Safer Surgery part 31. 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. | 274 Safer Surgery recommended defined triggers that mandate communication with an attending surgeon structured hand-offs and transfer protocols and standard use of readbacks. Our work complements these studies by specifying the intra-operative team behaviours briefings information sharing inquiry and vigilance that should be useful in preventing negative outcomes. Finally a recent study reported a significant correlation between subjective ratings of teamwork with postoperative morbidity Davenport et al. 2007 a finding which lends more support to our conclusions. Implications and Future Directions Development of interventions based on changing teamwork behaviour and their evaluation is a logical next step for research in this arena. Our study provides general support for development of team training programmes for surgical teams. Such programmes should be rigorously tested because they will require significant investments of time and money some studies in other areas have found only marginal benefit for patients Nielsen et al. 2007 . We believe that there are two broad lines of research that should be pursued and that will ultimately converge in the form of effective team training programmes. First research should focus on implementation and evaluation of training programmes. There is already a large body of knowledge that can inform the content of such programmes Baker et al. 2005 Clancy and Tornberg 2007 . These may focus on relatively specific processes of care like neonatal resuscitation Thomas et al. 2006 they may try to address multiple processes within a site of care like labour and delivery Nielsen et al. 2007 or there are training programmes like TeamSTEPPS which may be applicable across many locations processes and disciplines Clancy and Tornberg 2007 . However given the inconclusive results of initial evaluations of such programmes it is clear that there is a need for a second line of research which asks more fundamental questions about the relationships
