Making Surgery as Safe as It Should Be: A Qualitative Study

Abstract

Existing literature supports the view that adverse outcomes from surgical interventions are more likely to be the result of degraded nontechnical skills (NTS) rather than the technical skills of surgeons. In the present context, NTS comprise the behaviors and cognitions deployed by surgeons to make decisions, maintain awareness of the operating environment, communicate with and lead supporting personnel. A contemporary safety thesis suggests that focusing on what makes things go right (eg, NTS) is far more productive than retrospective analysis (learning from mistakes). The present qualitative research explored how surgeons deploy NTS to facilitate safe and effective outcomes from surgical interventions. The thematic analysis revealed that this surgical cohort engaged specific self-regulated NTS along an intervention construct consisting of planning, implementation, monitoring progress, and deliberate learning through reflection during the preoperative, operative, and postoperative phases of care. Behaviors supporting these contentions were identified in the data and used to amplify use of the construct.