Making surgery safer: non-technical skills of anaesthetists, surgeons, and operating room nurses

The operating theatre is a high-risk domain. Effective, safe anaesthesia and surgery require competence in both clinical skills and in non-technical skills, such as communication and teamwork. Unlike other potentially hazardous occupations (e.g. in aviation), non-technical skills have not been specifically addressed by the medical professions. Patient safety research by Professor Flin and colleagues revealed that failures in these skills are a common healthcare risk. 

Based on her involvement in research into the non-technical skills of airline pilots, Professor Flin led a series of multidisciplinary studies, at the University of Aberdeen, designed to identify and evaluate non-technical skills for operating theatre staff.

The research was applied to the work of anaesthetists, surgeons and other medical practitioners and its results have been incorporated into professional standards in several countries. The findings are being incorporated into the curriculum for UK surgical training (Intercollegiate Surgical Curriculum Programme - ISCP) in all surgical specialities.

Find out more

Key publications

  • Flin, R., Youngson, G. & Yule, S. (2015) (Eds.) Enhancing Surgical Performance. A Primer on Non-Technical Skills . London: CRC Press.
  • Fletcher, G, Flin, R, McGeorge, P, Glavin, R, Maran, N, & Patey, R. (2003). Anaesthetists' Non-Technical Skills (ANTS): Evaluation of a behavioural marker system. British Journal of Anaesthesia, 90 (5), 580 - 588.
  • Flin, R, Fletcher, G, McGeorge, P, Sutherland, A & Patey, R. (2003) Anaesthetists’ attitudes to teamwork and safety. Anaesthesia, 58, 233-242.
  • Yule, S, Flin, R, Maran, N & Paterson-Brown, S. (2006). Non-technical skills for surgeons in the operating room: A review of the literature. Surgery, 139, 140-149.
  • Yule, S, Flin, R, Paterson-Brown, S, & Maran, N. (2006). Development of a rating system for surgeons’ non-technical skills. Medical Education, 40, 1089-1044.
  • Yule, S, Flin, R, Maran, N, Rowley, D R, Youngson, G & Paterson-Brown, S. (2008). Surgeons' non-technical skills in the operating room: Reliability testing of the NOTSS behaviour rating system. World Journal of Surgery, 32, 548-556.
  • Mitchell, L, Flin, R, Mitchell, J, Coutts, K. & Youngson, G. (2012). Evaluation of the Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) system. International Journal of Nursing Studies, 49, 201-211.