Relationship Between Surgeon Nontechnical Skills and Operating Team Efficiency: A Mixed-Methods Study

Intraoperative nontechnical skills are necessary for optimal patient care. The aim of this study was to investigate how surgeons' intraoperative nontechnical skills influence operating team efficiency.

We conducted a convergent parallel mixed-methods study through nonparticipant observations of the surgical teams at 1 urban academic hospital from February to August 2022. The Nontechnical Skills for Surgeons (NOTSS) rating tool was used to assess the surgeons' intraoperative nontechnical skills. NOTSS scores for each surgeon were then compared with 3 quantitative measures of operating room efficiency: proportion of first case on-time start, actual to expected length of the operation, and turnover within the expected time.

We observed 167 procedures performed by 45 surgeons for 351 hours. For every unit increase in NOTSS score, there was a significant increase of 28.1 (95% CI 25.8 to 30.4) in the proportion of first case on-time start, a significant increase of 22.1 (95% CI 19.3 to 23.9) in the proportion of actual to expected length of the operation, and a significant increase of 74.8 (95% CI 65.2 to 84.3) in the proportion of case turnover within the expected time. Three themes emerged from our qualitative data: (1) preoperative planning ensured an on-time start, (2) verbal and nonverbal cues indicated the end of the operation, and (3) surgeons with effective nontechnical skills debrief on the performance of the current operation and plan or brief for the next operation.

This study revealed a positive association between NOTSS score and surgical team efficiency. Communication was key to team situational awareness across different phases of the operation. These findings may inform the design of interventions to improve operating room efficiency.