Non-technical skills training to enhance patient safety: a systematic review

Context: Many quality improvement education programmes have been introduced over the last decade with the purpose of enhancing patient safety. The importance of non-technical skills training is becoming increasingly prominent, but the extent to which educational interventions have been used and the theoretical underpinnings of such interventions remain unclear. These issues were investigated through a systematic review of the literature.

Methods: Any studies involving an educational intervention to improve non-technical skills amongst undergraduate or postgraduate staff in an acute health care environment were considered. A standardised search of online databases was carried out independently by two authors and consensus reached on the inclusion of studies. Data extraction and multimodal quality assessment were completed independently, followed by a content analysis of interventions and the extraction of key themes.

Results: A total of 22 studies met the inclusion criteria. Measured outcomes were variable, as was the strength of conclusions. Theoretical underpinning of interventions was not described in any studies. Content analysis revealed reasonable consistency with the emergence of five key themes: error; communication; teamwork and leadership; systems, and situational awareness. Teaching was often multidisciplinary and methods used included simulation and role-play exercises, and observation.

Conclusions: The methodological quality of published studies is reasonable, although the reporting of specific interventions is poor. Although a recognised model to support the design of patient safety education is lacking, a number of theories have been applied to guide educators in future instructional design. Further published work should clearly describe interventions and their theoretical underpinnings, and should aim to further explore which specific aspects of interventions are effective and why. Such research should also try to assess whether such interventions can impact patient outcomes.