Modified Oxford NOTECHS Assessment (Oxford NOTECHS II)

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Submitted by National Center... on Sep 6, 2016 - 11:12am CDT

Robertson, E.R.
Hadi, M.
Morgan, L.J.
Pickering, S.P
Collins, G.
New, S.
Griffin, D.
McCulloch, P.
Catchpole, K.C.

This tool was designed to evaluate the non-technical skills of operating theatre teams as they perform surgery. Specifically, the Oxford NOTECHS II measures leadership and management, teamwork and cooperation, problem-solving and decision-making, and situational awareness.  Two observers (one clinical, one human factors) rate the degree to which surgical teams maintain patient safety and effective teamwork behaviors in 14 items. The results are meant to be combined with a technical performance scale to provide a global description of the surgical team performance in operating theatres.  A validity study of 297 operations demonstrated good inter-rater reliability.  Oxford NOTECHS II scores significantly related to compliance with a surgical safety checklist, and non-significantly related to a process meaure described as "glitch count."

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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: 

Clinically and human factors trained observers record ratings.

Instrument Content: 
Behaviors / skills
Notes for Content: 

Four domains are rated by the observers:

  1. Leadership & Management
  2. Teamwork & Cooperation
  3. Problem Solving & Decision Making\
  4. Situation Awareness
Instrument Length: 

Three subteams (surgeon team, anesthetic team, and nursing team) are each rated on four domains (Leadership & Management, Teamwork & Cooperation, Problem Solving & Decision Making, and Situation Awareness) for a total of 12 ratings per operation. Length of time varies with the length of the surgery.

Item Format: 
An 8-point scale is used with anchors for every two scale points (i.e., 1 and 2, 3 and 4, 5 and 6, 7 and 8). The lowest anchor states, “Behaviour compromises patient safety and effective teamwork” and the highest anchor states, “Behaviour enhances patient safety and teamwork, a model for all other teams.” The two scale points for each anchor are further anchored with “consistent” or “inconsistent.”
Observers are trained before beginning administration for one month with “self-study and group practice sessions using video recordings of operating teams in simulated settings.” Two observers, one clinical and one human factors, rate the teams on a scoring sheet in the operating theater.
None described.
None described.
Open access (available on this website)
Notes on Access: 

Contact author to confirm permission to use.

Psychometric Elements: Evidence of Validity
Based on the content of Oxford NOTECHS.
Response Process: 
The scale was validated using teams from five sites across four specialties performing a total of 297 operations. The internal consistency of scoring between a clinical and a human factors observer was measured using the intraclass correlation coefficient (ICC). These correlations ranged from a low of 0.34 to a high of = 0.88. The ICCs were typically higher for the surgical teams and lower for the nursing and anesthetic teams.
Internal Structure: 
See ICC data above.
Relation to Other Variables: 
Oxford NOTECHS II scores were significantly higher for teams who met all three criteria for the WHO time-out (M=74.5, SD=7.3 vs. M=71.1, SD=8.0). The data showed a small but significant correlation between NOTECHS scores and glitch rate (r=-0.26, p<.05).
None described.