Enhancing Surgical Performance. a Primer in Non-Technical Skills

 

Description

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.

Features

• Presents a comprehensive review of surgeons’ non-technical skills using the Non-Technical Skills for Surgeons (NOTSS) system and behavioural rating framework
• Relates non-technical skills to overall surgical performance
• Explores the association between non-technical skills and patient safety
• Describes the developments of non-technical skills in assessing and enhancing surgical performance
• Describes how to use the NOTSS system for training, assessment, self-reflection and event analysis 

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

Editor(s) Bio

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.