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Enhancing Surgical Performance

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Table of Contents

SURGICAL PERFORMANCE: RECOGNITION OF THE CHALLENGE Intraoperative Performance, Non-Technical Skills and Surgical Safety Introduction Surgical Skills Non-Technical Skills What Non-Technical Skills Are Not Factors Influencing Surgical Performance Surgical Error About this Book Human Factors: The Science Behind Non-Technical Skills Introduction Human Factors Science Evolution of Non-Technical Skills Non-Technical Skills for Pilots NOTECHS: Non-Technical Skills for Pilots Non-Technical Skills in Other Industries Non-Technical Skills in Health Care Summary Non-Technical Skills for Surgeons: The NOTSS Behaviour Marker System Overview NOTSS System Using NOTSS Underpinning Theory of Non-Technical Skills Non-Technical Skills at Work in the Operating Room New Developments with NOTSS Since the Taxonomy Was Published Importance of NOTSS for Surgeons and Patients Conclusion UNDERPINNING CONCEPTS Situation Awareness Introduction Human Memory System Model of Situation Awareness Influencing Factors Training Situation Awareness Assessing Situation Awareness Summary Decision Making Introduction Model of Intra-Operative Decision Making Decision-Making Methods: What Shall I Do? Factors Influencing Intra-Operative Decision Making Training Surgeons' Intra-Operative Decision Making Assessing Surgeons' Intra-Operative Decision-Making Skills Summary Teamwork and Communication Introduction Exchanging Information Establishing a Shared Understanding Co-Ordinating Team Activities Interventions to Improve Teamworking and Communication Conclusion Leadership Introduction Leadership in NOTSS Setting and Maintaining Standards Supporting Others Coping with Pressure Surgeons' Leadership Inventory Conclusion Performance-Shaping Factors Introduction Stress in Surgery Fatigue Conclusion IMPLEMENTATION AND IMPROVEMENT Training Methods For Non-Technical Skills Introduction Training Design and Development for Non-Technical Skills Evaluation Integrating Non-Technical Skills Training into Surgical Training Training Modalities Practical Matters and Future Possibilities Assessing Non-Technical Skills in the Operating Room Introduction Emergence of Non-Technical Skills Assessment Principles of Assessment Behavioural Marker Systems Practical Issues and Problems with Behavioural Marker Systems Current Methods for Assessing Surgeons Summary What Next? Development of Non-Technical Skills Acquisition: Education in Patient Safety and Non-Technical Skills Using, Developing and Enhancing Non-Technical Skills Coaching and Debriefing Using Non-Technical Skills for Surgeons Non-Technical Skills and Quality Improvement Safety Management Systems Safety Culture and Non-Technical Skills Liability, Indemnity and Non-Technical Skills Adverse Event Analysis and Non-Technical Skills Demonstrating and Retaining Competence in Non-Technical Skills Limits and Boundaries Conclusions

About the Author

Edited by Rhona Flin, BSc, PhD, FRSE, FBPsS, holds the chair of Applied Psychology and is the director of the Industrial Psychology Research Centre at the University of Aberdeen in Scotland. She was involved in the NOTECHS project to develop a non-technical skills rating tool for pilots, and supervised the ANTS, NOTSS, SPLINTS and ANTS-AP projects. She was awarded the Roger Green Medal for Human Factors in Aerospace (Royal Aeronautical Society) and the John Bruce Medal for Behavioural Science in Surgery (Royal College of Surgeons Edinburgh). Her current research is on non-technical skills, surgeons' intra-operative decision making and senior managers' safety leadership. George G. Youngson, CBE, MBChB, PhD, FRCPEdin, FRCSEd is an emeritus professor of paediatric surgery at the Royal Aberdeen Children's Hospital and University of Aberdeen in Scotland. He is a past vice president of the Royal College of Surgeons of Edinburgh and is the founder of its Patient Safety Board. His interests and contributions have included re-configuration of children's surgical services in Scotland, surgical education, and clinical human factors as they affect surgical performance. He has been involved in the delivery of the NOTSS masterclass in various continents, including Asia, Europe, Africa and North America. Steven Yule, MA, MSc, PhD, is an assistant professor of surgery at Harvard Medical School in Boston, Massachusetts. Dr Yule is an Organizational Psychologist and Human Factors scientist. He has been involved in the development of a number of assessment tools including NOTSS, SPLINTS and the Surgical Leadership Inventory (SLI). He has led the development of curricula in non-technical skills for surgical trainees and practising surgeons in the United Kingdom and United States. Dr. Yule is the director of education & research at the STRATUS Center for Medical Simulation, Brigham and Women's Hospital in Boston, where the current research focus is on demonstrating the impact of surgeons' non-technical skills on process and outcomes, and implementing scalable interventions to enhance patient safety. He is the vice chair of the American College of Surgeons (ACS) committee on non-technical skills and also on faculty at both the Center for Surgery and Public Health and Ariadne Labs for Health System Innovation, at Brigham & Women's Hospital/ Harvard School of Public Health.


"Describes very well the process of thought, judgement, analysis and evaluation of risk by surgeons. It emphasises the role of the surgeon as a leader and setting up and maintenance of standards... This book explores a new dimension in the operating theatre environment. It is therefore a unique book." -(BMA Council Chair's Choice, chosen by Dr Mark Porter, BMA Medical Book Awards 2016) "I am in awe of the knowledge and deep understanding possessed [by the] ... contributors of this very important complementary set of skills that not only should but must be embraced by all surgical teams ..." -Bruce Barraclough, Former President, Royal Australasian College of Surgeons "It defines the types of decision making that surgeons make on a daily basis without necessarily being aware of how they reached those decisions. I believe having this insight will help improve performance." -Professor Sir Norman S. Williams, Past President, Royal College of Surgeons of England

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