Abstract
Background
Non-technical skills are defined as the cognitive, social, and personal resource skills that complement technical skills and contribute to safe and efficient task performance. Observable non-technical skills include both cognitive skills: situational awareness, decision-making, and social skills: communication, teamwork, and leadership. In high-acuity maternity aeromedical transfer settings, the potential impact of non-technical skills is significant due to their recognised role in preventing or mitigating adverse outcomes and maintaining patient safety. This doctoral thesis explored the non-technical skills and collaborative workplace behaviours that are pertinent to safety when transferring a pregnant woman by air ambulance. The research also explored how the application of the non-technical skills of health professionals and teams is influenced by organisational culture.
Methods
In order to establish the relevance of non-technical skills to maternity aeromedical transfer settings, the content and context of the New Zealand maternity aeromedical transfer services were explored by interviewing key stakeholders and undertaking field observations. Next, an integrative review was undertaken to select an existing non-technical skills framework on which to base a new non-technical skills framework specific to multidisciplinary teams undertaking maternity aeromedical transfers. Taking a post-positivist qualitative approach, the selected framework was then adapted to the maternity aeromedical transfer setting by triangulating interview data from health professionals and field observations. The basic psychometric properties of this newly developed non-technical skills framework were evaluated based on a survey of clinicians experienced in maternity aeromedical transfer, and a study based on direct field and simulation based observations. Finally, a focus group discussion was undertaken to qualitatively explore the effect of organisational culture on clinicians’ ability to apply non-technical skills in a high-acuity maternity aeromedical transfer setting.
Results
The importance of non-technical skills during all stages of maternity air transfer missions has been emphasised by the initial findings of this New Zealand-based research. The newly developed Non-technical skills in Obstetrics Aeromedical Transfers (NOAT) framework identifies specific non-technical skills and their observable behaviours indicative of good and bad performance, to apply in a maternity aeromedical transfer setting. The NOAT prototype consists of six main skills categories: communication with the pregnant woman and her birthing partner, task management, teamwork, situational awareness, communication with team members, and the environment of the cabin. Good face validity and content validity of the skill definitions and behavioural descriptors of the NOAT framework was also established. A rating scale can be used to assign a numerical value to the non-technical skill performance. Finally, eight organisational factors that negatively or positively influence clinicians when exercising their non-technical skills were identified: key decision-makers are largely unaware, ineffective methods of communication, barriers and facilitators to good team dynamics, lack of fatigue management systems, lack of preparation by referring hospital, lack of policies and protocols, inadequate training, lack of risk assessment processes.
Conclusion
The NOAT provides a common language for discussing non-technical skills in the maternity aeromedical transfer setting. The feasibility, content validity, and face validity of the NOAT framework suggest it has a high potential to function as a framework around which teaching, training, and debriefing can be structured. The findings of this doctoral study also support the conclusion that organisational culture has a direct impact on clinicians’ ability to exercise safety-related behaviours, thus it is critical to clinical care quality and patient safety.