Periodic Reporting for period 4 - TopSurgeons (Understanding the influence of human and organizational factors on surgeon performance to enhance patient outcomes: experimental evaluation of a customized coaching program)
Período documentado: 2023-08-01 hasta 2025-01-31
The factors contributing to surgical complications remain not fully understood. Previous research has primarily focused on patient-related preoperative characteristics and the complexity of delivered care. However, the surgeon’s performance during the operation is a key determinant of surgical outcomes. This surgeon-centered study primarily aimed to identify key factors related to the surgeon’s personal condition (stress management, sleep quality, and physical activity) and the organization of the operating room (workload, team composition, and case scheduling) that influence patient outcomes. Secondly, we developed and evaluated the impact of a program for surgeons, which included individualized coaching, performance feedback, and targeted training modules for improvement.
To achieve the complex objectives of this study, the TopSurgeons team was established. In addition to the PI and participating surgeons, the interdisciplinary team includes postdoctoral researchers and doctoral students, data analysts, statisticians, physiologists, neuroscientists, and research assistants. Experts also helped to prepare and conduct the analyses of the sleep, stress, and physical activity data. Furthermore, we contracted with professional coaches who were instrumental in the planning and implementation of the intervention phase of the project.
The initial phases of the project included meetings with surgeons, team members, and project partners, as well as detailed retro planning and task assignment. The ethical validation process was also completed. In order to prepare for the measurement of physiological data, different types of sensors were tested. In collaboration with surgeons, we developed e-CRF content based on scientific literature and consensus within each specialty. We also explored the hospital data warehouse to identify relevant variables for study purposes.
One of the greatest achievements of this project was the successful recruitment of 45 attending surgeons from 14 surgical departments across four university hospitals. All participating surgeons completed detailed questionnaires covering personal information. They agreed to wear an ActiGraph accelerometer continuously to track their physical activity and sleep patterns 24/7 for an entire year, and a Polar heart monitor in the operating room for 15-day periods on five separate occasions to analyze heart rate variability during surgery. Another significant achievement was the inclusion of 24,984 eligible patients operated on by these surgeons from November 2020 to December 2023. Overall, we successfully designed and implemented an ambitious and secured data management plan, enabling the creation of a unique dataset. All data were cross-checked across multiple sources and prospectively validated by research assistants.
Additionally, following the observational period (November 2020-December 2021), we successfully designed and implemented a multicomponent program for surgeons randomized to the intervention arm of a cluster randomized trial (November 2022-December 2023). Inspired by key principles used by elite athletes, this program aimed to empower surgeons to develop strategies for achieving both personal and professional goals. The program included six hours of coaching sessions, monthly surgical outcomes feedback using control charts, and three improvement modules focused on sleep quality, stress management, and physical activity. To facilitate surgeons’ adherence to the program, we organized two full-day workshops at six-month intervals, in October 2022 and March 2023 in Lyon.
The project has provided training opportunities for ten fellows, allowing them to gain valuable research experience at the early stages of their careers. This includes three postdoctoral researchers, three PhD students, and four surgical residents. Furthermore, this ERC-funded project has fostered collaborations between leading institutions in France, Germany, Italy, and the United States.
To date, we have conducted most of the data analyses for the observation period of the project and disseminated our findings through oral presentations at international conferences and scientific publications. Overall, we have demonstrated a relationship between surgeon stress and patient outcomes, as well as examined the factors influencing surgeon stress in relation to the surgeon’s daily physical activity and operating room organization. We have also shown that a familiar team and reduced delays in the operating room lead to better patient outcomes. Our scientific output has resulted in a dozen publications, including: Skinner, Int J Surg 2025; Stelzl, Int J Surg 2025; Awtry, JAMA Surg 2025; Cordier, BMJ Qual Saf 2024; Soelling, Surgeon 2024; Awtry, Ann Surg 2024; Pasquer, BJS Open 2024; Pasquer, Patient Saf Surg 2024; Skinner, JAMA Surg 2023; Skinner, Ann Surg Open 2022; Skinner, Ann Surg 2021. In addition, we have delivered several oral presentations at major international surgical conferences and have received many invitations to present our findings at prestigious conferences, such as the Harvard Surgical HSR Speaker Series. Our work has also gained recognition in both academic and mass media, with multiple written and oral communications, including: JAMA Surgery Podcast 2025 and Le Monde 2023.
Finally, a dedicated website for the project was developed and is continuously updated at http://topsurgeons.univ-lyon1.fr(se abrirá en una nueva ventana).
The initial phases of the project included meetings with surgeons, team members, and project partners, as well as detailed retro planning and task assignment. The ethical validation process was also completed. In order to prepare for the measurement of physiological data, different types of sensors were tested. In collaboration with surgeons, we developed e-CRF content based on scientific literature and consensus within each specialty. We also explored the hospital data warehouse to identify relevant variables for study purposes.
One of the greatest achievements of this project was the successful recruitment of 45 attending surgeons from 14 surgical departments across four university hospitals. All participating surgeons completed detailed questionnaires covering personal information. They agreed to wear an ActiGraph accelerometer continuously to track their physical activity and sleep patterns 24/7 for an entire year, and a Polar heart monitor in the operating room for 15-day periods on five separate occasions to analyze heart rate variability during surgery. Another significant achievement was the inclusion of 24,984 eligible patients operated on by these surgeons from November 2020 to December 2023. Overall, we successfully designed and implemented an ambitious and secured data management plan, enabling the creation of a unique dataset. All data were cross-checked across multiple sources and prospectively validated by research assistants.
Additionally, following the observational period (November 2020-December 2021), we successfully designed and implemented a multicomponent program for surgeons randomized to the intervention arm of a cluster randomized trial (November 2022-December 2023). Inspired by key principles used by elite athletes, this program aimed to empower surgeons to develop strategies for achieving both personal and professional goals. The program included six hours of coaching sessions, monthly surgical outcomes feedback using control charts, and three improvement modules focused on sleep quality, stress management, and physical activity. To facilitate surgeons’ adherence to the program, we organized two full-day workshops at six-month intervals, in October 2022 and March 2023 in Lyon.
The project has provided training opportunities for ten fellows, allowing them to gain valuable research experience at the early stages of their careers. This includes three postdoctoral researchers, three PhD students, and four surgical residents. Furthermore, this ERC-funded project has fostered collaborations between leading institutions in France, Germany, Italy, and the United States.
To date, we have conducted most of the data analyses for the observation period of the project and disseminated our findings through oral presentations at international conferences and scientific publications. Overall, we have demonstrated a relationship between surgeon stress and patient outcomes, as well as examined the factors influencing surgeon stress in relation to the surgeon’s daily physical activity and operating room organization. We have also shown that a familiar team and reduced delays in the operating room lead to better patient outcomes. Our scientific output has resulted in a dozen publications, including: Skinner, Int J Surg 2025; Stelzl, Int J Surg 2025; Awtry, JAMA Surg 2025; Cordier, BMJ Qual Saf 2024; Soelling, Surgeon 2024; Awtry, Ann Surg 2024; Pasquer, BJS Open 2024; Pasquer, Patient Saf Surg 2024; Skinner, JAMA Surg 2023; Skinner, Ann Surg Open 2022; Skinner, Ann Surg 2021. In addition, we have delivered several oral presentations at major international surgical conferences and have received many invitations to present our findings at prestigious conferences, such as the Harvard Surgical HSR Speaker Series. Our work has also gained recognition in both academic and mass media, with multiple written and oral communications, including: JAMA Surgery Podcast 2025 and Le Monde 2023.
Finally, a dedicated website for the project was developed and is continuously updated at http://topsurgeons.univ-lyon1.fr(se abrirá en una nueva ventana).
The TopSurgeons study aimed to improve our understanding of the human and organizational determinants that can influence surgeons’ results over time. We generated new, evidence-based knowledge that drives meaningful improvements in surgical healthcare. In particular, we showed that patient safety can be improved by optimizing operating room organization (e.g. maintaining stable and familiar teams, minimizing delays between procedures) and addressing surgeon-related human factors, such as stress management.
We demonstrated that higher surgical team familiarity was significantly associated with a reduction in major adverse events. Teams quickly developed mature collaboration, leading to substantial improvements in patient safety. (https://doi.org/10.1097/js9.0000000000002269(se abrirá en una nueva ventana)) Furthermore, maintaining a stable operating room environment could play a crucial role in improving surgeon stress and patient care. (https://doi.org/10.1097/SLA.0000000000006543(se abrirá en una nueva ventana)) Increased stress in attending surgeons was associated with a significant reduction in major surgical complications. (https://doi.org/10.1001/jamasurg.2024.6072(se abrirá en una nueva ventana))
We also introduced the risk-adjusted observed minus expected cumulative sum (RA O-E CUSUM) chart, a novel visualization tool inspired by statistical process control charts for real-time monitoring of surgical outcomes. (https://doi.org/10.1136/bmjqs-2024-017935(se abrirá en una nueva ventana)) Finally, we developed a conceptual framework for optimizing surgeon performance by applying continuous improvement methods used by athletes. We identified four key categories that contribute to athletic success: coaching, feedback, preparation, and recuperation. (https://doi.org/10.1001/jamasurg.2022.7732(se abrirá en una nueva ventana))
Our research group has two main future prospects. First, we will continue to analyze the unique dataset from the study’s observational period (2021 data). Second, we will finalize our analyses of the interventional period (2023 data) to assess the impact of our program.
We demonstrated that higher surgical team familiarity was significantly associated with a reduction in major adverse events. Teams quickly developed mature collaboration, leading to substantial improvements in patient safety. (https://doi.org/10.1097/js9.0000000000002269(se abrirá en una nueva ventana)) Furthermore, maintaining a stable operating room environment could play a crucial role in improving surgeon stress and patient care. (https://doi.org/10.1097/SLA.0000000000006543(se abrirá en una nueva ventana)) Increased stress in attending surgeons was associated with a significant reduction in major surgical complications. (https://doi.org/10.1001/jamasurg.2024.6072(se abrirá en una nueva ventana))
We also introduced the risk-adjusted observed minus expected cumulative sum (RA O-E CUSUM) chart, a novel visualization tool inspired by statistical process control charts for real-time monitoring of surgical outcomes. (https://doi.org/10.1136/bmjqs-2024-017935(se abrirá en una nueva ventana)) Finally, we developed a conceptual framework for optimizing surgeon performance by applying continuous improvement methods used by athletes. We identified four key categories that contribute to athletic success: coaching, feedback, preparation, and recuperation. (https://doi.org/10.1001/jamasurg.2022.7732(se abrirá en una nueva ventana))
Our research group has two main future prospects. First, we will continue to analyze the unique dataset from the study’s observational period (2021 data). Second, we will finalize our analyses of the interventional period (2023 data) to assess the impact of our program.