Assessing distractors and teamwork during surgery: developing an event-based method for direct observation

Seelandt, J. C.; Tschan, Franziska; Keller, S.; Beldi, Guido; Jenni, N.; Kurmann, Anita; Candinas, Daniel; Semmer, Norbert (2014). Assessing distractors and teamwork during surgery: developing an event-based method for direct observation. BMJ Quality and Safety, 23(11), pp. 918-929. BMJ Publ. Group 10.1136/bmjqs-2014-002860

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To develop a behavioural observation method to simultaneously assess distractors and communication/teamwork during surgical procedures through direct, on-site observations; to establish the reliability of the method for long (>3 h) procedures.


Observational categories for an event-based coding system were developed based on expert interviews, observations and a literature review. Using Cohen's κ and the intraclass correlation coefficient, interobserver agreement was assessed for 29 procedures. Agreement was calculated for the entire surgery, and for the 1st hour. In addition, interobserver agreement was assessed between two tired observers and between a tired and a non-tired observer after 3 h of surgery.


The observational system has five codes for distractors (door openings, noise distractors, technical distractors, side conversations and interruptions), eight codes for communication/teamwork (case-relevant communication, teaching, leadership, problem solving, case-irrelevant communication, laughter, tension and communication with external visitors) and five contextual codes (incision, last stitch, personnel changes in the sterile team, location changes around the table and incidents). Based on 5-min intervals, Cohen's κ was good to excellent for distractors (0.74-0.98) and for communication/teamwork (0.70-1). Based on frequency counts, intraclass correlation coefficient was excellent for distractors (0.86-0.99) and good to excellent for communication/teamwork (0.45-0.99). After 3 h of surgery, Cohen's κ was 0.78-0.93 for distractors, and 0.79-1 for communication/teamwork.


The observational method developed allows a single observer to simultaneously assess distractors and communication/teamwork. Even for long procedures, high interobserver agreement can be achieved. Data collected with this method allow for investigating separate or combined effects of distractions and communication/teamwork on surgical performance and patient outcomes.

Item Type:

Journal Article (Original Article)


07 Faculty of Human Sciences > Institute of Psychology
07 Faculty of Human Sciences > Institute of Sport Science (ISPW)
07 Faculty of Human Sciences > Institute of Psychology > Work and Organisational Psychology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Tschan, Franziska, Beldi, Guido Jakob Friedrich, Kurmann, Anita, Candinas, Daniel, Semmer, Norbert Karl


100 Philosophy > 150 Psychology
700 Arts > 790 Sports, games & entertainment
300 Social sciences, sociology & anthropology
600 Technology > 610 Medicine & health




BMJ Publ. Group




Lilian Karin Smith-Wirth

Date Deposited:

14 Apr 2015 15:15

Last Modified:

02 Mar 2023 23:26

Publisher DOI:


Uncontrolled Keywords:

Communication, Human Factors, Surgery, Teamwork




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