Understanding the influence of human and organizational factors on surgeon performance to enhance patient outcomes: experimentalevaluation of a customized coaching program – TOPSURGEONS

Background: Individual performance of surgeon is a core element of successful surgery that can vary greatly over career for poorly understood reasons. Solutions to optimize physical and mental condition of surgeon during operation have not been thoroughly explored so far, while this may represent basic foundation for delivering high quality surgery. Inspired from previous experiences in the aeronautic and sport arena to improve pilots and athletes performance, our approach will take place in real time at the point of care in close collaboration with front-line personnel.
Objectives: This surgeon-centred outcome research pursues three successive goals: 1-Identifying the key determinants related to surgeon's personal condition and operating room environment influencing his/her performance in terms of patient safety and care efficiency; 2- Developing a customized coaching program for surgeons based on the human and contextual factors previously discovered, which includes a charting system for surgical outcomes feedback, profiling of individual surgeon, and tailored modules of improvement; 3- Implementing and measuring the impact of this program on surgical outcomes of a randomized group of surgeons against a control group of non-exposed surgeons.
Methods: We shall conduct prospectively a multicentre cluster randomized trial in six surgical departments of a university hospital. Pre-intervention period will first serve as an observational phase to collect a large set of data on operating rooms environment, surgeons' individual parameters and patient outcomes. Data will be collected prospectively and gathered into a unique data warehouse from various sources, including the routinely collected data in the hospital information system, connected sensors wore by surgeons, clinical examinations and neuropsychology testing, direct observations in the operating room, and various questionnaires. Those information will in turn be exploited to reveal human and organizational determinants of surgeon performance, and to develop a coaching program customized to every surgeon according to his/her own needs and preferences. Then, coaching will be experimentally tested during the intervention period. Surgeons will be randomly assigned between two parallel arms according to major adverse events collected during the pre-intervention period in order to guarantee similar primary outcomes between arms at baseline. Customized coaching will then be implemented for surgeons allocated to the intervention arm, while no sham action will be undertaken among the surgeons allocated to the contemporary control arm. Trends in surgical outcomes (major adverse event and operative time) from the pre-intervention to the intervention periods will be compared between trial arms in order to identify any improvement caused by customized coaching.
Consequences: A particular attention will be paid to quantify the influence of several factors that may affect how the surgeon operates every day (i.e., physical and mental state, physiological parameters, workload, daily-life occupancies, and sleep quality). Generated knowledge on these factors will be exploited for identifying deficiencies that, if corrected, could improve surgeon's functional capacity. Solutions to control these factors and achieve optimal outcomes will then be experimentally tested to establish evidence-based standards of surgical practice. Those standards will be adapted to each surgeon's needs and preferences, potentially leading to a certification model for surgeons complying with excellence criteria.