1st Edition

Enhancing Surgical Performance A Primer in Non-technical Skills

Edited By Rhona Flin, George G. Youngson, Steven Yule Copyright 2016
    223 Pages 24 B/W Illustrations
    by CRC Press

    Enhancing Surgical Performance: A Primer in Non-Technical Skills explains why non-technical skills are vital for safe and effective performance in the operating theatre. The book provides a full account, with supporting empirical evidence, of the Non-Technical Skills for Surgeons (NOTSS) system and behavioural rating framework, which helps identify the key elements involved in successful operative surgery.

    The editors spent the last twelve years as part of the team developing and testing the NOTSS system and delivering presentations and workshops across the world. Readers will benefit by having, in one accessible handbook, a description of the NOTSS system and how it can be used for training, assessment, self-reflection and event analysis.

    The book also examines human error, performance limitations, and global safety initiatives in surgery. Because it encourages surgeons to reflect on their own performance and behaviour, it is suitable for surgeons in all specialties and at all levels.

    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

    Biography

    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