Intended for healthcare professionals


Improving patient safety through training in non-technical skills

BMJ 2009; 339 doi: (Published 23 September 2009) Cite this as: BMJ 2009;339:b3595
  1. Rhona Flin, professor of applied psychology1,
  2. Rona Patey, consultant anaesthetist2
  1. 1School of Psychology, University of Aberdeen, King’s College, Old Aberdeen AB24 2UB
  2. 2Aberdeen Royal Infirmary
  1. r.flin{at}

    As in aviation, education should occur early in the core curriculum

    To reduce iatrogenic injury, healthcare organisations have been encouraged to adopt approaches from high risk industries—most notably aviation—that focus on human factors. The best known of these methods is crew resource management (CRM) training, designed to reduce human error by enhancing non-technical skills such as situation awareness, decision making, and teamwork.

    Although CRM programmes are widely used in aviation, and mandated in many countries, measurable effects on safety outcomes remain elusive, partly because commercial aircraft accidents are infrequent. Although some studies have reported changes in behaviour, a meta-analysis of the effectiveness of CRM training only found significant improvements in trainees’ attitudes to safety.1

    Varieties of CRM training are being adopted for multiprofessional groups of clinical staff who have had no previous education in non-technical skills. Some courses focus on teamwork,2 others cover a range of topics.3 Although training in multidisciplinary teams has some benefits, it is not the ideal method for teaching …

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