The performance and success of surgeons in the Operating Room (OR) is often linked to their surgical technical skills such as dexterity, technical precision, and choice of procedure. However, less attention is typically given to the non-technical skills of surgeons, such as their cognitive and social skills and the effect that these have on the surgical team and on patient outcomes.

A new article published this month in the journal Patient Safety in Surgery argues that the non-technical skills may be as important, if not more important than the technical skills in terms of their impact on patient safety in the OR. According to the authors:

“There is widespread appreciation of the physical hazards to patient and staff posed by sharps, needles, electric currents, radiation, contaminated body fluids, poor patient positioning, and other risks contained in the operating theatre environment. Whereas there is an expectation that the individual technical skills of the surgeon, anesthetist and scrub nurse will blend in an imperceptible fashion to produce a successful surgical intervention, there has been less recognition of the risk to patients from failures in communication, leadership and decision making.”

Surgeons typically are trained on the latest skills techniques to successfully complete the intended procedure. However, these skills and techniques are not sufficient to guarantee patient safety. Surgical errors that can harm patients are in large part due to deficiencies in non-technical skills. Yet, they are normally not addressed in surgical research and consequently are not part of professional standards or training courses.

Most surgeons still don’t see the relevance of these kinds of skills to the clinical outcomes of surgery. What they fail to realize, however, is that inappropriate social behaviors (such as yelling at a junior surgeon or being rude to a nurse) can affect other team members’ surgical skills and thus can jeopardize the safety of a surgical procedure.

Surgeons, nurses, anesthesiologists and other members of the surgical team are trained in their own disciplines. However, once on the job, they are somehow expected to magically start functioning as a cohesive team. But communication and teamwork are not inherent attributes. Rather, they are acquired skills which need to learned and applied on a daily basis.

Several healthcare organizations have adopted techniques from the military and commercial aviation industry to train their healthcare professionals on how to operate as a team. In Scotland, for example, a specific course called the NOTSS (Non-Technical Skills for Surgeons) was developed to specify safe behaviors relevant to surgery. It focuses on four main non-technical skills: situation awareness; decision-making; communication and teamwork; and leadership.

The NOTSS was developed using task analysis with subject matter experts and was evaluated in trials using standardized video scenarios and real operations. It allows surgeons to give feedback to colleagues and trainees based on structured observations of non-technical aspects of performance during surgery.