| Summary: | This study examines the cognitive and social processes making up the non-technical skills that, together with technical expertise, are considered important for the safe and efficient functioning of operating theatre teams. Methods included observations of nurses and surgeons in the operating theatre undertaking operative procedures that involved both conscious and unconscious patients, individual interviews with a sub-set of these staff, and an examination of their perceived reactions to critical incidents. Based on ethnographic principles, such an approach affords a comprehensive and multidimensional understanding of the ways in which the work in an operating theatre is carried out and what may impact upon the successful development and manifestation of non-technical skills. From the framework analysis of the resultant data, and the themes that emerged across all three data collection methods, perceptions of team membership influenced the differing priorities in the way participants viewed their work, and shaped communication style and content; potentially contributing to barriers in communication between professions. The presence of a conscious patient had an inhibiting effect on explicit communication. This had a subsequent impact on the distributed cognition of the team and intensified the need for an increase in emotional labour, as well as affecting the effective implementation of other nontechnical skills, such as situation awareness. The accuracy of team mental models was also affected by the interaction of social and cognitive processes of both the individual and the team, with the teams' experience of working together also contributing to this and to the ways in which the recovery of non-standard events within theatre is managed. In the context of patient safety these results, and the subsequent enhanced understanding of the role of non-technical skills, provide a useful contribution to on-going discussions regarding how the performance of operating theatre staff teams may be optimised, leading to improved patient outcomes.
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