Enhancing Surgical Performance ─ A Primer in Non-Technical Skills

This new book provides a full account of cognitive and teamwork skills (non-technical skills), which are vital for safe and effective practice in the operating room. It also examines human error, performance limitations and reflects global safety initiatives in surgery. The book encourages surgeons to reflect on their own performance and behaviour, and is suitable for surgeons in all specialties and at all levels – from early trainees to experienced practitioners – as well as surgical educators and researchers.

The book aims to:

• Explain why non-technical skills are required for safe and effective surgical performance in the operating theatre
• Provide a full account, with supporting empirical evidence of the non-technical skills for surgeons skill set and behavioural rating framework (NOTSS)
• Describe how to use this system for training, assessment, self-reflection and event analysis
• Review current issues in this non-technical skills component of surgical competence

The editors have worked for the last seven years developing and testing the NOTSS system and delivering presentations and workshops across the world. Readers of the book will benefit by having, in one accessible handbook, a description of the NOTSS framework and the underpinning behavioural science, plus usable techniques and principles to guide the design of programmes to enhance non-technical skills.

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, China, Africa and the United States.

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.