Behavioural markers of surgical excellence

Abstract This paper applies the concept of behavioural markers of performance, previously used to understand the characteristics of the most successful aviation crews (Connelly, E.P., 1997. A Resource Package for CRM Developers: Behavioural Markers of CRM Skill From Real World Case Studies and Accidents. University of Texas Crew Research Project Technical Report, pp. 97–103; Helmreich, R.L., Merritt, A.C., 1998. Culture at Work in Aviation and Medicine: National, Cultural and Professional Influences. Ashgate Publishers, Aldershot, UK), to a surgical domain. A framework of ‘behavioural markers’ of surgical excellence was developed based on existing research. This framework was used to explain differences in ‘procedural excellence scores’ amongst a group of sixteen UK paediatric cardiac surgeons who had participated in a multi-centre UK study on the influence of human factors on surgical outcomes. Procedural exellence scores were derived from multivariable logistic regression models of the number of major and minor events (i.e. errors) per case, adjusted for known patient risk factors. Two binary outcomes were predicted; death and death and/or near miss. Results showed that those surgeons with the best scores (surgeons 3, 5, 8 and 14) were characterised by more of the behavioural markers than surgeons with lower scores. It is concluded that although behavioural markers have proven a useful method to explain performance differences between surgeons, further research is needed to validate and quantify the markers developed in this study and to test their applicability in other medical domains.