Non Technical Skills
John Salisbury
What are non technical
skills?
John Salisbury
• Non-technical skills are a combination of
cognitive (for example, decision making)
and social skills (for example, team
working), which complement knowledge
and technical skills and contribute to safe
performance.
Aims
• Why NTS are so important
• What they are
• How you can improve them
Origins of NTS
• http://www.youtube.com/watch?v=mLFZTzR5u84
• 2 High profile air crashes with many
casualties.
• Looked at causes of these and other air
disasters and near misses.
• Realised 70 to 90 % due to crew error.
• Since then extrapolated to many other
high risk industries including medical
teams. Similar results.
Relevance to you!
• In USA estimated that 44 to 98000 people die
every year because of medical mishap.
• 70-90 % of these incidents are due to a failure of
NTS.
• Its very important!
• Recognised by WHO that training needs to start
at beginning of medical school.
• NTS will play an increasingly important part of
undergrad and postgrad assessment
“To err is human to forgive divine”
Alexander Pope 1709
Swiss cheese model (Reason J
1990)
What are the NTS
applicable to medicine?
Some NTS applicable to medicine
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Situational awareness
Decision making
Communication
Team working
Leadership
Managing stress
Coping with fatigue
What is situational awareness?
• “What you need to know not to be
surprised” Kelly and Thompson 2005
• Knowing what the ***** is going on!
Why is this car braking?
Too late now!
Decision making
Medical decision making is hard because :
1)Ultimate complex system
2)Incomplete information
3)High stakes
4)Many pressures eg time
Decision making
• Stop and think
• Use of all of the team
• Use CLEAR
CLEAR
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Clarify the problem
Look for and share information
Evaluate options
Act ie decide communicate act
Review how’s it going, may need to start
again!
Communication
• Oral and written. Clear notes.
• Use of tools eg SBAR. Paraphrase check
understanding
• Giving info speak up if unhappy be
assertive but polite
• Include context and background
• Rec information, encourage dissent
• Min distractions
Team working
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Support
Conflict resolution
Exchange information
Coordinate actions
Managing stress
• Awareness of effects on self. Perception of
control.
• Performance arousal curve
• Deliberate calm.Hudson river crash audio
Performance arousal curve
Coping with fatigue
• Recognition of it in yourself
• Recognise its effects
• Coping mechs
• http://www.who.int/patientsafety/education/
curriculum/EN_PSP_Education_Medical_
Curriculum/en/index.html
• http://www.chfg.org/
• http://www.abdn.ac.uk/iprc/uploads/files/Br
omiley%20and%20Mitchell%20article.pdf
Human Factors Investigation Tool
Gordon et al 2005, Industrial Psychology
Research Centre, Aberdeen
Your brain at work
Rational Brain
Stimulus
Senses
STM
Outputs
Emotional Brain
LTM