Safer Surgery part 39. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. | 354 Safer Surgery base on surgical training and technical performance the technical skill of the surgeon . surgeons motor skill has been recognized as a factor that mediates the relationship between patient risk factors and patient outcomes . Aggarwal et al. 2004 Dankelman and DiLorenzo 2005 Fried and Feldman 2008 . In the past five years it has been proposed that this relationship should be qualified further. A number of other skills and factors have been suggested as potential determinants of performance and outcomes alongside motor skills. These include cognitive and behavioural skills and also other factors such as the operating theatre environment and procedures. Because of its multi-factorial perspective on surgical performance error and outcome this approach has been termed the systems approach Calland et al. 2002 Healey and Vincent 2007 Vincent et al. 2004 . The systems approach to surgical performance is novel and thus the existing conceptual and empirical work that stems from it is still somewhat limited. Interpersonal and cognitive skills are required for many occupations specific subsets of such skills have been identified in the relevant literature as being essential for surgeons Healey et al. 2006a Yule et al. 2006 . On the one hand there are skills that are related to the way the operating surgeon interacts with other members of the operating theatre team - including assistant surgeon s and members of the anaesthetic and nursing sub-teams. On the other hand there are the skills that reflect surgeons cognitive competence such as decision-making. These skills are complementary to the manual dexterity of the surgeons and they have been termed collectively non-technical skills . The working hypothesis for non-technical skills is that they contribute to surgical patient safety. The focus of this chapter is on one of these non-technical skills namely decision-making. Decision-making is becoming increasingly prominent in the surgical skills and .
