The flight management questionnaire and cockpit management questionnaire were returned by over 30
000 pilots, with response rates ranging from 15% to over 90% (average 45%). The operating room questionnaire was returned by 851 staff (response rate 40% to 100%) and the intensive care questionnaire by 182 staff (response rate 59%). In an effort to make the medical and aviation samples roughly equivalent, pilot data from Latin America and Asia, which were not sampled in medicine, were not included.
Perceptions of stress and fatigue
In response to the item, “Even when fatigued, I perform effectively during critical times,” 60% of all medical respondents agreed, ranging from 70% among consultant surgeons to 47% among consultant anaesthetists (table). The rate of agreement was much higher in medicine than in aviation (26% of pilots agreed). As there were no differences between captains, first officers, and second officers the data are not presented separately.
Sixty seven per cent of respondents believed that true professionals can leave personal problems behind when working. Pilots and anaesthesia consultants, residents, and nurses were less likely to deny the effects of personal problems (53%-59%) than surgical consultants (82%). In response to the item, “My decision making ability is as good in medical emergencies as in routine situations,” 70% of all medical respondents agreed. Among theatre staff, consultant surgeons were the most likely to agree with this statement, and intensive care staff were more likely to agree than surgeons (table). In general, only a minority of respondents openly recognised the effects of stress on performance.
Attitudes to teamwork and hierarchy
Seventy per cent of respondents did not agree that junior team members should not question the decisions made by senior team members, but there were differences with position and discipline (table). Consultant surgeons were least likely to advocate flat hierarchies (55%). By contrast, 94% of cockpit and intensive care staff advocated flat hierarchies.
Over 80% of all medical staff reported that preoperative and postoperative discussions (for intensive care staff before and after ward rounds) are an important part of safety and teamwork. A quarter indicated that they are not encouraged to report safety concerns, and only a third said that errors are handled appropriately in their hospital.
Differing perspectives of teamwork in medicine
The different perspectives on teamwork among medical staff were shown by the responses to the item “Rate the quality of teamwork and communication or cooperation with consultant surgeons” (fig ). In particular, surgical consultants and residents rated the teamwork they experienced with other consultant surgeons the highest (64% (29/45) and 73% (40-55) reported high levels of teamwork; 7% (3/45) and 9% (5/55) reported low levels), while anaesthesia residents, anaesthesia nurses, and surgical nurses rated interactions with consultant surgeons lowest (10% (8/77), 26% (36/141), and 28% (35/124) reported high levels of teamwork; 39% (48/124), 43% (33/77), and 48% (67/141) reported low levels). At the aggregate level, 62% (146/135) of surgical staff rated teamwork with anaesthesia staff highly, and 41% (106/250) of anaesthesia staff rated teamwork with surgical staff highly. In other words, surgery generally reports good teamwork with anaesthesia, but anaesthesia staff do not necessarily hold a reciprocal perception.
Rating of teamwork with consultant surgeons
Differences between doctors and nurses were found regarding the quality of teamwork in intensive care. Although 77% of intensive care doctors reported high levels of teamwork with nurses, only 40% of nurses reported high levels of teamwork with doctors.
Attitudes about error and safety
Over 94% of intensive care staff disagreed with the statement “Errors committed during patient management are not important, as long as the patient improves.” A further 90% believed that “a confidential reporting system that documents medical errors is important for patient safety.” Over 80% of intensive care staff reported that the culture in their unit makes it easy to ask questions when there is something they don't understand (this is undoubtedly related to the high endorsement of flat hierarchies in the unit). One out of three intensive care respondents did not acknowledge that they make errors. Over half report that decision making should include more team member input.
More than half of the respondents reported that they find it difficult to discuss mistakes, and several barriers to discussing error were acknowledged. The 182 staff in intensive care reported that many errors are neither acknowledged nor discussed because of personal reputation (76%), the threat of malpractice suits (71%), high expectations of the patients' family or society (68%), possible disciplinary actions by licensing boards (64%), threat to job security (63%), and expectations or egos of other team members (61% and 60%). The most common recommendation for improving patient safety in the intensive care unit was to acquire more staff to handle the present workload, whereas the most common recommendation in the operating theatre was to improve communication.