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Correlates of non-technical skills in surgery: a prospective study
  1. Brigid M Gillespie1,2,3,
  2. Emma Harbeck4,
  3. Evelyn Kang1,
  4. Catherine Steel5,
  5. Nicole Fairweather5,
  6. Wendy Chaboyer3
  1. 1School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
  2. 2Gold Coast University Hospital, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
  3. 3National Centre for Research Excellence in Nursing (NCREN), Menzies Health Institute Qld (MHIQ), Griffith University, Gold Coast, Queensland, Australia
  4. 4School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
  5. 5Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  1. Correspondence to Professor Brigid M Gillespie; b.gillespie{at}


Background Communication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams’ non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS.

Methods We assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams’ NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores.

Results We observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R2 0.12, p<0.001) to 24% (adjusted R2 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams’ NTS were observed.

Conclusions Miscommunications and interruptions impact on team NTS performance.

  • miscommunications
  • interruptions
  • teamwork
  • non-technical skills
  • surgical team

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors BMG conceived of the study, assisted in data analysis, interpreted results and drafted the manuscript. EH performed data analysis and assisted in interpretation. WC assisted in analysis and interpretation. EK, CS and NF assisted in recruitment and interpretation. All authors participated in the coordination of the study and read and approved the final manuscript.

  • Funding BMG acknowledges the financial support of the Australian Research Council, Early Career Discovery Fellowship Scheme and the National Centre for Excellence in Nursing Research (NCREN).

  • Competing interests None declared.

  • Ethics approval Metro South Health Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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