Final synthesis and analysis

InterventionsOur central purpose during the study was to examine the relative effects of interventions to improve process and outcomes, and to determine whether or not there could be synergy between them. We found in our parallel operating theatre studies that TT interventions always induced an improvement in team non-technical skills. As the WHO checklist is so intimately related to team culture, it was not surprising to note that TT also nearly always brought about some improvement in how the T/O and S/O procedures were performed. However, TT itself did not seem to affect technical performance, and for the study in which it was used alone, it was actually associated with deterioration in this. This combination of findings is in contrast to the findings of our initial intervention study on CRM in 2009, but is consistent with the results of our systematic review of studies of CRM/TT internationally. It suggests that TT …