Impact of surgical non-technical skills on clinical outcomes: systematic review
Recommended Citation
Norton J, Janda AM, Howie E, Pohl N, Abahuje E, Harrington SD, Popov V, Bauer TM, Borges P, Querejeta Roca G, Mathis MR, Strobel RJ, Airhart A, Pham N, Harari R, Awtry JA, Pagani FD, Dias RD, Likosky DS, and Yule S. Impact of surgical non-technical skills on clinical outcomes: systematic review. Br J Surg 2025;113(1).
Document Type
Article
Publication Date
12-24-2025
Publication Title
The British journal of surgery
Keywords
Humans, Leadership, Clinical Competence, Communication, Surgical Procedures, Operative, Postoperative Complications, Operating Rooms, Surgeons
Abstract
BACKGROUND: Deficiencies in non-technical skills (NTS) such as leadership and communication can lead to intraoperative inefficiency and error. However, the relationship between these skills and patient-level outcomes has yet to be synthesized. The aim of this study was to systematically review the evidence examining the relationship between intraoperative NTS and clinical outcomes.
METHODS: The PubMed, Embase, CENTRAL, CINAHL, and PsycINFO databases were searched for relevant studies published between inception and 1 November 2024. Eligible studies assessed NTS of operating room personnel, were conducted in non-simulated environments, and reported clinical outcomes. NTS were categorized into five core domains including leadership and communication. Patient-level outcomes comprised eight clinical measures including mortality and postoperative complications.
RESULTS: Of 6313 screened studies, 21 met the inclusion criteria. Included studies represented 8536 participants performing 251 180 procedures across 13 specialties. Eleven observational studies assessed NTS of surgical personnel via study participants or observers. Ten interventional studies introduced NTS team training initiatives. Twelve of 21 studies (57%) incorporating 247 036 of all procedures (98.4%) reported significant improvements in clinical outcomes. Nine of 11 observational studies (82%) reported significant improvement in clinical outcomes compared with 3 of 10 interventional studies (30%). No studies demonstrated a significant deterioration in clinical outcomes associated with improved NTS.
CONCLUSION: Published evidence shows a significant link between intraoperative NTS and patient-level outcomes. These findings reinforce the value of behavioural assessment in surgery, support evidence-based team training, and underscore the need to embed NTS into regulatory frameworks to improve surgical quality and safety worldwide.
Medical Subject Headings
Humans; Leadership; Clinical Competence; Communication; Surgical Procedures, Operative; Postoperative Complications; Operating Rooms; Surgeons
PubMed ID
41459916
Volume
113
Issue
1
