Development and application of a non-technical skills coaching intervention framework for surgeons: A pilot quality improvement initiative

Non-technical skills (NTS) challenges experienced by surgeons may degrade performance, ultimately impacting the safety and quality of care delivered to patients. The objectives of this work were to develop a framework for NTS coaching for surgeons and implement a coaching program utilizing the developed NTS coaching framework. Leveraging adult learning and self-determination theories, a specialty-agnostic NTS coaching framework was developed for individual coaching sessions with robotic surgeons. The framework was used to deliver NTS coaching sessions to robotic surgeons. Surgeon's robotic procedures were recorded, and expert raters assessed their NTS using the Non-Technical Skills for Surgeons tool. Measures of surgeon satisfaction, learning outcomes, and performance improvement were determined. Cohen's d statistic was used to estimate the effect size of the coaching intervention. To pilot the program, ten robotic-assisted surgeries (five pre-coaching and five post-coaching) were observed from five practicing robotic surgeons who were recruited from a large academic healthcare system. Expert raters' assessment of surgeons' NTS revealed several exemplar and non-exemplar behaviors. Surgeons were satisfied with the coaching, rating its quality very highly on all NTS dimensions. On a Likert scale of 1 (strongly disagree) to 5 (strongly agree), surgeons had a stronger agreement that the coaching could improve their situation awareness (4.0±.5) and leadership (4.8±.2) skills compared to their decision making and communication (3.8±.7). From the post-coaching observations, coaching had medium-to-large effect on situation awareness (d = .65) and leadership (d = .41), small effect on communication and teamwork (d = .14), and no effect on decision-making. Overall, the coaching intervention had a medium effect on total NTS (d = .33). We presented a quality improvement initiative to enhance the NTS of surgeons by implementing a coaching program that leverages our developed NTS framework. Recognizing the importance of NTS in surgeries, our initiative shows a commitment to continuous improvement of patient safety and quality of care.