Safer Surgery part 5. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. | 14 Safer Surgery process produced a list of 150 unsorted non-technical skills such as coordinates the team and confirms understanding with assistant as raw input data for system development in phase 2. Phase 2 Development of the NOTSS System The goal of Phase 2 was to develop a system that could be used by surgeons to rate other surgeons behaviours in vivo in the operating theatre rather than to develop a comprehensive taxonomy or research instrument. The tri-level hierarchical format used for behavioural marker systems in anaesthesia Fletcher et al. 2004 and European civil aviation Flin et al. 2003 was adopted. This format structures skills into category and element levels with observable behaviours markers indicative of good and poor performance for each element. The prototype system was developed in three stages to i refine the skill set that emerged from phase 1 ii sort those skills into a skills taxonomy and iii identify observable behaviours that were indicative of each skill in the taxonomy. The aim of Stage 1 was to refine the skills that emerged from Phase 1 and remove duplication without diluting the conceptual breadth of the skills that emerged from the task analysis. This process was to form the basis of the system. To achieve this the multidisciplinary research group reduced and refined the list of 150 skills extracted from the transcripts considering the results of the literature review survey and observations in theatre. The skills taxonomy was developed according to design criteria derived from the JARTEL JointAviation Requirements Translation and Elaboration of Legislation project Flin et al. 2003 an expert panel on behavioural markers Klampfer et al. 2001 and from Cognitive Task Analysis Seamster et al. 1997 .1 The reduced skills list was then thematically organized and broad categories emerged broken down into component elements. In Stage 2 an iterative process was used with four independent panels of consultant surgeons from four hospitals who .
