Enhancing Surgical Performance

Safety in surgery: surgical error; disruption to performance; never events, what crisis? The types, incidence and reasons for errors in the operating theatre. The factors that contribute to good and poor surgical performance. The consequences for patient, surgeon and surgical team as well as healthcare institutions. Existing policies for prevention. The pressures which may lead to policy violation. Human Factors: the science behind the non-technical skills approach. Non-technical skills: description of the NOTSS taxonomy. Description of the research problem in 2002 and task analysis methods used to identify behaviors and skills. Development of the skills taxonomy and behavior rating system. Psychometric testing, validation and refinement. Description of the four NOTSS categories as prelude to flowing four chapters. Situation awareness: definition: what compromises; mitigation of those factors, skill Set. Explanation of the concept and the elements involved. Discussion of the internal and external factors which compromise SA. How to build and maintain or how to lose it. Recognising poor SA in others. Importance for decision-making communication and teamwork. Decision making: description of the different mechanisms and the factors that influence them to both benefit and disadvantage, skill set. Classification and examples. Applying different techniques in different circumstances. Effect of risk and time. The basic information processing model and the relative use of the two main memory components in different types of decision-making. Decision errors. Violating behaviors. Teamwork and communication: skills for working in a team setting and for maximizing information exchange. Importance of shared mental model, acquiring that. How hierarchy and negativity can disrupt. Expert team or team of experts- building teams at short notice. Other barriers to communication, read back/feedback. Assertiveness or intimidation? Team decision-making. Common teamwork problems. Developing and resurrecting competencies. Leadership: skills for intra-operative leadership by surgeons and influencing factors. Leadership skills and styles. Transferred of leadership in different situations. Status gradients and hierarchy. Stress and Fatigue skills for coping and reducing negative effects. Detrimental effects of fatigue versus the beneficial effects of continuity of care. Circadian rhythms. Reducing fatigue in maintaining alertness. Effect of fatigue on performance. Effect of shift working. Factors that can offset fatigue. Assessment of non-technical skills: competence assessment. Putting them all together. Assessment methodologies in current surgical setting. What NTS adds. The underperforming surgeon and NTS. Degradation or remediation? Providing feedback on non-technical skills: coaching and debriefing in real and simulated settings. Definitions of key concepts, how to use NOTSS in the operating room and simulated operating room, methods of providing feedback, research evidence showing impact on learning and behavior, how to who should be an observer, how to train coaches. Now what? How to improve your own non-technical skills as an operating surgeon. International applications of NOTSS: Embedding non-technical skills curricula in surgical education, assessment, research. Description of international applications in Europe, Australasia, Japan, North America. Curriculum development and integration with technical skills. Faculty development. Incorporating non-technical skills in clinical and translational research programs.