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Non-Technical Skills, Rather than Technical Skills, Predict the Severity of Surgical Complications
*Alexandra Briggs, *Steven J Yule, Edward Whang, *Wei Jiang, Michael J. Zinner, Douglas S. Smink
Brigham and Women's Hospital, Boston, MA
Objective:
Surgical complications are often attributed to failures of technical skills (TS). Recent research suggests that non-technical skills (NTS) also contribute to surgical errors. We explored the contribution of TS and NTS to the severity of complications presented at Morbidity and Mortality (M&M) conference.
Design:
Survey based study
Setting:
M&M conferences in an academic surgery department
Patients/Participants:
Surgical faculty and residents
Interventions:
Surveys were distributed to faculty and residents at weekly M&M conferences
Main Outcome Measures:
Respondents rated the contribution of TS, NTS and patient factors (PF) to each complication on a scale of 0 (none) to 5 (significant). Complication severity was scored from 0 (not severe) to 5 (extremely severe). The categories of Situation Awareness, Decision Making, Communication/Teamwork and Leadership from the Non-Technical Skills For Surgeons (NOTSS) system were individually rated. Stepwise regression analysis was used to determine the effect of TS, NTS and PF on complication severity. NTS were analyzed collectively and were subdivided into Cognitive (Situation Awareness and Decision Making) and Social Skills (Communication/Teamwork and Leadership).
Results:
484 surveys were collected for 25 surgical cases. Increasing failure of NTS was associated with increasing complication severity (estimate=0.182,p=0.0002). Patient factors were also associated with increasing severity (0.118,p=0.019). Interestingly, failure of TS was inversely related to severity (-0.115,p=0.030). When cognitive and social skills were analyzed separately, only cognitive skills contributed to complication severity (0.120,p=0.012).
Conclusions:
Surgical complications are more likely to be severe when there are deficiencies in non-technical skills, rather than technical skills. Of NTS, cognitive skills contribute to complication severity more than social skills. Education aimed at improving surgeons’ non-technical skills could reduce complication severity.
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