Strengthening Perioperative Patient Safety Through Non-Technical Skills Training Among Surgical Teams at Hakim Gezaw Teaching Hospital, Ethiopia
Author Affiliations
- Department of Anesthesia, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
- The Operating Room Global (TORG).
- The Robotic Global Surgical Society (TROGSS).
- UL Hospitals, Ireland.
- University of Limerick, Limerick, Ireland.
- Department of Medicine, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
Corresponding author: Melkam Mulugeta Abebe · [email protected]
Abstract
Background: Non-technical skills such as communication, teamwork, situational awareness, decision-making, adaptability, task management and leadership are important for patient safety during surgery. Evidence evaluating context-adapted multidisciplinary interventions and their relationship with patient-level safety outcomes remains limited in low- and middle-income countries, including Ethiopia.
Aim: To assess changes in non-technical skills following context-adapted training and examine selected perioperative patient safety outcomes at Hakim Gezaw Teaching Hospital, Ethiopia.
Methods: A mixed-methods quasi-experimental pre–post study included 24 multidisciplinary operating-room professionals and 672 adult surgical patients. Staff non-technical skills were assessed before training, immediately afterwards and at one month using an eight-item, five-point Likert-scale instrument informed by NOTSS, ANTS and SPLINTS frameworks. Linear mixed-effects models assessed changes in staff scores. Patient outcomes were compared between 336 pre-intervention and 336 post-intervention patients. Focus group discussions were analysed thematically and integrated with quantitative findings.
Results: Mean overall non-technical skills scores rose from 3.36 ± 0.37 at baseline to 3.82 ± 0.34 immediately after training and 4.04 ± 0.61 at one month. Adjusted mean differences versus baseline were 0.464 (95% CI 0.161–0.766) immediately after training and 0.679 (95% CI 0.373–0.985) at one month. Situational awareness, adaptability and task management showed significant improvement. The post-intervention period was associated with fewer adverse events, care delays and communication-related safety events, alongside higher patient satisfaction. Qualitative findings described improvements in teamwork, communication, shared awareness, coordination and speaking up.
Conclusion: Context-adapted training was associated with improved team non-technical skills, maintained at one month. Concurrent improvements in patient outcomes cannot be attributed causally to the intervention because the study had no control group. Routine integration, refresher training and supportive leadership may help sustain improvements.
Keywords: Non-technical skills; Patient safety; Teamwork; Communication; Operating room; Ethiopia.
Study Highlights
| Overall NTS assessment | Participants | Mean score (SD) |
|---|---|---|
| Before training | 24 | 3.36 (0.37) |
| Immediately after training | 24 | 3.82 (0.34) |
| One-month follow-up | 23 | 4.04 (0.61) |
Patient safety outcomes
| Outcome | Before (n=336) | After (n=336) |
|---|---|---|
| Perioperative adverse events | 40 (11.9%) | 6 (1.8%) |
| Delays in care | 54 (16.1%) | 18 (5.4%) |
| Communication-related safety events | 13 (3.9%) | 1 (0.3%) |
| Patient satisfaction, mean (SD) | 2.97 (1.44) | 3.70 (1.29) |
Descriptive figures reproduced from Tables 2 and 5 of the published article; consult the full PDF for statistical analyses and limitations.
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Declarations & Ethics
Ethical approval: Asrat Woldeyes Health Science Campus Institutional Review Board (AWHSC-IRB-447), 17 March 2026.
Informed consent: Written informed consent was obtained from participating surgical team members and patients, as applicable, as described in the article.
Conflicts of interest: None declared.
Funding: No funding received.
Authors’ contributions: Abebe: conceptualisation, methodology, analysis and drafting; Owokole: supervision, methodology and critical revision; Demelash: investigation, resources and editing; Kebede: investigation and data curation; Tadesse: investigation and editing. All authors approved the manuscript.
Acknowledgements: The article acknowledges the TORG Research Fellowship Programme, mentorship support and Debre Berhan University.
Publication Information
Accepted: 14 October 2026
Published online: 16 October 2026
ISSN 3105-3262
Volume 2, Issue 4 (December 2026), pp. 23–39
Creative Commons Attribution 4.0
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The full text, study methodology, results tables, discussion, limitations and references are available in the published PDF.