Human variability: Two aspects (Reason, 2000)

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1 Safe and Efficient Job Performance Non-Technical Skills in Industry and Medicine Rhona Flin Industrial Psychology Research Centre The Royal College of Pathologists, London, 28 November, 2013 Latent Conditions Safety Systems Organisational/ Professional Culture Work Conditions Individual actions Worker Behaviour Technical & Non-Tech. Skills Job Performance Human variability: Two aspects (Reason, 2000) Gorilla on the lung Human as hazard Slips Lapses Mistakes Violations Human as hero Adjustments Compensations Recoveries Improvisations Drew et al (2013) Psychological Science Non-Technical/ CRM Skills Situation Awareness Decision Making Team Work Leadership Communication Personal Limitations managing stress and fatigue NTS for safety-critical workplaces Focus on behaviours, especially related to cognition and portable team skills. Agreed frameworks of desirable and undesirable behaviours for safe work. Common language Applications in selection, training, debriefing, competence assessment, accident analysis Informed by psychological research on behaviour 1

2 Tenerife (1977) Closing the NTS/ CRM Loop Monitor Evaluate Behaviour/ Safety Problem Two Boeing 747s crashed into each other on the runway. 583 people killed (61 survived). NTS/ CRM training Task Analysis Accid. analy Behaviour-related causes: conflict resolution, assertiveness, communication, situation awareness & stress. Identify NTS & conditions Identifying Pilots Non-Technical Skills Task analysis Flight deck or simulator observations Interviews with pilots Surveys of pilots attitudes, experiences Confidential safety reporting systems Accident analysis, especially analysis of cockpit voice recorder Pathology Black Box? Don t bother with that. I ve seen this hundreds of times Just write it on a paper towel Can anyone read this chit? It s obvious. Couldn t be anything else. Aviation training of Non-Tech Skills: Crew Resource Management To address identified failures in individual pilot and crew performance- new training called CRM devised(1980s). using all the available resources- information, equipment and people- to achieve safe and efficient flight operations. (Lauber, 1977) CRM training provides a set of countermeasures against human error; it is based on the premise that human error is ubiquitous and inevitable. (Helmreich, 1996) Crew Resource Management (NTS) Based and updated on human factors research identifying behaviours (NTS) critical for safe performance 2-3 days basic training (lectures, videos, role-plays, etc.) plus annual recurrent training mandated by CAA (UK) Skills practised with feedback in simulator (LOFT) Regular formal assessment of non-technical skills for UK pilots mandated by CAA (2004) NTS Trainers/ examiners must be assessed as competent 2

3 Primary goals of CRM Mitigate consequences of error Non-Technical Skills, error, adverse events Non-Technical Skills Training Trap error Poor Non- Technical Skills Error Increased chance Avoid error Observation using ANTS/ NOTSS etc Good Non- Technical Skills Avoid/ Capture Error Decreased chance Adverse event Observation, rating and feedback using behavioural rating system (adapted from Helmreich & Schaefer, 1996) Pilots Non- Technical Skills Term non-technical skills first used in European civil aviation. Cognitive and social skills of flight crew members in the cockpit, not directly related to aircraft control, system management, and standard operating procedures. Non-technical skills are the cognitive and social skills that complement technical skills, and contribute to safe and efficient task performance. (Crew Resource Management (CRM) skills) NOTECHS system (1998) Pan-European Non-technical skills For European Pilots Behaviour rating method to assess a pilot s nontechnical (CRM) skills. Recommended by JAA/ CAA Adopted by some airlines, adapted by others. Flin et al (2003) Development of the NOTECHS system for assessing pilots CRM skills. Human Factors and Aerospace Safety, 3, The NOTECHS framework for pilots Co-operation Non-technical skills Leadership & management skills Situation awareness Decision making Non-technical skills in the operating theatre? I am giving the safety briefing! Team building & maintaining Considering others Supporting others Conflict solving Category Element Behaviour Helps other crew members in demanding situations Offers assistance 3

4 Why focus on non-technical skills in OR? Good non-technical skills can lead to positive outcomes for the team and patient Edmondson (2003) effective leadership Carthey et al (2003) behaviours in cardiac surgery Healey et al (2004) observations of team performance Moorthy et al (2005) team skills in operating theatre simulator Adverse events in surgery are primarily caused by failures in perception, judgement, communication and teamwork de Leval et al (2000) cardiac switch operations Way et al (2003) bile duct injuries Gawande et al (2003; 2004) insurance claims in the US Christian et al (2006) observations in the operating theatre Non-Technical Skills for Anaesthetists (ANTS) Fletcher, Flin, Glavin, Maran, Patey British Journal of Anaesthesia (2003; 2004; 2010) Non-Technical Skills for Surgeons (NOTSS) Scrub Practitioners (SPLINTS) Yule, Flin, Maran, Paterson-Brown, Rowley, Youngson (2006) Surgery; (2008) World Journal of Surgery Non-technical skills for scrub nurses/ ODPs SPLINTS Mitchell et al (2009) International J. Nursing; Mitchell & Flin (2008) J. Advanced Nursing Non-technical skills/ HF training Undergraduate human performance and limitations/ non-technical skills WHO patient safety student course (HF module) Aberdeen Medical School intro to NTS fifth year Postgraduate specific non-technical skills e.g. ANTS for anaesthetists Consultants training, observing, evaluating and debriefing NTS (in trainees and consultants) Health Committee patient safety report for NHS England (July, 2009) The NHS lags unacceptably behind other safety-critical industries, such as aviation, in recognising the importance of effective team working and other non-technical skills. (p5) There are serious deficiencies in the undergraduate medical curriculum.. which are detrimental to patient safety, in respect of training in:.. non-technical skills.. (p6) 4

5 Further information Further information lists of projects and papers and reports 5