Team Non-technical Skills Research Articles

Deep Learning Analysis of Surgical Video Recordings to Assess Nontechnical Skills

Assessing nontechnical skills in operating rooms (ORs) is crucial for enhancing surgical performance and patient safety. However, automated and real-time evaluation of these skills remains challenging. To explore the feasibility of using motion features extracted from surgical video recordings to automatically assess nontechnical skills during cardiac surgical procedures. This cross-sectional study used video recordings of cardiac surgical procedures at a tertiary academic US hospital collected from January 2021 through May 2022. The OpenPose library was used to analyze videos to extract body pose estimations of team members and compute various team motion features. The Non-Technical Skills for Surgeons (NOTSS) assessment tool was employed for rating the OR team's nontechnical skills by 3 expert raters. NOTSS overall score, with motion features extracted from surgical videos as measures. A total of 30 complete cardiac surgery procedures were included: 26 (86.6%) were on-pump coronary artery bypass graft procedures and 4 (13.4%) were aortic valve replacement or repair procedures. All patients were male, and the mean (SD) age was 72 (6.3) years. All surgical teams were composed of 4 key roles (attending surgeon, attending anesthesiologist, primary perfusionist, and scrub nurse) with additional supporting roles. NOTSS scores correlated significantly with trajectory (r = 0.51, P = .005), acceleration (r = 0.48, P = .008), and entropy (r = -0.52, P = .004) of team displacement. Multiple linear regression, adjusted for patient factors, showed average team trajectory (adjusted R2 = 0.335; coefficient, 10.51 [95% CI, 8.81-12.21]; P = .004) and team displacement entropy (adjusted R2 = 0.304; coefficient, -12.64 [95% CI, -20.54 to -4.74]; P = .003) were associated with NOTSS scores. This study suggests a significant link between OR team movements and nontechnical skills ratings by NOTSS during cardiac surgical procedures, suggesting automated surgical video analysis could enhance nontechnical skills assessment. Further investigation across different hospitals and specialties is necessary to validate these findings.

Review article: Use of the Team Emergency Assessment Measure in the rating of emergency teams' non-technical skills: A mapping review.

The present study aims to explore the utility of the Team Emergency Assessment Measure (TEAM) in relation to the enhancement of emergency team non-technical skills based on research conducted over the last decade. In this mapping review, a citation mining process identified 22 primary studies for inclusion, published between 2012 and 2022. It provides outcome data on emergency teams' non-technical skills following team training and/or real-life patient emergencies. Emergency team studies related to resuscitation teams (adult, paediatric, newborn and obstetric cases) and medical emergency team (MET) management of patient deterioration. Team performance ratings varied, ranging from approximately 90% for experienced clinical teams down to 38% for students. Statistically significant improvements in performance were notable following training and/or repeated practice. Validity evidence, across 11 studies that provided change data described positive learning outcomes and moderate intervention effects. However, according to Kirkpatrick's model of educational evaluation the studies were limited to professional development phases of learning and immediate post-training assessments rather than care quality improvement. The review highlights a lack of studies evidencing quality improvement or clinical impact such as change of patient care practice or health service performance. There is a need to conduct well-designed studies that explore both technical and non-technical skills of resuscitation teams and METs. Currently, non-technical skills training and repeated performance evaluations using the TEAM contribute immensely to the proficiency of emergency teams.

Analyzing interprofessional teamwork in the operating room: An exploratory observational study using conventional and alternative approaches

ABSTRACT Intraoperative teamwork is vital for patient safety. Conventional tools for studying intraoperative teamwork typically rely on behaviorally anchored rating scales applied at the individual or team level, while others capture narrative information across several units of analysis. This prospective observational study characterizes teamwork using two conventional tools (Operating Theatre Team Non-Technical Skills Assessment Tool [NOTECHS]; Team Emergency Assessment Measure [TEAM]), and one alternative approach (modified-Systems Engineering Initiative for Patient Safety [SEIPS] model). We aimed to explore the advantages and disadvantages of each for providing feedback to improve teamwork practice. Fifty consecutive surgical cases at a Canadian academic hospital were recorded with the OR Black Box®, analyzed by trained raters, and summarized descriptively. Teamwork performance was consistently high within and across cases rated with NOTECHS and TEAMS. For cases analyzed with the modified-SEIPS tool, both optimal and suboptimal teamwork behaviors were identified, and team resilience was frequently observed. NOTECHS and TEAM provided summative assessments and overall pattern descriptions, while SEIPS facilitated a deeper understanding of teamwork processes. As healthcare organizations continue to prioritize teamwork improvement, SEIPS may provide valuable insights regarding teamwork behavior and the broader context influencing performance. This may ultimately enhance the development and effectiveness of multi-level teamwork interventions.

Using Trauma Video Review to Assess EMS Handoff and Trauma Team Non-Technical Skills

Objective Handoffs by emergency medical services (EMS) personnel suffer from poor structure, inattention, and interruptions. The relationship between the quality of EMS communication and the non-technical performance of trauma teams remains unknown. Methods We analyzed 3 months of trauma resuscitation videos (highest acuity activations or patients with an Injury Severity Score [ISS] of ≥15). Handoffs were scored using the mechanism-injury-signs-treatment (MIST) framework for completeness (0–20), efficiency (category jumps), interruptions, and timeliness. Trauma team non-technical performance was scored using the Trauma Non-Technical Skills (T-NOTECHS) scale (5–15). Results We analyzed 99 videos. Handoffs lasted a median of 62 seconds [IQR: 43–74], scored 11 [10–13] for completeness, and had 2 [1–3] interruptions. Most interruptions were verbal (85.2%) and caused by the trauma team (64.9%). Most handoffs (92%) were efficient with 2 or fewer jumps. Patient transfer during handoff occurred in 53.5% of the videos; EMS providers giving handoff helped transfer in 69.8% of the Primary surveys began during handoff in 42.4% of the videos. Resuscitation teams who scored in the top-quartile on the T-NOTECHS (>11) had higher MIST scores than teams in lower quartiles (13 [11.25–14.75] vs. 11 [10–13]; p < .01). There were no significant differences in ISS, efficiency, timeliness, or interruptions between top- and lower-quartile groups. Conclusions There is a relationship between EMS MIST completeness and high performance of non-technical skill by trauma teams. Trauma video review (TVR) can help identify modifiable behaviors to improve EMS handoff and resuscitation efforts and therefore trauma team performance.

Using Trauma Video Review to Assess Emergency Medical Services Handoff and Trauma Team Non-Technical Skills

Nagaraj, Madhuri B. MD, MS; Lowe, Jessica E. BA; Marinica, Alexander L. DO; Morshedi, Brandon B. MD, DPT; Isaacs, Marshal MD; Miller, Brian L. MD; Chou, Andrew D. MD; Cripps, Michael W. MD, FACS; Dumas, Ryan P. MD, FACS Author Information

Effect of mental rehearsal on team performance and non-technical skills in surgical teams: systematic review.

BackgroundSimulation‐based training in medical education has become a common method to develop both technical and non‐technical skills in teams. Mental rehearsal (MR) is the cognitive act of simulating a task in our heads to pre‐experience tasks imaginatively. It has been used widely to improve individual and collective performance in fields outside healthcare, and offers potential for more efficient training in time‐pressured surgical and medical team contexts. This study aimed to review the available literature to determine the impact of MR on team performance and non‐technical skills in healthcare.MethodsMEDLINE, Embase, British Educational Index, CINAHL, Web of Science, PsycInfo and Cochrane databases were searched for the period 1994–2018. The primary outcome measure was improvement in team performance and non‐technical skills. Study quality of RCTs was assessed using the Medical Education Research Quality Instrument. The reported impacts of MR in all included studies were mapped on to the Kirkpatrick framework for evaluation of educational interventions.ResultsEight studies with 268 participants were identified that met the inclusion criteria, of which there were six randomized trials, one prospective pragmatic trial and one qualitative study. Three studies found MR to be effective in improving team non‐technical skills. MR practices were varied and often poorly defined. MR benefited team non‐technical skills when it was specifically designed to do so, but was not an automatic consequence of technical MR alone. The majority of studies demonstrated benefits of MR for technical performance, but only three showed positive impacts on teamwork. Overall the studies were of low quality and lacked sufficient discriminatory focus to examine impacts on teamwork dynamics.ConclusionMR can improve technical performance, but the benefits on non‐technical skills are less clear. Future research should look at longitudinal mixed‐method evaluation designs and focus on real clinical teams.

Utilizing Black Box Technology to Identify and Describe Intraoperative Delays, Distractions and Threats in the Gynecology OR: A Pilot Study

Study Objective Operating room delays can result from a chain of intra-operative events including technical factors, equipment failures or unavailability, and non-technical human factors. Operating Room Black Box (ORBB) technology can be used to capture information during surgery for analysis and potential identification of root causes of inefficiencies. Our objective was to measure and characterize procedural steps, intra-operative distractions and delays during a common minimally invasive gynecologic procedure and identify if these delays correlated with team technical and non-technical scores. Design Cross-sectional study. Setting Canadian tertiary care academic hospital. Patients or Participants Eleven patients undergoing total laparoscopic hysterectomy (TLH) between May and October 2019. Interventions Video, audio, and patient physiologic data from all procedures were obtained through a multichannel synchronized recording device. Trained analysts reviewed the recordings and coded procedural timing, distractions, delays, threats and team technical and non-technical scores. Measurements and Main Results Mean total case time was 172 minutes (SD +/- 16 minutes) and mean procedure time was 117 minutes (SD +/- 17 minutes). Mean surgical times for the pre-operative, intra-operative and post-operative phases were 85 mins (SD ± 40 mins), 116 mins (SD ± 17 mins) and 28 mins (SD ± 16 mins) respectively. Correlations between total case time and team non-technical scores and procedure time and team non-technical scores were positive and moderate in strength. Medians of 83 door openings [interquartile range (IQR) 76-104], 173 distractions (IQR 19-190) and 3 threats (IQR 2-5) were identified per case. Conclusion The ORBB allowed us to identify variations in procedural case times for elective TLH. There were frequent intraoperative distractions as well as latent threats noted and there was a moderately positive correlation between case times and team non-technical skills.

Measuring the teamwork performance of operating room teams: a systematic review of assessment tools and their measurement properties

ABSTRACT Teamwork is fundamental to surgical patient safety but is inconsistently measured. While many tools have been developed for elective intraoperative situations, it is unclear which is the most robust. This systematic review aimed to identify tools to measure the teamwork of operating room teams. Studies were included if they examined the measurement properties of these tools. PsycINFO, Embase (via OVID), CINAHL, ERIC, Medline and Medline in Process (via OVID) were searched through to May 3, 2019, as were reference lists of included studies and previously published relevant reviews. Retrieved articles were screened and data extracted in duplicate by two independent reviewers. Quality was assessed using the COSMIN checklist. Of the 2121 references identified, 14 studies of six assessment tools were included. Tools were validated across various specialties, mostly in clinical rather than simulated settings. The Observational Teamwork Assessment for Surgery (OTAS) and Operating Theater Team Non-Technical Skills Assessment Tool (NOTECHS) were the most frequently investigated tools. Though acceptable for assessing teamwork, both NOTECHS and OTAS rely on the questionable assumption that the teamwork of a team is equivalent to the sum of individual performances. Future studies may investigate other assessment tools that assess the whole team as the unit of analysis along with the potential of these tools to provide healthcare providers with meaningful feedback in clinical practice.

Pilot One-Hour Multidisciplinary Team Training Simulation Intervention in the Operating Room Improves Team Nontechnical Skills

The primary objective of this study was to determine if a 1-hour simulation-based training with interdisciplinary operating room (OR) teams could improve nontechnical skills of the providers as assessed by the nontechnical skills tool (NOTECHS II). Interprofessional otolaryngology OR teams consisting of surgery faculty and resident, anesthesiology faculty and resident, and OR nurses, scrub technician, and perioperative technician underwent a 1-hour simulation-based intervention in the OR. The teams were rated on their nontechnical skills during the intervention and throughout the clinical day following. They also completed self-reflection surveys (SRS) before the intervention and in 3 intervals after the intervention (immediately following the intervention, at the end of their shift on the day of the intervention, and again 2 weeks later). Four interprofessional teams with a total of 26 unique participants participated in this pilot program. Team nontechnical skills, assessed using NOTECHS II, improved from the first simulation to the second simulation during the intervention. Team NOTECHS II scores remained higher throughout the clinical day. Individual self-reflection scores (SRS) followed the same trend. On-site interprofessional OR team training simulation can take place in a brief time period that is dedicated for education. A brief intervention resulted in improved team nontechnical scores when assessed following intervention. In addition, participants found the intervention to be effective and beneficial to their learning.

Important Non-Technical Skills in Video-Assisted Thoracoscopic Surgery Lobectomy: Team Perspectives

Safety in the operating room is dependent on the team's non-technical skills. The importance of non-technical skills appears to be different for minimally invasive surgery as compared with open surgery. The aim of this study was to identify which non-technical skills are perceived by team members to be most important for patient safety, in the setting of video-assisted thoracoscopic surgery (VATS) lobectomy. This was an explorative, semistructured interview-based study with 21 participants from all four thoracic surgery centers in Denmark that perform VATS lobectomy. Data analysis was deductive, and directed content analysis was used to code the text into the Oxford Non-Technical Skills system for evaluating operating teams' non-technical skills. The most important non-technical skills described by the VATS teams were planning and preparation, situation awareness, problem solving, leadership, risk assessment, and teamwork. These non-technical skills enabled the team to achieve shared mental models, which in turn facilitated their efforts to anticipate next steps. This was viewed as important by the participants as they saw VATS lobectomy as a high-risk procedure with complementary and overlapping scopes of practice between surgical and anesthesia subteams. This study identified six non-technical skills that serve as the foundation for shared mental models of the patient, the current situation, and team resources. These findings contribute three important additions to the shared mental model construct: planning and preparation, risk assessment, and leadership. Shared mental models are crucial for patient safety because theyenable VATS teams to anticipate problems throughadaptive patterns of both implicit and explicit coordination.

Developing a Team Behavioural Marker Framework Using Observations of Simulator-Based Exercises to Improve Team Effectiveness: A Drilling Team Case Study

Background. Due to the challenge of conducting observations of drilling team behaviours on an offshore installation during actual operations, a high fidelity simulator provided the opportunity to observe team behaviours when managing complex and uncertain situations. Aim. This article describes how such observations were used to develop a team behavioural marker framework subsequently used for debriefing. Method. Team behaviours and interactions were recorded during 25 simulator-based training exercises which had been integrated into a technical training course. These were then analysed, and four dimensions, with example behaviours, were identified. Results. The behavioural markers formed the basis of training objectives, and provided structure for debriefing team performance. The use of the simulator provided concrete examples of both effective and ineffective behaviours. Conclusions. Notable improvements in drilling team interactions and behaviours were noted over the course of five exercises, which ranged in complexity and uncertainty, throughout the training course. Enhancing team non-technical skills will lead to safer and more effective performance, and facilitate the transfer from training to actual operations. Team members also became more familiar with the concepts and terminology of non-technical skills and integrated behavioural markers into workplace practices such as Tool Box Talks, Stop Work Authority, and Time-Outs.

Safer delivery of surgical services: a programme of controlled before-and-after intervention studies with pre-planned pooled data analysis

BackgroundHigh rates of iatrogenic harm have been confirmed in observational studies of surgery. Most interventions designed to reduce this have been targeted at either workplace culture or operational systems. We hypothesised that an integrated intervention addressing both culture and system might be more effective than either approach alone.ObjectiveTo evaluate interventions designed to improve surgical team performance by impacting culture or systems in isolation or combination.DesignFive controlled intervention experiments, addressing system, culture or both, were performed in operating theatres. A final whole-system intervention study integrated approaches that showed benefit in these experiments. The five linked studies were subjected to a pre-planned pooled analysis to identify the effects of interventions, combinations and confounders. A qualitative interview study provided explanatory data on the mechanisms of intervention success and failure. An economic analysis was conducted.SettingOperating theatres in five hospitals, performing orthopaedic, trauma, vascular and plastic surgery were used for the linked studies. The final study occurred in a tertiary referral neurosurgery unit.ParticipantsThe main study subjects were clinical staff. Patient outcomes, both clinical and patient reported, were collected as secondary outcome measures.InterventionsThe interventions tested were (1) teamwork training (TT) based on the aviation crew resource management model, (2) the development of a set of standard operating procedures (SOPs), (3) a safety improvement programme based on lean principles, (4) TT plus SOPs and (5) TT plus lean. The final intervention used elements of all three strategies.Main outcome measuresPrimary outcomes were team non-technical skills [as measured by the Oxford Non-Technical Skills (NOTECHS) II scale score] and team technical performance (via the ‘glitch count’). Secondary outcomes were compliance with the World Health Organization (WHO)’s checklist procedures, patient length of stay, readmissions, 30-day mortality, complications and patient-reported outcome measures [as measured by the European Quality of Life-5 Dimensions (EQ-5D)]. A qualitative interview study provided explanatory data on the mechanisms of intervention success and failure. An economic analysis was conducted.Data sourcesDirect observation of whole operations, clinical records, hospital information systems and EQ-5D questionnaires. The qualitative study used semistructured interviews.Statistical methodsIndividual studies were analysed using two-way analysis of variance, and an overall individual patient pooled analysis was performed. Methods validation studies and other analyses used chi-squared test, correlation and regression methods as appropriate.ResultsWe studied 453 operations. The results of single interventions were inconsistent. TT alone improved non-technical skills and WHO compliance (p &lt; 0.001) but not technical performance, whereas the systems interventions (lean and SOP) improved non-technical skills and technical performance (p &lt; 0.001), but were less effective in improving WHO compliance. The integrated intervention approaches improved all aspects of team performance except time-out attempt rate, whereas the single approaches were significantly poorer at improving checklist compliance (p &lt; 0.001) and failed to improve glitch rate. Combining all three strategies did not increase the percentage of successful projects. The qualitative analysis confirmed that integrated interventions better addressed the breadth of challenges that face surgical safety but also indicated that differences in implementation between integrated- and single-intervention studies amplified their differential effect.ConclusionsA combination of TT plus systems improvement training appears more effective in improving team performance than either approach alone. An implementation strategy based on an understanding of the barriers to change in hospitals is important for success.Future workMore work is required to understand and measure barriers to safety improvement. Implementation strategies need to be tested empirically. Methods for delivering integrated interventions on a larger scale need development. A cluster randomised trial of the integrated-systems/culture-improvement approach is warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

From cockpit to operating theatre to drilling rig floor: five principles for improving safety using simulator-based exercises to enhance team cognition

For over 30 years, aviation has conducted training courses to enhance team performance and improve safety involving simulation with observation and directed feedback. Participants’ performance is observed by trained and experienced observers who then provide feedback using behaviour-based evidence noted during the simulator exercise. More recently, in healthcare, operating theatre personnel have adopted simulator-based training (SBT), observation and feedback for learning and practice to reduce the potential for human errors and improve safety. Maritime and nuclear power also incorporate high-fidelity simulators and feedback in team training interventions including technical and non-technical skills. The design and development of drilling rig simulators means that drill crews can now practise and test out their decision-making and receive feedback from observers, with the aim of improving team non-technical skills and consequently reducing the potential for errors. This paper presents five principles gleaned from research and the experiences of both aviation and healthcare to be applied to the development of simulator-based exercising for drilling teams. The principles include: (a) developing learning objectives and expected performance standards; (b) training the team as a whole; (c) using a structured observation tool; (d) providing feedback during a structured debrief; (e) repeat the SBT regularly to enhance expertise and retain performance standards. It is anticipated that these principles can be generalised for simulator-based exercising to benefit team social and cognitive competences in other high-hazard or process industries.

Human Factors and Ergonomics for the Dental Profession.

This paper proposes that the science of Human Factors and Ergonomics (HFE) is suitable for wide application in dental education, training and practice to improve safety, quality and efficiency. Three areas of interest are highlighted. First it is proposed that individual and team Non-Technical Skills (NTS), such as communication, leadership and stress management can improve error rates and efficiency of procedures. Secondly, in a physically and technically challenging environment, staff can benefit from ergonomic principles which examine design in supporting safe work. Finally, examination of organizational human factors can help anticipate stressors and plan for flexible responses to multiple, variable demands, and fluctuating resources. Clinical relevance: HFE is an evidence-based approach to reducing error rates and procedural complications, and avoiding problems associated with stress and fatigue. Improved teamwork and organizational planning and efficiency can impact directly on patient outcomes.

A Quantitative Team Situation Awareness Measurement Method Considering Technical and Nontechnical Skills of Teams

Human capabilities, such as technical/nontechnical skills, have begun to be recognized as crucial factors for nuclear safety. One of the most common ways to improve human capabilities in general is training. The nuclear industry has constantly developed and used training as a tool to increase plant efficiency and safety. An integrated training framework was suggested for one of those efforts, especially during simulation training sessions of nuclear power plant operation teams. The developed training evaluation methods are based on measuring the levels of situation awareness of teams in terms of the level of shared confidence and consensus as well as the accuracy of team situation awareness. Verification of the developed methods was conducted by analyzing the training data of real nuclear power plant operation teams. The teams that achieved higher level of shared confidence showed better performance in solving problem situations when coupled with high consensus index values. The accuracy of nuclear power plant operation teams' situation awareness was approximately the same or showed a similar trend as that of senior reactor operators' situation awareness calculated by a situation awareness accuracy index (SAAI). Teams that had higher SAAI values performed better and faster than those that had lower SAAI values.

Quality Improvement in Surgery Combining Lean Improvement Methods with Teamwork Training: A Controlled Before-After Study.

BackgroundTo investigate the effectiveness of combining teamwork training and lean process improvement, two distinct approaches to improving surgical safety. We conducted a controlled interrupted time series study in a specialist UK Orthopaedic hospital incorporating a plastic surgery team (which received the intervention) and an Orthopaedic theatre team acting as a control.Study DesignWe used a 3 month intervention with 3 months data collection period before and after it. A combined teamwork training and lean process improvement intervention was delivered by an experienced specialist team. Before and after the intervention we evaluated team non-technical skills using NOTECHS II, technical performance using the glitch rate and WHO checklist compliance using a simple 3 point scale. We recorded complication rate, readmission rate and length of hospital stay data for 6 months before and after the intervention.ResultsIn the active group, but not the control group, full compliance with WHO Time Out (T/O) increased from 14 to 71% (p = 0.032), Sign Out attempt rate (S/O) increased from 0% to 50% (p<0.001) and Oxford NOTECHS II scores increased after the intervention (P = 0.058). Glitch rate decreased in the active group and increased in the control group (p = 0.001). Complications and length of stay appeared to rise in the control group and fall in the active group.ConclusionsCombining teamwork training and systems improvement enhanced both technical and non-technical operating team process measures, and were associated with a trend to better safety outcome measures in a controlled study comparison. We suggest that approaches which address both system and culture dimensions of safety may prove valuable in reducing risks to patients.

The effect of teamwork training on team performance and clinical outcome in elective orthopaedic surgery: a controlled interrupted time series study

ObjectivesTo evaluate the effectiveness of aviation-style teamwork training in improving operating theatre team performance and clinical outcomes.Setting3 operating theatres in a UK district general hospital, 1 acting as a control...

The Role of Nontechnical Skills in Simulated Trauma Resuscitation

Trauma team training provides instruction on crisis management through debriefing and discussion of teamwork and leadership skills during simulated trauma scenarios. The effects of team leader's nontechnical skills (NTSs) on technical performance have not been thoroughly studied. We hypothesized that team's and team leader's NTSs correlate with technical performance of clinical tasks. Retrospective cohort study. Brigham and Women's Hospital, STRATUS Center for Surgical Simulation A total of 20 teams composed of surgical residents, emergency medicine residents, emergency department nurses, and emergency services assistants underwent 2 separate, high-fidelity, simulated trauma scenarios. Each trauma scenario was recorded on video for analysis and divided into 4 consecutive sections. For each section, 2 raters used the Non-Technical Skills for Surgeons framework to assess NTSs of the team. To evaluate the entire team's NTS, 2 additional raters used the Modified Non-Technical Skills Scale for Trauma system. Clinical performance measures including adherence to guidelines and time to perform critical tasks were measured independently. NTSs performance by both teams and team leaders in all NTS categories decreased from the beginning to the end of the scenario (all p < 0.05). There was significant correlation between team's and team leader's cognitive skills and critical task performance, with correlation coefficients between 0.351 and 0.478 (p < 0.05). The NTS performance of the team leader highly correlated with that of the entire team, with correlation coefficients between 0.602 and 0.785 (p < 0.001). The NTSs of trauma teams and team leaders deteriorate as clinical scenarios progress, and the performance of team leaders and teams is highly correlated. Cognitive NTS scores correlate with critical task performance. Increased attention to NTSs during trauma team training may lead to sustained performance throughout trauma scenarios. Decision making and situation awareness skills are critical for both team leaders and teams and should be specifically addressed to improve performance.

The human factor in agriculture: An interview study to identify farmers’ non-technical skills

BackgroundFarming represents a high risk occupation, responsible for several thousand worker injuries and fatalities worldwide per year. Research within other high risk industries, such as aviation, shipping and healthcare, has identified the importance of non-technical skills in maintaining effective performance and reducing the risk of an adverse event. The aim of the current study was to identify the categories of non-technical skills that are typically used by farmers. MethodA sample of 32 farmers, from within two geographical regions (Scotland and Northern Ireland), were interviewed using the critical incident technique. The interview transcripts were then coded using thematic analysis in order to identify reported non-technical skills. ResultsParticipants reported the daily use of a range of non-technical skills, these differed according to whether the farmer was working as part of a team or alone. Team non-technical skills were identified as: situation awareness, decision-making, leadership, teamwork and task management. Lone worker non-technical skills were identified as: situation awareness, decision-making and task management. ConclusionThe results indicate that non-technical skills are an important aspect of farmers’ work performance and safety; mirroring the findings reported within other high risk industries. Further research is required to validate the skill set suggested here, and to develop a behavioural marker system similar to that used in other industries.

Relationship between Non-technical Skills and Resuscitation Performance of Nurses' Team in in-situ Simulated Cardiac Arrest

Purpose: The aim of this descriptive study was to explore the relationship between non-technical skills (NTSs) and cardiopulmonary resuscitation (CPR) performance of nurses' teams in simulated cardiac arrest in the hospital. Methods: The sample was 28 teams of nurses in one university hospital located in Seoul. A high fidelity simulator was used to enact simulated cardiac arrest. The nurse teams were scored by raters using both the CPR performance checklist and the NTSs checklist. Specifically the CPR performance checklist included critical actions; time elapsed to initiation of critical actions, and quality of cardiac compression. The NTSs checklist was comprised of leadership, communication, mutual performance monitoring, maintenance of guideline, and task management. Data were collected directly from manikin and video recordings. Results: There was a significant difference between the medians of the NTSs and CPR performance (Mann Whitney U=43.5, p=.014). In five subcategories, communication (p=.026), mutual performance monitoring (p=.005), and maintenance of guideline (p=.003) differed significantly with CPR performance in medians. Leadership (p=.053) and task management (p=.080) were not significantly different with CPR performance. Conclusion: The findings indicate that NTSs of teams in addition to technical skills of individual rescuers affect the outcome of CPR. NTSs development and assessment should be considered an integral part of resuscitation training.