1. Non Technical Skills John Salisbury

2. What are non technical skills? John Salisbury

3. 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.

4. Aims Why NTS are so important What they are How you can improve them

5. Origins of NTS http://www.youtube.com/watch?v=mLFZTzR5u84

6. 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.

7. 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

8. “To err is human to forgive divine” Alexander Pope 1709

9. Swiss cheese model (Reason J 1990)

10. What are the NTS applicable to medicine?

11. Some NTS applicable to medicine Situational awareness Decision making Communication Team working Leadership Managing stress Coping with fatigue

12. What is situational awareness? “What you need to know not to be surprised” Kelly and Thompson 2005 Knowing what the ***** is going on!

15. Dr Mica Endsley

17. Why is this car braking?

18. Too late now!

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

20. Decision making Stop and think Use of all of the team Use CLEAR

21. CLEAR 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!

22. 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

23. Team working Support Conflict resolution Exchange information Coordinate actions

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

25. Performance arousal curve

26. Coping with fatigue Recognition of it in yourself Recognise its effects Coping mechs

28. http://www.who.int/patientsafety/education/ curriculum/EN_PSP_Education_Medical_ Curriculum/en/index.htmlhttp://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

30. Human Factors Investigation Tool Gordon et al 2005, Industrial Psychology Research Centre, Aberdeen

31. Your brain at work SensesSTM LTM Emotional Brain Rational Brain Stimulus Outputs