series of observations to assist teams in identifying areas in need of training.

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Descriptive Elements
Who is Being Assessed or Evaluated?: 
Instrument Type: 
Observer-based (e.g., rubric, rating tool, 360 degree feedback)
Notes for Type: 

This is an onsite (in situ) observational tool.

Source of Data: 
Health care providers, staff
Notes for Data Sources: 

Physicians, nurses, and nonclinical patient safety/quality improvement specialists have been used as observers. 

Instrument Content: 
Behaviors / skills
Notes for Content: 

Behaviors in four domains are rated by the observers:

  1. Situation awareness
  2. Coordination
  3. Communication
  4. Cooperation

Raters also record the date, start time, end time, and procedure being observed. 

Instrument Length: 

21 behaviors are rated; time varies with the scenario being rated.

Item Format: 
Behaviors are marked in rows each time they occur and are rated for quality in columns labeled “Observed and Good,” “Variation in Quality” (meaning incomplete or of variable quality), and “Expected but not Observed.”
A glossary of behavior definitions is provided, and scores should reflect the degree to which behaviors match the definition. If two or more observers are used, a pre-observation checklist and review of glossary definitions is recommended. When in the operating room, observers should stand watching, listening, and taking notes, without interacting with staff. Feedback can then be provided to the surgeons, preoperative nursing directors, and chair of anesthesia. The tool has been administered in gastric bypass surgery, interdisciplinary rounds, and cesarean sections.
For each behavior, marks in the “Observed and Good” category are assigned a 1, marks in the “Variation in Quality” category are assigned .5, and those in the “Expected but not Observed” category are assigned a 0. The sum of these weighted marks divided by the total number of marks made is then adjusted to a 100 point scale. The scores for each behavior can then be averaged to create scores for the four domains or the total measure.
None described.
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Notes on Access: 

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Psychometric Elements: Evidence of Validity
The behaviors were selected from behavioral-based markers adapted to health care from the crisis resource management work done in aviation and the military. The behaviors were also aligned with two other tools: the Anesthesiologist Non-Technical Skills and Observational Teamwork Assessment of Surgery tools.
Response Process: 
A quality improvement team of two physicians, one nurse, and one nonclinical patient safety/quality improvement specialist was formed. This team piloted the scoring method on six videotaped simulations and three live gastric bypass surgeries. The team refined and adjusted the scoring procedure through these plan-do-study-act cycles of rapid improvement.
Internal Structure: 
None described.
Relation to Other Variables: 
None described.
None described.