Non-Technical Skills in Healthcare
What are Non-Technical Skills?
A series of skills which improve human performance at both the individual and team level and as a consequence, improve patient safety and quality. Importantly, they are not directly related to the role at hand.
Non-technical skills (NTS) or NOTECHS are a development of the aviation-related activity Crew Resource Management (CRM) and covers decision-making, situational awareness, communications, teamwork, leadership/followership & performance shaping factors such as fatigue/stress. The use of the term Non-Technical Skills or NOTECHS has benefits because it gets over some of the ‘stigma’ associated with trying to directly transfer aviation skills to healthcare. - http://qualitysafety.bmj.com/content/18/2/104
Why do we need Non-Technical Skills?
How many accidents, incidents or near misses that have happened in your direct area are down to the lack of technical skills or failure of equipment? We spend years developing surgeons, nurses, anaesthetists, doctors, and allied healthcare professionals but how much time is spent on developing teamwork, leadership, communications skills, effective decision making, understanding causes and management of human error? Is it any wonder that mistakes and errors happen, stresses are raised and things go wrong?
What research has been done to show the value of NOTECHS in a healthcare environment?
Human factors in healthcare: welcome progress, but still scratching the surface - http://bit.ly/1RXOqC9
Communication skills and error in the intensive care unit - http://bit.ly/1mY1kTZ
Team leadership in the intensive care unit: The perspective of specialists - http://bit.ly/1StBAL8
Team situation awareness and the anticipation of patient progress during ICU rounds - http://bit.ly/1YYMkWY
Non-technical skills in the intensive care unit - http://bit.ly/1P9onld
Return of Investment of Non-Technical Skills or Crew Resourcement Management Training
There is a constant battle between investment to improve patient safety and quality improvement and how much money there is in the pot to pay for improvement interventions. The following two papers show that a significant return on investment can be made.
This article presents a description of a health system-wide implementation of CRM focusing on the return on investment (ROI). The costs included training, programmatic fixed costs, time away from work, and leadership time. Cost savings were calculated based on the reduction in avoidable adverse events and cost estimates from the literature. Between July 2010 and July 2013, roughly 3000 health system employees across 12 areas were trained, costing $3.6 million. The total number of adverse events avoided was 735—a 25.7% reduction in observed relative to expected events. Savings ranged from a conservative estimate of $12.6 million to as much as $28.0 million. Therefore, the overall ROI for CRM training was in the range of $9.1 to $24.4 million. CRM presents a financially viable way to systematically organize for quality improvement - Moffat-Bruce at al, 2015
Occurrence of serious complications was 67.1/1000 patients and 66.4/1000 patients during the baseline and imple- mentation year respectively, decreasing to 50.9/1000 patients in the post-implementation year. Adjusted odds ratios for occurrence of complications were 0.92 and 0.66 in the implementation and post-implementation year. The incidence of cardiac arrests was 9.2/1000 patients and 8.3/1000 patients during the baseline and implementation year, decreasing to 3.5/1000 patients in the post-implementation year, while cardiopulmonary resuscitation success rate increased from 19% to 55% and 67%. Standardized mortality ratio decreased from 0.72 in the baseline year to 0.60 (95% CI 0.53- 0.67) in the post-implementation year - Haerkens et al, 2015
What training is available?
Human in the System can provide bespoke training and/or coaching for each organisation or setting. These would range from a 2-hour seminar through to a multi-day training intervention using the GemaSim simulation tool and follow-up coaching. The advantage of running a practical session using GemaSim combined with follow-up coaching is that the skills are more likely to be transferred to the work environment. This 2015 paper shows that just doing simulation doesn't have a significant impact on transferred skills whereas work from Joyce and Showers (1982) and Spencer (2011) shows that coaching does improve skills transfer for a number of different reasons.
Human in the System has just developed a one-day intensive non-technical skills pilot course for a hospital to develop their multi-disciplinary teams within the ICU. This course will specifically target teamwork, leadership and communication skills and is now being considered as part of long-term training within the department.
However, it is recognised that such an approach only provides a short term solution to getting the non-technical skills into the team. Using coaching follow-ups at the individual level does provide a level of sustainability but to really effect change, at least two days should be spent in getting the basic skills ingrained with coaching follow-ups and the leadership need to be committed to make this happen. This recently released report from Marie Curie highlights the amount spent on litigation, the majority of which has miscommunication as a key contributory factor. Wouldn't it be better to use some of that to provide quality training to develop high performing teams?
