Impact of surgical non-technical skills on clinical outcomes: systematic review
3
Issued Date
2026-01-01
Resource Type
ISSN
00071323
eISSN
13652168
Scopus ID
2-s2.0-105026222681
Pubmed ID
41459916
Journal Title
British Journal of Surgery
Volume
113
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
British Journal of Surgery Vol.113 No.1 (2026)
Suggested Citation
Norton J., Janda A.M., Howie E., Pohl N., Abahuje E., Harrington S.D., Popov V., Bauer T.M., Borges P., Roca G.Q., Mathis M.R., Strobel R.J., Airhart A., Pham N., Harari R., Awtry J.A., Pagani F.D., Dias R.D., Likosky D.S., Yule S., Epperson T., Krein S., Manojlovich M., Rafferty M., Ariyo P., Sirihoracha R., Wojcik B. Impact of surgical non-technical skills on clinical outcomes: systematic review. British Journal of Surgery Vol.113 No.1 (2026). doi:10.1093/bjs/znaf271 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114706
Title
Impact of surgical non-technical skills on clinical outcomes: systematic review
Author(s)
Author's Affiliation
Harvard Medical School
University of Michigan, Ann Arbor
Johns Hopkins University
Harvard University
Brigham and Women's Hospital
University of Michigan Medical School
Indiana University School of Medicine
Mahidol University
University of Virginia School of Medicine
The University of Vermont
Edinburgh Medical School
Royal Infirmary of Edinburgh
Georgetown University School of Medicine
Mass General Brigham
University of Michigan School of Nursing
Munson Medical Center
Henry Ford Macomb Hospital
University of Michigan, Ann Arbor
Johns Hopkins University
Harvard University
Brigham and Women's Hospital
University of Michigan Medical School
Indiana University School of Medicine
Mahidol University
University of Virginia School of Medicine
The University of Vermont
Edinburgh Medical School
Royal Infirmary of Edinburgh
Georgetown University School of Medicine
Mass General Brigham
University of Michigan School of Nursing
Munson Medical Center
Henry Ford Macomb Hospital
Corresponding Author(s)
Other Contributor(s)
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.