Non Technical Skills

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Poor technical skills hurt, poor non technical skills kill.

Martin Bromiley
Chair Clinical Human Factors Group

Human Factors & Non Technical Skills

As patient safety has also become one of the key quality indicators in healthcare, there has been analysis of patterns to reveal that Human Factors have been responsible for three quarters of errors in healthcare.

Human Factors refer to environmental, organisational and job factors, and human and individual characteristics which influence behaviour at work1. Clinical human factors refer to enhancing clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture, organisation on human behaviour and abilities (Catchpole, 2010).

Non-technical skills are part of the human factors and specifically examine the interaction of team members. They include the interpersonal skills of communication, leadership and followership (being a team member) and the cognitive skills of decision making, situation awareness and task management that contribute to safe and efficient task performance.

Problems in non-technical skills have been implicated in accidents in high risk industries such as aviation, off shore oil processing, and nuclear power generation. Anaesthetists work in teams and error producing conditions (tight coupled, complex systems) where not everything is standardized and has variability. Together with the Anaesthetist being challenged to ‘think on the feet’ on many occasions, inculcation and development of non-technical skills seems to be an essential skill of a safe Anaesthetist.

University of Aberdeen has developed Anaesthetists’ Non-Technical Skills (ANTS) System2 – a behavioural marker system developed by industrial psychologists and anaesthetists during a four year collaborative research project. The purpose of the system is to “provide the anaesthetic community with a framework for describing non-technical skills and a tool to guide their assessment in an explicit and transparent manner”.

ANTS System : Categories and Elements

Task Management
Planning and preparing
Providing and maintaining standards
Identifying and utilising resources
Team Working
Co-ordinating activities with team members
Exchanging information
Using authority and assertiveness
Assessing capabilities
Supporting others
Situation Awareness
Gathering information
Recognising and understanding
Decision Making
Identifying options
Balancing risks and selecting options

There is growing awareness that non-technical skills are essential for competent and safe practice and they have been incorporated into medical education and training programmes for other healthcare groups as well. There is increasing evidence and acceptance that the introduction of concepts into healthcare via training, development and research has had positive impact on medical outcomes.

This website is an attempt to continue and persist with that practice!

Dr Rohit Garkoti
Consultant Anaesthetics
Queen Elizabeth Hospital, Gateshead


  1. Reducing Error and Influencing Behaviour, Health and Safety Executive, 1999
  2. Anaesthetists’ Non-Technical Skills (ANTS) System Handbook v1.0, University of Aberdeen, 2012