10IMPORTANCE OF NON-TECHNICAL SKILLS DURING SURGERY
Importance of Non-Technical Skills during Surgery
Importance of Non-Technical Skills during Surgery
Summary of the findings
According to the questionnaire, situation awareness had positive results with most of the non-technical skills registering the score of 3. This score illustrated that the team in the operation room had gathered information before the task and had understood the information before commencing the operation that is in the evacuation of the uterus of three patients. Although the team understood the information, the response in demonstrating their skills was poor and uncoordinated with most failing to portray their skills in projecting and anticipating what was required of them hence registering the score of 1 in the SPLINT system rating. The poor anticipation led to poor decision-making and lack of coordination as the team was unable to understand and implement the surgeon’s requests leading to delays hence a score of 1 as the delays risked the patients’ health whereby one of the patients nearly lost her life due to excessive bleeding.
Communication slightly improved with an average score of 2 calling for attention on improving teamwork and communicating in the first operation where the patient almost lost her life. This resulted from the surgeon requests being unspecified to the members of the team hence leading to the inadequate passing of information. The surgeon failed to articulate the problem in time and resulted in non-verbal communication while clarification could have been more convenient. The team member responsible for ensuring that all the required tools were available leading to more waste of time and improvising that is risky for the patient (MITCHELL, & FLIN, 2008, p. 15).
Although the coordination of the team was high the leadership skills in the first operation were lacking but after the additional of a skilled practitioner to guide the trainees, leadership was evident from the beginning as the set standards were maintained although there was still room for improvement (MITCHELL, & FLIN, 2008, p. 21). The trainees in the last two operations were more coordinated as the skilled practitioner was able to guide them and support them when need arose. The shocking event of the first operation made the trainees learn the necessity of maintaining concentration, planning in advance and requesting clarification and support hence the improvement portrayed under the guidance of the practitioner leading to a score of 4 in handling pressure and supporting each other. The poor non-technical skills illustrated in the first operation improved slightly in the other operations since the team was assigned tasks and instructed to check constantly out the patient’s reactions making it easier to anticipate future complications. This led to the improved mean score of about 3 in all the categories leading to few complications and easier dealing with the issues arising hence successful operations that were safe and completed within the stipulated time unlike in the first that was disastrous.
It is clear that trainees need supervision and guidance from experienced staffs since theory alone is not enough for the trainees to portray their non-technical skills in real life situation as the data portrayed in the first operation. The data illustrates that surgeons are not the best leaders and it is hard for them to multi-task thus the necessity for experienced practitioners to offer the needed help in organizing and setting. Maintaining standards to ensure that the surgeon uses his/her technical skills thus guarantee or increase the chances of success (YULE, FLIN, MARAN, ROWLEY, YOUNGSON, & PATERSON-BROWN, 2008, p. 550).
Following the summary of the three surgeries, it is evident that non-technical skills are important in the success of any operation as when they are administered in the best possible manner, the surgeons have an easier time to concentrate on his/her technical knowledge and skills to ensure safety and success of the operation. The changing nature of the world has called for improvement of healthcare and due to the huge sums of capital invested to prolong the life expectancy thus the increment of nurses and other medical practitioners to seek knowledge in the best possible way of helping ease the task on physicians and surgeons in operational rooms. Patient’s safety being the key determinant of pressure placed on medical staffs has led to many systems that focus on determining the competence of the staffs by enabling objective rating. In addition, it has structured feedback based on non-technical skill performance, for instance, Scrub Practitioners’ List of Intraoperative Non-Technical Skills (SPLINTS) and other systems developed for anaesthetists and surgeons namely ANTS and NOTSS respectively (FLIN, R & MARAN, 2004, p. 180).
Since the first surgical operation by Sushruta in 600BC in India, surgery has been based mostly on technical skills of the surgeon, which has helped save lives of billions of people. Historical evidence proves that technical skills illustrate the undeniable importance of technical skills for instance laparoscopic cholecystectomy done in France in 1987 by Philipe that change that offered an alternative to open approach. The professionalism and knowledge became essential leading to more studies to improve surgery helping the discovery of better methods and techniques of operations that were safer. The random improvements reduced mortality but with over 254 million critical surgeries annually, safety concerns became more important than just seeking knowledge as over 7 million complications were witnessed leading to about 1 million deaths during operations (BAKER, SALAS, BARACH, BATTLES, & KING, 2007, p. 263). Technological and civilization have in time increased the number of surgical requirements due to transplantation, and other microsurgical developments in the modern population. The increment led to scrutiny of technical skills to enable safety illustrating that the main cause of deaths was due to errors that is common to every human (FLIN, O’CONNOR, & CRICHTON, 2008). These results led to many studies on the issue of negligence and other errors that can easily be overcome by using non-technical skills to help complement the technical skills of the surgeons. The aim of this paper is to critically evaluate and analyze the importance of non-technical skills by using different journals and studies on non-technical skills.
There are different definitions of non-technical skills, but they can be categorized into main types namely; cognitive thinking skills and social or interpersonal skills since they are based on situational awareness, communication, and teamwork. Different systems categorize the skills in different categories, but they are all interrelated in the broad category hence the choice to use SPLINTS categorization when identifying, evaluating and analyzing the roles of non-technical skills. SPLINTS categorizes the non-technical skills into three namely; Situation awareness that includes gathering information, recognizing and understanding information and anticipating, Communication and teamwork that includes acting assertively, exchange of information and co-coordinating with others. The last category is task management that also includes three elements namely; planning and preparing, providing and maintaining standards and coping with pressure (MITCHELL, & FLIN, 2008, p. 16). The three categories and their elements are essential in assessing non-technical skill performance hence useful in the evaluation of the roles of non-technical skills.
Roles of non-technical skills
Communication breakdown is the cause of most unwanted results in any industry or relationship, and its effects are more evident in the health sector whereby any miscommunication, inadequacy or mis-interruption is fatal or leads to harming the patients in future. In about 258 retrospective reviews of closed malpractices, claims that portray that although 82% of the cases were caused by system errors more than 24% of the system errors were due to communication breakdown. Most of the reviews claim that the main communication breakdown happens during handoff whereby the lack of handing over the handoff due to poor teamwork skills threatens the life of patients from OR to the wards or transfer to other hospitals. According to the National Patient Safety Agency quote in FLETCHER, FLIN, MCGEORGE, GLAVIN, MARAN, & PATEY, 2003, p. 584, “Handover of care is a perilous procedure in medicine, and when conducted poorly can contribute to subsequent error and harm to patients.” The handoffs are simple tasks that can complicate and reduce the safety of the patients hence the need for non-technical skills that will ensure co-ordination and effective communication of the team that is from the OR team to the clinicians. The current handoff is below requirements for effective communication and teamwork as illustrated by several studies, hence calling for improvements that will enable standardization to improve communication skills and willingness to work as a team for the sake of patients’ safety.
Great leaders are known for their planning, making a hard decision and implementing the plans while involving others in the effort of pursuing a common objective. Leadership skills are becoming fundamental in surgical practice due to the necessity planning, overcoming complications during operations and ensuring teamwork in and outside OR. The leadership qualities are not hierarchical hence the need for the team to negotiate or air solutions during times of urgent need making it important for the non-technical skills essential in surgical practice. It is necessary for one to note that just as other industries need great leaders, the health industry is not an exception and with the changing trend in the medical fields, every opinion matters in the success of any surgical practice. According to SPLINTS handbook, leadership is key in ensuring composure during complications which is necessary for enabling effective communication, creative and critical thinking as panic would cause more harm to the complicated issue thus it is clear to note that non-technical skills that are more used to illustrate individual leadership qualities are important (MITCHELL, & FLIN, 2008, p. 17).
The rampant spending by various government on healthcare portrays the necessity and seriousness of patients’ safety issue and improvement of Medicare. The increment of information is increasing at an increasing rate making it difficult for surgeons to read every detail hence making it a requirement to consult with other members of the team. This is a purely technical skill, but the ability to consult and willingness to listen to opinion from the juniors is a great personal value that can be easily be categorized in the social and interpersonal relationship thus making it a non-technical skill, which changes or determines the success of any surgical practice.
Evaluation of Non-technical Skills Audit
The summary of the role played by non-technical skills makes it mandatory to analyze the non-technical skills audits. The increasing number of auditing systems makes it difficult to figure out the best auditing system thus the paper uses the main auditing systems. Thus, the paper used the key areas audited based on the three categories used by SPLINTS system since it gives room for feedback. Communication being the main focus as illustrate in the roles played by non-technical skills determines the success of OR results thus the audit will help identify the main shortcomings and improvements needed to foster improved communication and teamwork (SEDALIS, UNDRE, HENRY, SYDNEY, KOUTANTJI, DARZI, & VINCENT, 2009, p. 1188). The audits help new practitioners develop the necessary non-technical skills and enable brighter careers whereas experienced practitioners may learn the necessary skills need to help guide and improve the outcomes in future. Some practitioners may not be aware that their personal values hinder communication thus auditing makes them aware and learn to improve their social skills that are essential in surgical practices (FLIN, & MITCHELL, (Eds.) 2009).
Preparation and ability to overcome complication is vital for the success of surgical operations but it may seem as repetitive to some or personal negligence may lead to poor preparations, which in turn results in delays, poor co-ordination, and blame in the OR. Thus, it is necessary for the audit systems to record to illustrate the cause of delays, complications, and negligence in the attempt of enabling better preparations, which will ensure easier dealing with complications.
The summary provides detailed analysis on the issue of non-technical skills by using a brief background on surgical practice and the changes over the years that has led to the increment of the roles of non-technical skills. It is crucial to note that the summary does not discredit the role played by technical skills thus the discussion on its role, but it portrays that technical skills must be complimented with effective non-technical skills to enhance patients’ safety. The roles discussed are essential hence the need for audits to keep in check and give feedbacks on the needed changes.
. Mahwah, NJ: Lawrence Erlbaum Associates, pp. 259-271.The relationship between teamwork and patient safety. In P. Carayon (Ed) Handbook of human factors and ergonomics in health care and patient safetyBAKER, D.P., SALAS, E., BARACH, P., BATTLES, J. & KING, H. (2007).
. British Journal of Anaesthesia, 90, 580-588.Anaesthetists’ Non- Technical Skills (ANTS): evaluation of a behavioural marker systemFLETCHER, G., FLIN, R., MCGEORGE, P, GLAVIN, R., MARAN, N. & PATEY, R. (2003).
Identifying and training non-technical skills for teams in acuteFLIN, R & MARAN, N. (2004).
Farnham: Ashgate.FLIN, R. & MITCHELL, L. (Eds.) (2009). Safer Surgery: Analysing Behaviour in the Operating Theatre.
medicine. Quality & Safety in Health Care, 13 (suppl II), 180-184. Aldershot: Ashgate.Safety at the Sharp End. A Guide to Non-Technical Skills.FLIN, R., O’CONNOR, P. & CRICHTON, M. (2008).
, 63, 15-24Journal of Advanced Nursingreview. MITCHELL, L. & FLIN, R. (2008). Non-technical skills of the operating theatre scrub nurse: literature
, 46, 1187-1193.Development, initial reliability and validity testing of an observational tool for assessing technical skills of operating room nurses. International Journal of Nursing StudiesSEDALIS, N., UNDRE, S., HENRY, J., SYDNEY, E., KOUTANTJI, M., DARZI, A. & VINCENT, C.A. (2009).
, 32, 548-556.Surgeons’ non-technical skills in the operating room: Reliability testing of the NOTSS behaviour rating system. World Journal of SurgeryYULE, S., FLIN, R., MARAN, N., ROWLEY, D. R., YOUNGSON, G.G. AND PATERSON-BROWN, S. (2008).