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Background: Teamwork in the operating theatre is becoming increasingly recognized as a major factor in clinical outcomes. Many tools have been developed to measure teamwork. Most fall into two categories: self-assessment by theatre staff and assessment by observers. A critical and comparative analysis of the validity and reliability of these tools is lacking. Methods: MEDLINE and Embase databases were searched following PRISMA guidelines. Content validity was assessed using measurements of inter-rater agreement, predictive validity and multisite reliability, and interobserver reliability using statistical measures of inter-rater agreement and reliability. Quantitative meta-analysis was deemed unsuitable. Results: Forty-eight articles were selected for final inclusion; self-assessment tools were used in 18 and observational tools in 28, and there were two qualitative studies. Self-assessment of teamwork by profession varied with the profession of the assessor. The most robust self-assessment tool was the Safety Attitudes Questionnaire (SAQ), although this failed to demonstrate multisite reliability. The most robust observational tool was the Non-Technical Skills (NOTECHS) system, which demonstrated both test-retest reliability (P > 0·09) and interobserver reliability (Rwg = 0·96). Conclusion: Self-assessment of teamwork by the theatre team was influenced by professional differences. Observational tools, when used by trained observers, circumvented this.

Original publication




Journal article


BJS Open

Publication Date





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