Abstract
Non-technical skills are increasingly recognized as essential to providing safe and effective surgical care. In this chapter, we first review the policy context for studying surgeons’ non-technical skills. Next, we define the Non-Technical Skills for Surgeons (NOTSS) behavior rating system, including situation awareness, decision making, communication and teamwork, and leadership in the operating room. We review major domains of ongoing research on surgeons’ non-technical skills and discuss measurement considerations for researchers planning to study non-technical skills. Finally, we identify promising areas for future health services researchers to develop successful careers studying non-technical skills in surgery.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Flin R, Youngson G, Yule S. Enhancing surgical performance: a primer in non-technical skills. Boca Raton, FL: CRC Press; 2016.
Osborne NH, Nicholas LH, Ryan AM, Thumma JR, Dimick JB. Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for medicare beneficiaries. J Am Med Assoc. 2015;313(5):496–504.
Hawn M, Vick CC, Richman J, et al. Surgical site infection prevention: time to move beyond the surgical care improvement program. Ann Surg. 2011;254(3):494–501.
Urbach DR. Pledging to eliminate low volume surgery. N Engl J Med. 2015;373(15):1385–8.
Birkmeyer JD, Finks JF, O’Reilly A, et al. Surgical skill and complication rates after bariatric surgery. N Engl J Med. 2013;369(15):1434–42. https://doi.org/10.1056/NEJMsa1300625.
Gawande AA, Zinner MJ, Studdert DM. Analysis of errors reported by surgeons at three teaching hospitals. Surgery (United States). 2003;133:614–21.
Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003;237(4):460–9.
Mazzocco K, Petitti DB, Fong KT, et al. Surgical team behaviors and patient outcomes. Am J Surg. 2009;197(5):678–85.
Greenberg CC, Regenbogen SE, Studdert DM, et al. Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg. 2007;204(4):533–40.
Flin R, Martin L. Behavioural marker systems in aviation. Int J Aviat Psychol. 2001;11:95–118.
The Non-Technical Skills for Surgeons (NOTSS). System Handbook v1.2: Structuring observation, rating and feedback of surgeons’ behaviours in the operating theatre. Aberdeen, Scotland: University of Aberdeen; 2006.
Pauley K, Flin R, Yule S, Youngson G. Surgeons’ intraoperative decision making and risk management. Am J Surg. 2011;202(4):375–81. https://doi.org/10.1016/j.amjsurg.2010.11.009.
Klein G. A Recognition-Primed Decision (RPD) model of rapid decision making. New York: Ablex; 1993.
Yule S, Gupta A, Gazarian D, et al. Construct and criterion validity testing of the Non-Technical Skills for Surgeons (NOTSS) behaviour assessment tool using videos of simulated operations. Br J Surg. 2018;105(6):719–27.
Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491–9. https://doi.org/10.1056/NEJMsa0810119.
Haynes AB, Edmondson L, Lipsitz SR, et al. Mortality trends after a voluntary checklist-based surgical safety collaborative. Ann Surg. 2017;266(6):923–9. https://doi.org/10.1097/SLA.0000000000002249.
Lagoo J, Berry WR, Miller K, et al. Multisource evaluation of surgeon behavior is associated with malpractice claims. Ann Surg. 2019;270(1):84–90. https://doi.org/10.1097/SLA.0000000000002742.
Doumouras AG, Hamidi M, Lung K, et al. Non-technical skills of surgeons and anaesthetists in simulated operating theatre crises. Br J Surg. 2017;104(8):1028–36.
Edmondson A. Psychological safety and learning behavior in work teams. Adm Sci Q. 1999;44(2):350–83.
Singer SJ, Molina G, Li Z, et al. Relationship between operating room teamwork, contextual factors, and safety checklist performance. J Am Coll Surg. 2016;223(4):568–580.e2. https://doi.org/10.1016/j.jamcollsurg.2016.07.006.
Molina G, Berry WR, Lipsitz SR, et al. Perception of safety of surgical practice among operating room personnel from survey data is associated with all-cause 30-day postoperative death rate in South Carolina. Ann Surg. 2017;266(4):658–66.
Non-Technical Skills for Surgeons (NOTSS). The Royal College of Surgeons of Edinburgh. https://www.rcsed.ac.uk/professional-support-development-resources/learning-resources/non-technical-skills-for-surgeons-notss. Published 2019. Accessed March 27, 2019.
Friends of NOTSS. NOTSS.org. https://www.notss.org/communitynts/. Published 2019. Accessed March 27, 2019.
Fletcher G, Flin R, McGeorge M, Glavin R, Maran N, Patey R. Anaesthetists’ non-technical skills (ANTS): Evaluation of a behavioural marker system. Br J Anaesth. 2003;90(5):580–8. https://doi.org/10.1093/bja/aeg112.
Rutherford JS, Flin R, Irwin A, McFadyen AK. Evaluation of the prototype Anaesthetic Non-technical Skills for Anaesthetic Practitioners (ANTS-AP) system: a behavioural rating system to assess the non-technical skills used by staff assisting the anaesthetist. Anaesthesia. 2015;70(8):907–14. https://doi.org/10.1111/anae.13127.
Yule S, Flin R, Paterson-Brown S, Maran N, Rowley D. Development of a rating system for surgeons’ non-technical skills. Med Educ. 2006;40(11):1098–104. https://doi.org/10.1111/j.1365-2929.2006.02610.x.
Mitchell L, Flin R, Yule S, Mitchell J, Coutts K, Youngson G. Development of a behavioural marker system for scrub practitioners’ non-technical skills (SPLINTS system). J Eval Clin Pract. 2013;19(2):317–23. https://doi.org/10.1111/j.1365-2753.2012.01825.x.
Mitchell L, Flin R, Yule S, Mitchell J, Coutts K, Youngson G. Evaluation of the scrub practitioners’ list of intraoperative non-technical skills system. Int J Nurs Stud. 2012;49(2):201–11.
Russ S, Hull L, Rout S, Vincent C, Darzi A, Sevdalis N. Observational teamwork assessment for surgery: feasibility of clinical and nonclinical assessor calibration with short-term training. Ann Surg. 2012;255(4):804–9. https://doi.org/10.1097/SLA.0b013e31824a9a02.
Mishra A, Catchpole K, Mcculloch P. The Oxford NOTECHS system: reliability and validity of a tool for measuring teamwork behaviour In the operating theatre. Qual Saf Heal Care. 2009;18(2):104–8. https://doi.org/10.1136/qshc.2007.024760.
Sevdalis N, Davis R, Koutantji M, Undre S, Darzi A, Vincent CA. Reliability of a revised NOTECHS scale for use in surgical teams. Am J Surg. 2008;196(2):184–90. https://doi.org/10.1016/j.amjsurg.2007.08.070.
Robertson ER, Hadi M, Morgan LJ, et al. Oxford NOTECHS II: a modified theatre team non-technical skills scoring system. PLoS One. 2014;9(3):1–8. https://doi.org/10.1371/journal.pone.0090320.
Nagpal K, Abboudi M, Fischler L, et al. Evaluation of postoperative handover using a tool to assess information transfer and teamwork. Ann Surg. 2011;253(4):831–7. https://doi.org/10.1097/SLA.0b013e318211d849.
Steinemann S, Berg B, Ditullio A, et al. Assessing teamwork in the trauma bay: introduction of a modified “NOTECHS” scale for trauma. Am J Surg. 2012;203(1):69–75. https://doi.org/10.1016/j.amjsurg.2011.08.004.
Frengley RW, Weller JM, Torrie J, et al. The effect of a simulation-based training intervention on the performance of established critical care unit teams. Crit Care Med. 2011;39(12):2605–11. https://doi.org/10.1097/CCM.0b013e3182282a98.
Flowerdew L, Gaunt A, Spedding J, et al. A multicentre observational study to evaluate a new tool to assess emergency physicians’ non-technical skills. Emerg Med J. 2013;30(6):437–43. https://doi.org/10.1136/emermed-2012-201237.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Pradarelli, J.C., Yule, S., Smink, D.S. (2020). Evaluating Non-Technical Skills in Surgery. In: Dimick, J., Lubitz, C. (eds) Health Services Research. Success in Academic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-28357-5_12
Download citation
DOI: https://doi.org/10.1007/978-3-030-28357-5_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-28356-8
Online ISBN: 978-3-030-28357-5
eBook Packages: MedicineMedicine (R0)