How Non-Technical (Soft) Skills Actually Impact Surgical Outcomes

Previously, we explored on this blog how technical skills can impact surgical outcomes. But, recent studies show how poor non-technical skills could be a significant cause of adverse events in the OR.

It’s been 20 years since the Institute of Medicine (IOM) released the landmark publication “To Err is Human: Building a Safer Health System”, highlighting teamwork as an important factor for improving patient safety during surgery. Despite the findings from this report, shortcomings in non-technical skills – such as teamwork, communication, decision-making, and coping with stress –  continue to be identified as important contributors to adverse events occuring in the OR.

Typically, breakdowns in nontechnical skills lie at the heart of harm and near-misses in the OR and are the primary causes of surgical errors worldwide. A study published in JAMA Surgery reports that patients operated by surgeons who displayed poor non-technical skills or showed unprofessional behavior in the 36 months before the patient’s operation appeared to experience a higher rate of postoperative complications.

Among 13,653 patients in the cohort study undergoing surgery, performed by 202 surgeons, patients whose surgeons had a higher number of coworker reports had a significantly increased risk of surgical complications.

Flipped around, researchers have also looked into the effects of working with those surgeons exhibiting a higher-level of nontechnical skill. Researchers at UK’s National Institute for Health Research (NIHR) identified 2,041 articles for study, 341 articles were retrieved for evaluation, 28 were accepted for review and 21 articles were finally assessed. Data was extracted from the articles regarding sample population, study design and setting, measures of nontechnical skills and technical performance.

The results from the study show that receiving feedback and effectively coping with stressful events in the OR can impact technical performance in a positive way. Additionally, surgeons are prone to make less number of errors when they are not functioning under stress or fatigue. One article found a strong positive correlation between the anesthesiologists’ nontechnical skills and anesthetic technical performance. Six other articles assessed the impact of various nontechnical skills of the entire OR team on surgical performance and a strong correlation between teamwork failure and technical error was empirically demonstrated in these studies.

Conclusion and Moving Forward

Evidence from various research studies point out that nontechnical aspects of performance can strengthen or, if lacking, weaken surgeons’ technical performance. Currently, most nontechnical skill training for surgeons are delivered in-person at national surgical conferences, or locally in the hospitals with OR teams in a simulated environment. But web-based platforms can also be used to transform training and assessment for surgeons’ nontechnical skills. A surgical coaching and training web based platform removes the limitations of in-person intraoperative assessments and coordinating surgeons’ schedules for direct observation. Online surgical skill assessments would also enable surgeons to receive considerably more evaluations than from in-person assessments and play a pivotal role in enhancing their non-technical skills.