Importance of “Non-Technical Skills” in Improving Quality of MCH Services

Situational (or situation) Awareness

Situational awareness is essentially perception or attention to the surroundings and the detection of any changes. This concept is familiar on the delivery suite, where multiple tasks may present simultaneously, task interruption is common and delegation is often required. It is also essential as part of good surgical decision making in the operating theatre. Situational awareness may be influenced by factors such as experience, preconceptions, expectations and task workload. Of use in building situation awareness are quick updates, team huddles and planning meetings in order to maintain a shared mental model and ensure that team members are able to anticipate future events.

Decision Making

The process of reaching a judgement or choosing an option to meet the needs of a given situation or task is required in almost every patient encounter in maternity ward especially in labour room. Conditions for decision making can vary in relation to time pressures, feasibility of options, task demands and levels of support for the decision maker. Broadly speaking, the first stage in decision making requires situation assessment – i.e. observation and identification of the problem. In the second stage of decision making, there is a process of choosing a course of action to meet the needs of the situation assessment. The effectiveness of the response chosen will depend on the accuracy of the initial assessment and the experience of the individual making the decision. Decision making may be degraded by fatigue, as it erodes working (short-term) memory, thereby reducing one’s ability to retrieve problem solving information from the long-term memory.

Team Work

Poor teamwork and risk to women is well known observation of confidential maternal death inquiries. Key elements of team working include support for other team members through sharing workload, accepting individual responsibility, conflict resolution and exchange of information. We work in teams that are constantly changing, with different health professionals and different levels of expertise coming together on each shift, and there is increasing demand for flexibility and responsiveness within the team. The focus must be on the individual to be as effective as possible and to have a clear understanding of their individual role.

Communication

Communication is an important element of effective teamwork (i.e. a co-skill) and is the exchange of information, ideas, feelings or feedback. The ability to communicate effectively with the mother and her relatives is also essential in order to gain their confidence and provide reassurance in a stressful life-situation. Communication issues are particularly relevant in maternity services where there may be multiple handovers, transfers between home settings and hospital and referrals between professional groups. Poor communication between primary care and hospital or within hospital has frequently been cited as a contributor to adverse events. In an emergency, more efficient teams are likely to recognise and verbalise the crisis and use closed- loop communication (i.e. task clearly and loudly delegated to specific individuals, accepted, executed and completion acknowledged) to protect the flow of information. The SBAR format (situation, background, assessment, response) is also of use in transmitting critical information and is now common place on many delivery suites.

Leadership

Effective leadership is essential for maintaining safe performance in the workplace and maintaining morale.

Leadership requires motivating, directing and organising the team, encouraging individuals to work together, assessing performance, task assignment and generating a positive environment. Leadership skills may also be needed by other members of the team when necessary to plan, prioritise and manage workload.

Other Non-Technical Skills

In labour room and operation theatre, maintaining dignity and a professional relationship with the woman when she is awake and vulnerable should be considered as an additional key NTS. Partner (relative or accompanying person) management and dealing with disruptive behaviour are also essential and can be classed as separate, but related, entities to communication skills. In addition, professional behaviour (i.e. remaining calm under pressure, coping with distractions and interruptions) and cross-monitoring of performance are also skills required.