Leadership and working in teams

Leadership and teamwork are essential components of surgical practice and now recognized in the Generic Professional Capabilities framework from the GMC. Surgical application of these skills can be usefully explored through the NOTSS (Non-Technical Skills for Surgeons) taxonomy. This identifies the essential elements of performance in key areas: exchanging information; establishing a shared understanding and co-ordinating team activities (for teamwork); and setting and maintaining standards, supporting others and coping with pressure (for leadership). In addition, there are a number of well-evidenced tools and techniques which can be utilized to improve performance. This includes team briefing and debriefing, closed loop communication, SBAR (situation, background, assessment, recommendation), graded assertiveness and 'flying by voice'. Practising and integrating these techniques into surgical practice can improve individual and overall team performance. Finally, to optimize our performance requires careful balancing of each non-technical element to stretch and develop teamwork while providing support and maintenance of a healthy working environment. And of course, always aligning these developments with the goal of improvement in patient care.