Development of instruments for assessment of individuals’ and teams’ non-technical skills in healthcare: a critical review

Abstract

Focus on patient safety has increased over the last decades; however, patient safety still relies on technology and the performance of healthcare professionals. Technology improves rapidly but despite numerous reports on how to improve the performance of healthcare professionals, this improvement has been more slow than expected. The performance of healthcare professionals is a product of each individual's medical knowledge, technical and non-technical skills as well as the settings in which these skills are used. Training and the assessment of non-technical skills for individuals or teams in healthcare have shown to improve a safe and efficient performance. However, the implementation has been slow. One reason for this might be the shortage of assessment instrument to assess individuals' and teams' non-technical skills. In this paper, we review the development process of 23 instruments for assessment of non-technical skills for individuals or teams within healthcare. The instruments are mainly for use in the operating room or for teams handling emergency situations. Several of the instruments are developed based on a thorough needs analysis by a team having the same professional background as the target group. Most of the instruments consist of almost the same categories of non-technical skills and many use behavioural markers. Overall, the instruments have been validated to some extent, but there is room for improvement. However, there seems to be a lack of training of the raters. The importance of providing feedback after the assessment is emphasised. The criteria on which the behavioural markers are developed should undergo continuous changes, representing the development of the patient safety culture in healthcare organisations.