Operating room human factors questionnaire

Abstract

The Operating Theatre Human Factors Questionnaire (OTHFQ) is a specialized psychometric instrument designed to measure the attitudes and knowledge of surgical personnel concerning critical non-technical skills, collectively known as Human Factors. Developed by O’Connor, Keogh, and Ryan, the OTHFQ adapts tools originally used in U.S. Naval aviation to the high-stakes environment of the operating room. The scale consists of 23 attitude items distributed across four core subscales—including ‘my stress’, ‘stress of others’, ‘communication’, and ‘command responsibility’—alongside eight multiple-choice knowledge questions covering areas such as situation awareness, decision making, and fatigue management. The primary goal of the OTHFQ is to identify deficits in teamworking and safety culture that contribute to poor performance and adverse outcomes in surgical environments.

Keywords

Operating Theatre, Human Factors, Teamwork, Non-Technical Skills, Surgery, Communication, Stress Management, Situation Awareness, Surgical Environments, Patient Safety.

Authors

O’Connor, P., Keogh, I., & Ryan, S.

Purpose

The primary purpose of the Operating Theatre Human Factors Questionnaire (OTHFQ) is to facilitate a structured assessment of the attitudes and knowledge held by surgical staff regarding various aspects of Human Factors and collaborative teamworking. This tool is instrumental in identifying areas where training interventions may be required to enhance patient safety and operational efficiency within the high-pressure environment of the operating room.

By adapting established aviation safety questionnaires, the OTHFQ specifically targets core teamwork issues—such as stress management, communication protocols, and delegation—that have been causally linked to accidents in aviation and, by extension, to adverse events and Sentinel Events in healthcare settings. The inclusion of both attitudinal and knowledge components provides a comprehensive profile of a respondent’s understanding and acceptance of crucial non-technical skills.

Construct

The OTHFQ is designed to measure the psychological construct of non-technical skills and safety culture as they apply to the operating theatre team. The instrument conceptualizes these skills across two main domains: attitude and knowledge.

The 23 attitude items are structured into four distinct subscales, focusing on interpersonal dynamics and self-awareness: ‘my stress’ (self-management of stressors), ‘stress of others’ (awareness and compensation for colleagues’ stressors), ‘communication’ (clarity of intent, delegation, and monitoring), and ‘command responsibility’ (appropriate leadership and task delegation). Furthermore, the eight knowledge questions specifically test theoretical understanding of critical teamwork elements, including situation awareness, decision-making processes, fatigue, and stress, emphasizing the link between these factors and surgical performance.

Validity

Specific detailed reports on construct validity (e.g., convergent or discriminant validity) or criterion validity are not explicitly detailed in the provided source material. However, the instrument derives its initial face validity and domain relevance from its foundation in the well-established Naval Aviator Human Factors Questionnaire, which is widely recognized for assessing critical non-technical skills in high-risk environments.

The adaptation process, which involved two surgeons modifying the language from aviation-specific terminology (e.g., changing ‘aircrew’ to ‘team member’) to be relevant to the surgical environments, further supports the content validity of the OTHFQ for its intended population.

Reliability

The internal consistency reliability of the attitude survey subscales was evaluated using Cronbach’s alpha. The psychometric analysis indicated that the scores for the surgeon sample ranged from 0.41 to 0.66.

While these alpha values are reported as being “comparable to that of questionnaires of this type,” the range suggests that some subscales exhibit moderate reliability (closer to 0.66), whereas others demonstrate lower levels of internal consistency (0.41). This variability highlights the need for cautious interpretation of the lower-scoring subscales and potentially suggests areas for future refinement of the instrument.

Factor Analysis

The structure of the attitude section is based on four predefined factors or scales derived from the original Naval Aviator Human Factors Questionnaire: ‘my stress’, ‘stress of others’, ‘communication’, and ‘command responsibility’. Although the source material defines these scales, explicit details of an exploratory or confirmatory factor analysis performed on the OTHFQ data itself to confirm this four-factor structure in the surgical population are not provided.

Instrument

Test Type: Psychometric Attitude and Knowledge Survey

Format: Self-report questionnaire combining 23 Likert-type attitude items (5-point scale) and 8 multiple-choice knowledge questions.

Language Available: English (as utilized with Irish surgeons and adapted from U.S. Naval materials).

Population Group: Operating Theatre Personnel (primarily surgeons, but applicable to nurses, anesthetists, and other surgical team members).

Age Group: Adult professionals.

Population Details: Originally validated and utilized with a sample of Irish surgeons, comparing their results to U.S. Naval aviators.

Test Methodology: Paper-based self-completion survey administered to assess awareness of non-technical skills critical for preventing Sentinel Events.

Keywords

Safety Culture, Crew Resource Management (CRM), Non-technical Skills, Human Factors, Teamworking, Leadership, Delegation, Cronbach’s alpha, Surgical Safety.

Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: Not provided in source material.

Correspondence Address: Not provided in source material.

Permissions & Fee and Test Year

Information regarding specific permission requirements, licensing fees, or the exact year of publication is not available in the provided source content. The key reference indicates the tool was discussed in a paper “in press,” suggesting development occurred shortly prior to or around the publication date of that article.

Reference’s

• O’Connor, P., Keogh, I., & Ryan, S. (in press). A comparison of the teamwork attitudes and knowledge of Irish surgeons and U.S. Naval aviators. Surgeon. The original publication link is preserved here: http://www.sciencedirect.com/science/article/pii/S1479666X11001247

Items of the Operating theatre human factors questionnaire

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Please answer the following items by using the following scale in writing your response beside each item:

• A B C D E
• Disagree Strongly
• Disagree Slightly
• Neutral
• Agree Slightly
• Agree Strongly

____1. I let other team members know when my workload is becoming (or is about to become) excessive.
____2. My decision making ability is as good in emergencies as it is in routine situations.
____3. I am more likely to make judgment errors in an emergency.
____4. A regular debriefing of procedures and decisions after a theatre session or shift is an important part of developing and maintaining effective team co-ordination.
____5. In critical situations, I rely on my superiors to tell me what to do.
____6. I am less effective when stressed or fatigued.
____7. If I perceive a problem with the management of a patient, I will speak up, regardless of who might be affected.
____8. The pre-session team briefing is important for safety and for effective team management.
____9. Team members should monitor each other for signs of stress or tiredness.
____10. Personal problems can adversely affect my performance.
____11. Team members should feel obligated to mention their own psychological stress or physical problems to other theatre personnel before or during a shift or assignment.
____12. Good communication and team coordination are as important as technical proficiency for patient safety.
____13. Effective team coordination requires team members to consider the personal work styles of others
____14. Team members should alert others to their actual, or potential, work overload.
____15. The specific roles and responsibilities of team members in an emergency are identified during the pre-operation brief.
____16. Team members should be aware of, and sensitive to, the personal problems of other team members.
____17. Junior theatre team members should not question the decisions made by senior personnel in emergencies.
____18. The senior person, if available, should take over and make all decisions in life threatening emergencies
____19. The team member in charge should verbalize plans for procedures or actions and should be sure that the information is understood and acknowledged by others.
____20. Team members should not question the decisions or actions of senior staff except when they threaten patient safety.
____21. There are no circumstances where a junior team member should assume control of patient management.
____22. Junior team members should not question the decisions made by senior personnel during routine situations.

• 23. How frequently are junior personnel afraid to express disagreement with more senior personnel (please circle below)?
  A. Very frequently
  B. Frequently
  C. Sometimes
  D. Seldom
  E. Very seldom
• 24. How frequently are adequate pre-operation team briefs conducted (please circle below)?
  A. Very frequently
  B. Frequently
  C. Sometimes
  D. Seldom
  E. Very seldom
• 25. How frequently are adequate post-operation team briefs conducted (please circle below)?
  A. Very frequently
  B. Frequently
  C. Sometimes
  D. Seldom
  E. Very seldom

Please answer the following to the best of your ability by circling or filling in your response:

1. What percentage of sentinel events in healthcare are attributed to human error?

• A. 0-10%
• B. 20-30%
• C. 50-60%
• D. 80-90%

2. What is the most common reason skilled personnel fail to obtain a good understanding of what is happening in a high workload situation?

• A. Data/information is unavailable
• B. Information/data is difficult to detect
• C. Memory loss
• D. Failure to monitor or observe

3. You are working in a potentially high-risk situation with a more senior person. Identify whether each of the statements below is PASSIVE, which is ASSERTIVE, and which is AGGRESSIVE.

• A. “I think that perhaps this may not be the best thing to do.”____________
• B. “There may be a better way to do this task. In my opinion we should do ….”___________
• C. “There is no way we should do this.” _____________

4. During an operation, something unexpected happens. There is no procedure available. You have seconds to make a decision to attempt to prevent a bad outcome, what is the best thing to do?

• A. Consider all of the possible options, and select the best.
• B. React the best you can to the situation based upon your experience.
• C. Do nothing.

5. During a time limited, abnormal, situation what is the most effective team communication strategy?

• A. The team should talk a lot about what is happening in an attempt to solve a problem.
• B. Use the minimum amount of communication necessary in an attempt to solve the problem.
• C. Don’t talk. This distracts from thinking about the problem.

6. The following are all characteristics of an effective pre-operation brief EXCEPT:

• A. Assigning of roles and responsibilities
• B. Rapid information dissemination
• C. Professional
• D. Involve input from all members of the team

7. The normal need for sleep to maximize performance in a 24 hour period is:

• A. 1-3 hours
• B. 4-6 hours
• C. 7-9 hours
• D. 10-12 hours

8. Which of the following statement is true regarding the relationship between stress and performance:

• A. Performance is optimized when an individual is experiencing no or a very little amount of stress.
• B. Performance is optimized when an individual is experiencing a moderate amount of stress.
• C. Performance is optimized when an individual is experiencing an excessive amount of stress.
• D. Stress has no effect on an individual’s performance.

BACKGROUND INFORMATION

1. Position (Please circle the appropriate response):

Nurse Surgeon
Anesthetist Other (please specify) ____________

2. What is your grade? _________
3. How much experience do you have working in the Operating Room? _____ years

Thank you for your participation