Operating theatre human factors questionnaire


The Operating Theatre human factors questionnaire is based upon the Naval Aviator Human Factors Questionnaire and a human factors knowledge questionnaire designed for U.S Naval aviation (also listed in MIDSS).

The questionnaire consists of 23 attitude items, and eight knowledge questions. The attitude items are divided into four scales: ‘my stress’ (the consideration of, and possible compensation for, stressors in oneself), ‘stress of others’ (the consideration of, and possible compensation for, stressors in other team members), ‘communication ‘(encompasses communication of intent and plans, delegation of tasks and assignment of responsibilities, and the monitoring of team members), and ‘command responsibility’ (appropriate leadership and its implications for the delegation of tasks and responsibilities. Three further attitude items were included that to obtain information on whether junior personnel were afraid to speak up to more senior personnel, and whether adequate pre- and post-operative team briefs were conducted (the latter two questions were only asked of the surgeons).

The eight item multiple-choice knowledge test was developed to address teamwork issues that have been identified as causal to accidents in aviation (situation awareness, decision making, communication, stress, and fatigue). However, as described in the introduction, these teamwork issues also contribute to poor performance and sentinel events in a surgical environments. As the questionnaire was initially developed for use with naval aviators, two surgeons checked, and where necessary adapted, the language so that it was not aviation specific (e.g. aircrew was changed to team member).


The internal consistency of the attitude survey subscales was found to be comparable to that of questionnaires of this type (the Cronbach’s alpha scores for the surgeon sample ranged from 0.41 to 0.66).

Author of Tool:

O’Connor, Keogh, & Ryan

Key references:

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. http://www.sciencedirect.com/science/article/pii/S1479666X11001247

Primary use / Purpose:

To allow an assessment of the attitudes and knowledge of surgeons to various aspects of human factors and teamworking


Operating Theatre Human Factors Questionnaire

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.


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