The development of the helicopter non-technical skills (HeliNOTS) behavioural marker systems.

Behavioural marker systems (observational frameworks geared towards the assessment of non-technical skills by way of behavioural markers) exist across a variety of high-risk occupations, however, no identifiable system currently exists developed from rotary operative data. In this study, discussion groups (n = 9) were undertaken with subject matter experts (n = 20)-including pilots and technical crew operating across search and rescue and offshore transport environments-with the objective of identifying role-specific behavioural markers. Systems were reviewed on an iterative basis by the academic team and received final reviews by additional subject matter experts (n = 6). Two behavioural marker systems were constructed: HeliNOTS (O) for offshore transport pilots and HeliNOTS (SAR) for search and rescue crews; each with domain-specific behavioural markers. Both represent a significant step towards a nuanced approach to training and assessment of helicopter flight crews' non-technical skills and are the first publicly available systems tailored to these distinct mission types.Practitioner summary: There is no publicly available behavioural marker system based on data from rotary operatives. Across this study, two prototype systems were developed: HeliNOTS (SAR) for helicopter search and rescue, and HeliNOTS (O) for helicopter offshore transport. Both HeliNOTS systems represent a nuanced approach towards rotary CRM training and assessment.

State of science: models and methods for understanding and enhancing teams and teamwork in complex sociotechnical systems.

This state of the science review brings together the disparate literature of effective strategies for enhancing and accelerating team performance. The review evaluates and synthesises models and proposes recommended avenues for future research. The two major models of the Input-Mediator-Output-Input (IMOI) framework and the Big Five dimensions of teamwork were reviewed and both will need significant development for application to future teams comprising non-human agents. Research suggests that a multi-method approach is appropriate for team measurements, such as the integration of methods from self-report, observer ratings, event-based measurement and automated recordings. Simulations are recommended as the most effective team-based training interventions. The impact of new technology and autonomous agents is discussed with respect to the changing nature of teamwork. In particular, whether existing teamwork models and measures are suitable to support the design, operation and evaluation of human-nonhuman teams of the future. Practitioner summary: This review recommends a multi-method approach to the measurement and evaluation of teamwork. Team models will need to be adapted to describe interaction with non-human agents, which is what the future is most likely to hold. The most effective team training interventions use simulation-based approaches.

Factors influencing surgeons' intraoperative leadership: video analysis of unanticipated events in the operating room.

BACKGROUND: The achievement of surgical goals and the successful functioning of operating room (OR) teams are dependent on leadership. The attending surgeon is a team leader during an operation, with responsibility for task accomplishment by the clinical team. This study examined surgeons' leadership behaviors during surgical procedures, with particular reference to the effect of intraoperative events on leadership. METHODS: Videos of operations (n = 29) recorded at three UK teaching hospitals were analyzed to identify and classify surgeons' intraoperative leadership behaviors using the Surgeons' Leadership Inventory. The frequency and type of leadership behaviors were compared before and after the point of no return (PONR) (n = 24), and during an unexpected intraoperative event (n = 5). RESULTS: Most of the surgeons' leadership behaviors were directed toward the resident during an operation. No significant differences were found for the overall number or type of leadership behaviors pre- and post-PONR. The frequency of leadership behaviors classified as "Training" and "Supporting others" significantly decreased during an unanticipated intraoperative event. DISCUSSION: Overall, surgeons engaged in the same leadership behaviors throughout the course of an operation unless they were dealing with an unanticipated event. Surgeons appeared to adopt a "one size fits all" leadership style approach regardless of the team or situation. Additionally, surgeons seemed to limit their intraoperative leadership focus to other surgeons rather than to the wider OR team.

Paramedics' non-technical skills: a literature review.

Healthcare organisations have started to examine the impact that the human worker has on patient safety. Adopting the Crew Resource Management (CRM) approach, used in aviation, the CRM or non-technical skills of anaesthetists, surgeons, scrub practitioners and emergency physicians have recently been identified to assist in their training and assessment. Paramedics are exposed to dynamic and dangerous situations where patients have to be managed, often with life-threatening injuries or illness. As in other safety-critical domains, the technical skills of paramedics are complemented by effective non-technical skills. The aim of this paper was to review the literature on the non-technical (social and cognitive) skills used by paramedics. This review was undertaken as part of a task analysis to identify the non-technical skills used by paramedics. Of the seven papers reviewed, the results have shown very little research on this topic and so reveal a gap in the understanding of paramedic non-technical skills.

Review article: the influence of psychology and human factors on education in anesthesiology.

PURPOSE: We look at the changing nature of medical education in the developed world with particular reference to those areas of the new curriculum frameworks which have introduced topics from the psychosocial realm. PRINCIPLE FINDINGS: Research in the branch of psychology dealing with human factors has developed a useful body of working knowledge which applies to other industries where humans interact with the complex systems in which they function. Some findings are already being applied to facets of anesthesia performance, including situation awareness, effective teamwork, countermeasures against active errors and latent pathogens, and limitations of human performance. However, existing lessons and practices from industrial or military research may not translate directly into effective strategies for anesthesiologists. Collaborative studies between psychologists and clinicians should continue in order to provide the anesthetic curriculum with an effective body of knowledge for each role of the anesthesiologist. Although individual anesthesiologists have made important contributions in this field, such material has not been formally incorporated into the curricula serving anesthesiologists in the developed world. CONCLUSIONS: There is a gap between the human factors psychologists now know and the human factors anesthesiologists need to know. As that gap closes, anesthesiologists may come to think more like human factor psychologists as well as biomedical scientists.

Job Insecurity during an Economic Crisis: the Psychological Consequences of Widespread Corporate Cost-Cutting Announcements.

Economic crises, such as the one induced by the COVID-19 pandemic, and resulting widespread corporate cost-cutting, drastically alter the nature of work. Job insecurity represents a critical intermediate between the economic ramifications of an economic crisis and work and stress outcomes, however, the underlying cognitive consequences of job insecurity and how to buffer those effects are not well understood. We examine how corporate cost-cutting announcements indirectly relate to employees' attention through their relationship with employee job insecurity and investigate supervisor support as a potential buffer of these relationships. We used multi-source data to test our research model, combining data on cost-cutting announcements (budget cuts, layoffs, and furloughs) in news articles for 165 organizations with survey data from 421 full-time employees from these organizations between March 26, 2020 and April 8, 2020. Cost-cutting announcements are positively related to job insecurity, which is related to employee's attention with supervisor support mitigating the effects of job insecurity on attention. Grounded in self-regulation theories, we contribute to and extend the theoretical understanding of the organizational context for job insecurity and cognitive outcomes. We discuss the implications for organizations to manage and prepare for future economic crises, specifically on organizational communication and supervisor interventions.

Building a transdisciplinary expert consensus on the cognitive drivers of performance under pressure: An international multi-panel Delphi study.

Introduction: The ability to perform optimally under pressure is critical across many occupations, including the military, first responders, and competitive sport. Despite recognition that such performance depends on a range of cognitive factors, how common these factors are across performance domains remains unclear. The current study sought to integrate existing knowledge in the performance field in the form of a transdisciplinary expert consensus on the cognitive mechanisms that underlie performance under pressure. Methods: International experts were recruited from four performance domains [(i) Defense; (ii) Competitive Sport; (iii) Civilian High-stakes; and (iv) Performance Neuroscience]. Experts rated constructs from the Research Domain Criteria (RDoC) framework (and several expert-suggested constructs) across successive rounds, until all constructs reached consensus for inclusion or were eliminated. Finally, included constructs were ranked for their relative importance. Results: Sixty-eight experts completed the first Delphi round, with 94% of experts retained by the end of the Delphi process. The following 10 constructs reached consensus across all four panels (in order of overall ranking): (1) Attention; (2) Cognitive Control-Performance Monitoring; (3) Arousal and Regulatory Systems-Arousal; (4) Cognitive Control-Goal Selection, Updating, Representation, and Maintenance; (5) Cognitive Control-Response Selection and Inhibition/Suppression; (6) Working memory-Flexible Updating; (7) Working memory-Active Maintenance; (8) Perception and Understanding of Self-Self-knowledge; (9) Working memory-Interference Control, and (10) Expert-suggested-Shifting. Discussion: Our results identify a set of transdisciplinary neuroscience-informed constructs, validated through expert consensus. This expert consensus is critical to standardizing cognitive assessment and informing mechanism-targeted interventions in the broader field of human performance optimization.

Team leadership in the intensive care unit: the perspective of specialists.

OBJECTIVES: To identify the behaviors senior physicians (e.g., specialists, staff attendings) report using to lead multidisciplinary teams in the intensive care unit. DESIGN: Semistructured interviews focusing on team leadership, crisis management, and development of an environment that enable effective team performance in the intensive care unit. SETTING: Seven general intensive care units based in National Health Service hospitals in the United Kingdom. PARTICIPANTS: Twenty-five senior intensive care medicine physicians. MEASUREMENTS AND MAIN RESULTS: Responses to a semistructured interview were transcribed and subjected to "content" analysis. The interview analysis focused on references to the "functional" behaviors used by leaders to manage team performance and the "team development behaviors" used to build the conditions that enable effective team performance. Seven of the interviews were coded by a second psychologist to measure inter-rater reliability. Inter-rater reliability (Cohen's κ) was acceptable for both scales (κ = 0.72 and κ = 0.75). In total, 702 functional leadership behaviors (behaviors for information gathering, planning and decision-making, managing team members) were coded as being used to manage the intensive care unit, along with 216 team development behaviors (for providing team direction and establishing team norms). These behaviors were grouped together in a theoretically driven framework of intensive care unit team leadership. CONCLUSIONS: Intensive care unit senior physicians report using a variety of leadership behaviors to ensure high levels of team performance. The data described in this study provide insight into the team leadership behaviors used by intensive care unit team leaders and have implications for the development of team leadership training and assessment tools.

Non-technical skills in histopathology: definition and discussion.

Health care is a high-risk industry, with most documented adverse incidents being associated with 'human factors' including cognitive and social skills termed 'non-technical skills'. Non-technical skills complement the diagnostic and specialist skills and professional attributes required by medical practitioners, including histopathologists, and can enhance the quality of practice and delivery of health-care services and thus contribute to patient safety. This review aims to introduce histopathologists to non-technical skills and how these pertain to everyday histopathological practice. Drawing from other domains in medicine, specifically anaesthesia and surgery, a variety of non-technical skills are identified and described in the context of histopathology to illustrate the role each plays, often collectively, in daily practice. The generic non-technical skills are defined as situation awareness, decision-making, communication, teamwork, leadership, managing stress and coping with fatigue. Example scenarios from histopathology are presented and the contributions to outcomes made by non-technical skills are explained. Consideration of these specific non-technical skills as a component in histopathology training may benefit practitioners as well as assuring patient safety.

Hospital safety climate surveys: measurement issues.

PURPOSE OF REVIEW: Organizational safety culture relates to behavioural norms in the workplace and is usually assessed by safety climate surveys. These can be a diagnostic indicator on the state of safety in a hospital. This review examines recent studies using staff surveys of hospital safety climate, focussing on measurement issues. RECENT FINDINGS: Four questionnaires (hospital survey on patient safety culture, safety attitudes questionnaire, patient safety climate in healthcare organizations, hospital safety climate scale), with acceptable psychometric properties, are now applied across countries and clinical settings. Comparisons for benchmarking must be made with caution in case of questionnaire modifications. Increasing attention is being paid to the unit and hospital level wherein distinct cultures may be located, as well as to associated measurement and study design issues. Predictive validity of safety climate is tested against safety behaviours/outcomes, with some relationships reported, although effects may be specific to professional groups/units. Few studies test the role of intervening variables that could influence the effect of climate on outcomes. SUMMARY: Hospital climate studies are becoming a key component of healthcare safety management systems. Large datasets have established more reliable instruments that allow a more focussed investigation of the role of culture in the improvement and maintenance of staff's safety perceptions within units, as well as within hospitals.

I Don't Want to Go Back: Examining the Return to Physical Workspaces During COVID-19.

OBJECTIVE: We study employee perspectives on return to physical workspaces to ultimately inform employers' and policy makers' decision making around the return to work during COVID-19. METHODS: We tested the three-component conceptual model using survey data collected in the United States in May 2020 from samples of energy workers (N = 333). RESULTS: Women, non-Caucasians, and employees living in multi-generational households were less willing to return. Concerns about childcare were negatively related to willingness to return, whereas organizational strategies for mitigating COVID-19 transmission at work were positively related to willingness to return. COVID-19 infections in an employees' network were also negatively related to employees' willingness to return. CONCLUSIONS: Blanket policies may miss the nuanced needs of different employee groups. Employers and policy makers should adopt flexible approaches to ensure a return to workspaces that addresses employee concerns and needs.

Developing a team performance framework for the intensive care unit.

OBJECTIVE: There is a growing literature on the relationship between teamwork and patient outcomes in intensive care, providing new insights into the skills required for effective team performance. The purpose of this review is to consolidate the most robust findings from this research into an intensive care unit (ICU) team performance framework. DATA SOURCES: Studies investigating teamwork within the ICU using PubMed, Science Direct, and Web of Knowledge databases. STUDY SELECTION: Studies investigating the relationship between aspects of teamwork and ICU outcomes, or studies testing factors that are found to influence team working in the ICU. DATA EXTRACTION: Teamwork behaviors associated with patient or staff-related outcomes in the ICU were identified. DATA SYNTHESIS: Teamwork behaviors were grouped according to the team process categories of "team communication," "team leadership," "team coordination," and "team decision making." A prototype framework explaining the team performance in the ICU was developed using these categories. The purpose of the framework is to consolidate the existing ICU teamwork literature and to guide the development and testing of interventions for improving teamwork. CONCLUSIONS: Effective teamwork is shown as crucial for providing optimal patient care in the ICU. In particular, team leadership seems vital for guiding the way in which ICU team members interact and coordinate with others.

Year 1 medical undergraduates' knowledge of and attitudes to medical error.

CONTEXT: To improve patient safety, medical students should be taught about human error and the factors influencing adverse events. The optimal evaluation of new curricula for patient safety requires tools for baseline measurement of medical students' attitudes and knowledge. OBJECTIVES: The aim of the study was to design and evaluate a questionnaire for measuring the attitudes of Year 1 medical students to patient safety and medical error. METHODS: A questionnaire entitled 'Medical Students' Patient Safety Questionnaire (Year 1)' was designed to assess Year 1 medical students' attitudes and anticipated behaviours relating to medical error and patient safety. This was administered to two cohorts of Year 1 medical students in a UK medical school during 2008 (n = 296) and the data subjected to psychometric analyses. RESULTS: Medical students' attitudes to good patient safety practices were generally positive, but the students had little knowledge of how to report errors and were unsure about what to do if a colleague made an error or if a patient indicated that an error had been made. On the five scales of the questionnaire, Cronbach's alpha values ranged from 0.59 (Attitudes to patient safety scale) to 0.88 (Knowledge of error and patient safety scale) and three scales showed internal consistencies below the recommended value of 0.70. Exploratory factor analysis showed that the five factors explain 51.7% of variance. CONCLUSIONS: With some minor item trimming and re-allocation, the Medical Students' Patient Safety Questionnaire (Year 1) can function as an instrument with which to assess the attitudes of new medical students to patient safety and medical error. To assess the suitability of the instrument beyond the UK would require additional work.

Non-technical skills of the operating theatre scrub nurse: literature review.

AIM: This paper is a report of a review to identify the non-technical (cognitive and social) skills used by scrub nurses. BACKGROUND: Recognition that failures in non-technical skills contributed to accidents in high-risk industries led to the development of research programmes to study the role of cognition and social interactions in operational safety. Recently, psychological research in operating theatres has revealed the importance of non-technical skills in safe and efficient performance. Most of the studies to date have focused on anaesthetists and surgeons. DATA SOURCES: On-line sources and university library catalogues, publications of the Association for Perioperative Practice, National Association of Theatre Nurses and Association of Peri-Operative Registered Nurses were searched in 2007. REVIEW METHODS: Studies were included in the review if they presented data from scrub nurses on one or more of their non-technical skills. These findings were examined in relation to an existing medical non-technical skills framework with categories of communication, teamwork, leadership, situation awareness and decision-making. RESULTS: Of 424 publications retrieved, 13 were reviewed in detail. Ten concerned communication and eight of those also had data on teamwork. In 11 papers teamwork was examined, and one focused on nurses' situation awareness, teamwork and communication. None of the papers we reviewed examined leadership or decision-making by scrub nurses. CONCLUSION: Further work is needed to identify formally the non-technical skills which are important to the role of scrub nurse and then to design training in the identified non-technical skills during the education and development of scrub nurses.

Facets of job effort in bus driver health: deconstructing "effort" in the effort-reward imbalance model.

This research aimed to test the relative value of developing and using job-specific facets of effort and testing them using J. Siegrist's (1996) effort-reward imbalance (ERI) theory to extend understanding of how one might determine job strain in urban bus driving. In addition, the interactive effects of the ERI model are further investigated to address the lack of research into the relationships of the model's constructs. Using focus groups and published papers, a measure of bus driver effort was created, which was subsequently completed by 186 male U.K. bus drivers as part of a questionnaire study. The results were factor analyzed to create 4 facets of effort, which demonstrated additional variance in predicting strain, above and beyond J. Siegrist's original effort construct. One facet, workload and fatigue, was observed to be a particularly important contributor to strain. The analyses further indicated that the ERI model's assumptions that ERI creates job strain could not be completely upheld, although poorer levels of reward and higher levels of overcommitment were strong main predictors of job strain. Research and applied implications are considered.

Safety in shipping: the human element.

INTRODUCTION: There are numerous diverse papers that have addressed issues within maritime safety; to date there has been no comprehensive review of this literature to aggregate the causal factors within accidents in shipping and surmise current knowledge. METHODS: This paper reviewed the literature on safety in three key areas: common themes of accidents, the influence of human error, and interventions to make shipping safer. The review included 20 studies of seafaring across the following areas: fatigue, stress, health, situation awareness, teamwork, decision-making, communication, automation, and safety culture. RESULTS: The review identifies the relative contributions of individual and organizational factors in shipping accidents, and also presents the methodological issues with previous research. CONCLUSIONS: The paper concludes that monitoring and modifying the human factors issues presented in this paper could contribute to maritime safety performance. IMPACT ON INDUSTRY: This review illustrates which human factors issues are prevalent in incidents therefore this gives shipping practitioners a focus for interventions.

Basic concepts for crew resource management and non-technical skills.

In this paper, we explain the conceptual background to non-technical skills and show how they can influence job performance in anaesthesia. We then describe the taxonomy of anaesthetists' non-technical skills (ANTS) and related systems, such as ANTS-AP for anaesthetic practitioners. We discuss the training courses that have been designed to teach these non-technical skills, which are called crew resource management (CRM), crisis resource management (CRM) or crisis avoidance resource management (CARMA). Finally, we discuss the application of non-technical skills assessment systems.

Car driver attitudes, perceptions of social norms and aggressive driving behaviour towards cyclists.

The interaction of car drivers and cyclists is one of the main causes of cycle incidents. The role of attitudes and social norms in shaping car drivers' aggressive behaviour towards cyclists, is not well understood and merits investigation. A sample of 276 drivers completed an online questionnaire concerning their attitudes towards cyclists, attitudes towards risky driving, perception of social norms concerning aggressive driving towards cyclists, and the frequency with which they engage in such aggressive driving behaviours. The results showed that attitudes towards cyclists, as well as social norm perceptions concerning aggressive driving towards cyclists, were associated with aggressive driving towards cyclists. Negative attitudes towards cyclists were more pronounced in non-cyclists than cyclists and their association with aggressive driving behaviour was stronger in cyclists than non-cyclists. The perception of social norms concerning aggressive driving towards cyclists had a stronger association with aggressive driving in non-cyclists than cyclists. Attitudes towards risk taking did not affect aggressive driving towards cyclists. These findings can inform campaigns that aim to improve cyclist and car driver interaction on the roads, making them safer to use for cyclists.

Staying in the zone: offshore drillers' situation awareness.

OBJECTIVE: The aim of this study was to identify the cognitive components required for offshore drillers to develop and maintain situation awareness (SA) while controlling subsea hydrocarbon wells. BACKGROUND: SA issues are often identified as contributing factors to drilling incidents, most recently in the Deepwater Horizon blowout. Yet, there is a limited body of research investigating SA in the offshore drilling environment. METHOD: In the first study, critical incident interviews were conducted with 18 experienced drilling personnel. Transcripts were subjected to theory-driven thematic analysis, producing a preliminary cognitive framework of how drillers develop and maintain SA during well control. In the second study, 24 hr of observations (in vivo and video) of drillers managing a high fidelity well-control simulator were analyzed to further develop the framework. RESULTS: The cognitive components that enable drillers to build up an understanding of what is happening in the wellbore and surrounding environment, to predict how this understanding may develop, were identified. These components included cue recognition, interpretation of information in conjunction with the current mental model, and projection through mental simulation. Factors such as distracters, expectations, and information sharing between crew members can both positively and negatively influence the drillers' SA. CONCLUSION: The findings give a preliminary understanding into the components of drillers' SA, highlighting the importance of SA for safe and effective performance and indicating that Endsley's model of SA can be applied to drilling. APPLICATION: The results have consequences for training, task management, and work design recommendations.