Non Technical SkillsNon Technical Skills

John SalisburyJohn Salisbury

What are non technical What are non technical skills?skills?

John SalisburyJohn 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.

AimsAims

• Why NTS are so important

• What they are

• How you can improve them

Origins of NTSOrigins 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!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 divineTo err is human to forgive divine””

Alexander Pope 1709

Swiss cheese model (Reason J Swiss cheese model (Reason J 1990)1990)

What are the NTS What are the NTS applicable to medicine?applicable to medicine?

Some NTS applicable to medicineSome NTS applicable to medicine

• Situational awareness

• Decision making

• Communication

• Team working

• Leadership

• Managing stress

• Coping with fatigue

What is situational awareness?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?Why is this car braking?

Too late now!Too late now!

Decision makingDecision making

Medical decision making is hard because :

1)Ultimate complex system

2)Incomplete information

3)High stakes

4)Many pressures eg time

Decision making Decision making

• Stop and think

• Use of all of the team

• Use CLEAR

CLEARCLEAR

• 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!

CommunicationCommunication

• 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 workingTeam working

• Support

• Conflict resolution

• Exchange information

• Coordinate actions

Managing stressManaging stress

• Awareness of effects on self. Perception of control.

• Performance arousal curve

• Deliberate calm.Hudson river crash audio

Performance arousal curvePerformance arousal curve

Coping with fatigueCoping 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/Bromiley%20and%20Mitchell%20article.pdf

Human Factors Investigation ToolHuman Factors Investigation Tool

Gordon et al 2005, Industrial Psychology Research Centre, Aberdeen

Your brain at workYour brain at work

Senses STMLTM

Emotional Brain

Rational Brain

Stimulus

Outputs