Human factors


prevents adequate education of new nurses, surgeons, doctors and other medical staff. The open discussion about errors and


hindrances to collective learning should be a quality improvement in learning and support for the new generation. Ultimately, fear can turn into perpetuating silence and defensiveness within the team. Toxic theatre culture not only affects healthcare workers, but also patients in the process – from diagnosis, through to surgery, and all other treatments. Patients are directly


SKILL Communication WHAT Clear, respectful, and


structured communication is the cornerstone of effective teamwork in the operating theatre.


HOW


Tools like SBAR (Situation-Background- Assessment-Recommendation) and closed-loop communication ensure that information is accurately conveyed and confirmed. Encouraging all team


members to voice concerns or suggestions,


regardless of rank, helps build psychological safety.


Teamwork and Collaboration


A culture that values collective


success over individual performance promotes better coordination and resource sharing.


Effective teams demonstrate an


understanding of each other’s roles and foster a sense of shared purpose. Team


briefings and debriefings, for instance, provide opportunities for all members to align on objectives, anticipate challenges, and reflect on what went well and what can be improved.


Leadership


Leadership in the operating theatre should not be limited to positional authority. Effective leaders, regardless of role, exhibit emotional intelligence, adaptability, and the ability to inspire and support their team goals.


Encourage participation, promote accountability, and maintain focus on patient-centred goals.


Regular evaluation of team performance and individual non-technical skills helps identify strengths and areas for development.


Senior leaders and consultants must model non-technical behaviours and actively support a culture of inclusivity and continuous improvement. Policies and leadership practices should prioritise safety culture


and psychological safety. Encouraging feedback from all levels of staff demonstrates that everyone’s voice matters.


Situational Awareness


Situational awareness refers to the ability to perceive, understand, and anticipate factors that impact the current and future status of the operating theatre.


Decision-Making


Intraoperative decision-making can be complex and time-sensitive.


Non-technical skills enhance decision making by incorporating diverse perspectives, mitigating cognitive biases, and fostering structured problem solving approaches.


Stress and Fatigue Management


Operating theatre personnel often work long hours under intense pressure, which can impair


performance. Team members should be encouraged to support one another and speak up when someone appears overwhelmed.


Table 1: Guide to non-technical skills development 46 www.clinicalservicesjournal.com I July 2025


Involves monitoring the patient’s condition, the progress of the surgery, the functionality of equipment, and the mental state of team members.


Teams that make decisions collectively and transparently are more resilient in the face of uncertainty.


Situational awareness is shared across the team, enabling faster, more coordinated responses to evolving circumstances.


Simulation training is particularly effective, allowing teams to practice skills in realistic, risk-free environments


IMPLEMENT


Structured training programmes such as the Non-Technical Skills for Surgeons (NOTSS), Anaesthetists’ Non-Technical Skills (ANTS), and Scrub Practitioners’ List of Intraoperative Non-Technical Skills (SPLINTS) provide evidence-based frameworks.


Implement regular team briefings & debriefings. Briefings before a procedure allow team


members to introduce themselves, clarify roles, and discuss the plan. Debriefings after procedures provide a space for feedback, reflection, and continuous learning.


Feedback should be constructive, specific, and oriented toward growth.


Training in stress recognition and coping strategies helps individuals remain composed and maintain performance.


Encouraging collaboration across professional boundaries promotes a deeper understanding of each team member’s contributions. Interdisciplinary training and teambuilding activities help break down silos and foster respect.


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