Non Technical Skills

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Non Technical Skills

• John Salisbury

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What are non technical skills?

• John Salisbury

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• 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.

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Aims

• Why NTS are so important
• What they are
• How you can improve them

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Origins of NTS

• http//www.youtube.com/watch?vmLFZTzR5u84

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• 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.

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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

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To err is human to forgive divine
Alexander Pope 1709
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Swiss cheese model (Reason J 1990)
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What are the NTS applicable to medicine?
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Some NTS applicable to medicine

• Situational awareness
• Decision making
• Communication
• Team working
• Leadership
• Managing stress
• Coping with fatigue

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What is situational awareness?

• What you need to know not to be surprised Kelly
  and Thompson 2005
• Knowing what the is going on!

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Dr Mica Endsley
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Why is this car braking?
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Too late now!
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Decision making

• Medical decision making is hard because
• 1)Ultimate complex system
• 2)Incomplete information
• 3)High stakes
• 4)Many pressures eg time

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Decision making

• Stop and think
• Use of all of the team
• Use CLEAR

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CLEAR

• Clarify the problem
• Look for and share information
• Evaluate options
• Act ie decide communicate act
• Review hows it going, may need to start again!

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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

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Team working

• Support
• Conflict resolution
• Exchange information
• Coordinate actions

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Managing stress

• Awareness of effects on self. Perception of
  control.
• Performance arousal curve
• Deliberate calm.Hudson river crash audio

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Performance arousal curve
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Coping with fatigue

• Recognition of it in yourself
• Recognise its effects
• Coping mechs

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• http//www.who.int/patientsafety/education/curricu
  lum/EN_PSP_Education_Medical_Curriculum/en/index.h
  tml
• http//www.chfg.org/
• http//www.abdn.ac.uk/iprc/uploads/files/Bromiley
  20and20Mitchell20article.pdf

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Human Factors Investigation Tool
Gordon et al 2005, Industrial Psychology Research
Centre, Aberdeen
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Your brain at work
Rational Brain
Stimulus
LTM
Senses
STM
Outputs
Emotional Brain