Surgery (2021)30


described non-technical skills as a set


of generic cognitive and social skills, exhibited by individuals and teams, that support technical skills when performing complex tasks. Prineas et al (2021)30


concluded that “the


stated that non-technical skills are fast becoming an established and indispensable building block of patient safety. Finally, research by Lock and Novoa (2021)31


investigation of incidents in healthcare, as in other high-risk industries, has highlighted that, in many cases, they were not due to a lack of technical skills among professionals but to the complexity of the system and a number of failures in non-technical skills”. Casali, Lock and Novoa (2021)31


suggested


that, to start the change, non-technical skills must be recognised as mandatory. Figure 1 highlights respondents’ feedback as to whether non-technical skills should be taught as part of mandatory training. As can be seen, 95% of respondents replied in agreement that the NHS should provide non-technical skills training. With regard to how training should be


delivered, 86% of staff stated that training should be a combination of online, practical and simulation. Training in any format, whether via a presentation, e-learning, poster, simulation sessions or video for the introduction of a new tool or technique, is important for success, as well as ensuring the staff have the correct skills and knowledge they need to perform the role safely and effectively. The focus must be on how training and education interventions can actively improve patient safety (HEE, 2016).32 The tools at our disposal must be used effectively to build a long-term, sustainable learning environment. Health Education England (2016)32


commissioned a report on patient safety


and found that “Getting it right involves instilling the right culture from the very beginning of a healthcare worker’s career. Education and training from undergraduate and apprentice level throughout one’s career can not only embed the right approach to preventing and learning from errors but also keeps the mind receptive to new ideas that could improve safety”. Catchpole (2010), cited in HEE (2016),32


stated


that “Human Factors in healthcare is about enhancing clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture and organisation on human behaviour and abilities and application of that knowledge in clinical settings.” HEE (2016)32


further expanded and


suggested that, to build the under-pinning knowledge of patient safety, staff well-being must be recognised as an essential component of clinical human factors when it comes to the delivery of training.


22 www.clinicalservicesjournal.com I April 2023


Conclusion To conclude, there is still much work needed to ensure that the surgical safety checklist is fully accepted and used in the operating theatre. It is not possible to say from only the quantitative research whether the lack of compliance leads to greater risk of Never Events occurring. While statistical analysis is important, the study hints that a greater qualitative understanding is needed of the factors that impact upon the persistence of ‘Never Events’. The intention is not to single out Trusts for


criticism based on non-compliance and without greater appreciation of context. Murphy (2016)33 has pointed to poor communication and lack of leadership as being common factors in the causation of procedural mishaps. Rather than criticism, the focus needs to shift from simply understanding adverse events, to the introduction of measures that will prevent their occurrence. The application of NatSSIPs 2 must ensure that the clinical approach to safety is the same, irrespective of the location, time, and resources available. Similarly, Radcliffe (2016)34


affirms that such standards aim to


minimise risks of variation in practice. Moreover, safety standards are aimed at embedding best practice by minimising the risk of variation, maximising consistency, and therefore ensuring harmonisation across organisations. Wali et al ’s (2020)35


paper concluded that


high quality training is integral to ensuring that checklists are not treated as a tick-box exercise. Atul Gawande’s checklist manifesto (2012), cited in Wali, Halai and Koshal (2020),35


describes how


the surgical safety checklist “provides reminders of only the most critical and important steps; the ones that even the highly skilled professionals using them could miss.” Likewise, collaborative and interdisciplinary


approaches do not always feature in the literature. To conclude, teamworking and team learning are essential to effective implementation. Finally, the three Delphi study rounds


will further enhance and add to the current knowledge and literature and provide an over- arching view of the current practice and what needs to change in order for full compliance of the surgical safety checklist. It is realising – along with Radcliffe


(2016)34 – that these standards alone cannot


prevent ‘Never Events’ from occurring but, when combined with the staff education, the promotion of teamwork and human factors training, these measures must go some way to ensure the triad – designed to standardise, educate and harmonise – is complete.


References for the article are available upon request.


CSJ


About the author


Mr Nigel D Roberts, MSc, BA (Hons) is a PhD student, head theatre practitioner, at Birmingham Children’s hospital, and a visiting lecturer at Birmingham City University. This paper is part of a literature review undertaken by the lead author towards the award of Doctor of Philosophy (PhD). It takes an exploratory approach to inform a more in-depth doctoral research study intended to improve patient safety in the operating theatre, inform policy making and quality improvement.


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