182 © 2006 Blackwell Publishing Ltd Journal of Evaluation in Clinical Practice, 12, 2, 182–189 doi:10.1111/j.1365-2753.2006.00614.x Blackwell Science, LtdOxford, UKJEPJournal of Evaluation in Clinical Practice1356-1294Blackwell Publishing Ltd 200512 2182189Original ArticlePerceptions of teamwork in the operating theatreS. Undre et al. Correspondence Dr Nick Sevdalis Clinical Safety Research Unit Department of Surgical Oncology and Technology Imperial College London 10th Floor QEQM Building St Mary’s Hospital South Wharf Road London W2 1NY UK E-mail: n.sevdalis@imperial.ac.uk Keywords: communication, mental models, operating theatre, patient safety, role perception, teamwork Accepted for publication: 22 March 2005 Teamwork in the operating theatre: cohesion or confusion? Shabnam Undre MBBS FRCSE, 1 Nick Sevdalis BSc MSc PhD, 2 Andrew N. Healey BSc(Hons) PhD CPsychol, 3 Sir Ara Darzi KBE Professor MD FRCS, FRCSI 4 and Charles A. Vincent BA MPhil PhD 5 1 Clinical Research Fellow, 2 Research Associate, 3 Research Associate, 4 Professor of Surgery and Head of Department, 5 Professor of Clinical Safety Research, Department of Surgical Oncology and Technology, Imperial College, London, UK Abstract Rationale The aim of the research that we report here was to empirically assess the cohesiveness of the multidisciplinary operating theatre (OT) team. Method We used concepts from the team performance and team mental models literature to assess OT professionals’ perceptions of their teamwork, the structure of their teams and their respective roles within them and their teams’ performance. Results Team structure: OT profes- sionals would welcome a change from the current structure of the team, although there was no agreement on what that structure is. Nurses per- ceived the team as unitary, surgeons and anaesthetists perceived it as com- prising multiple subteams. Team roles: OT professionals tended to overrate their own understanding of their colleagues’ role in the OT relative to the role understanding that the colleagues attributed to them. This tendency was especially marked for the surgeons. Team communication and team per- formance: OT professionals agreed on the relative importance of the vari- ous communicating pairs in the OT. Moreover, they were satisfied with the quality of communication among them, except for the communication between the surgeon and the anaesthetist, which received lower ratings. Finally, the quality of the teamwork in the OT was deemed acceptable, although there is room for improvement. Conclusions The OT environ- ment need not be as cohesive as previously assumed – a finding that carries implications for the effectiveness of team training interventions. Further research is needed in order to fully comprehend the dynamics of the OT as a working environment and, most importantly, their relation to patient safety. Introduction Effective teamwork is increasingly recognized as an important mechanism for enhancing the safety of health care. It is particularly important in high-risk environments such as the operating theatre (OT). Surgical teamwork involves complex interdiscipli- nary interactions between highly specialized profes- sionals, namely anaesthetists, nurses and surgeons, and evidence suggests that poor communication may increase the potential for human error (e.g. Helmre- ich & Shaefer 1994; Sexton et al. 1998). The interde- pendent nature of surgical teams demands a high level of shared understanding among the members about their respective roles, tasks and objectives throughout the surgical process. Evaluating team- work behaviours and shared understanding within surgical teams is, therefore, important for identifying