Dora Bilan explains why the adoption of non-technical skills is essential for ensuring effective and efficient operating theatres and discusses the need for strategies to help minimise the high-pressure environment of the workplace.
In the operating theatre's specific and high-pressure environment, efficiency, effectiveness, and patient safety are paramount. The technical skills of the operating theatre team are recognised and expanded to protect patients from harm, neglect or even death. All teams make sure that each surgery step is correct and based on evidence-based practice to prevent incidents that can affect the patient and the team. It comes with competence, clinical expertise, communication skills and life experience.1
The operating theatre, with its specific environment, demands precision, coordination, and efficiency.2 While technical skills are essential for safe surgical outcomes, increasing attention to non-technical skills (NTS) can enhance surgical team performance and improve not only patient outcomes but also the operating theatre's performance. Non-technical skills encompass cognitive, social, and personal resource skills that complement technical competencies and support safe and effective task performance. These skills include communication, teamwork, leadership, decision-making, situational awareness, and stress management. By embedding non-technical skills into the culture of the operating theatre, healthcare institutions can create a more collaborative, resilient, and safety-oriented environment for patients and the team.
Traditionally, operating theatre culture has been hierarchical, with clear divisions between roles — surgeons, anaesthetists, scrub nurses, circulating nurses, and operating department practitioners (ODPs). While role clarity is important, such hierarchies have often stifled communication and discouraged team members from speaking up, particularly when concerns about patient safety arise. This dynamic or hierarchy can lead to errors, miscommunication, human factors issues and a lack of cohesion.3 Furthermore, the stress and pace of surgical procedures can create an emotionally charged environment, contributing to burnout, disengagement, and ineffective teamwork. In such conditions, a strong culture grounded in mutual respect, open communication, and shared responsibility becomes essential.4,5
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