Competency framework in human factors for the quality and safety of care (non-technical skills)

Source: 📒 Competency framework in human factors for the quality and safety of care (non-technical skills)

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Number of pages: 118

1. Analytical summary

1.1. Context, issues, and audiences

The framework starts from the observation that the majority of adverse events associated with care are due to failures in communication, coordination, decision-making, stress, or fatigue, rather than strictly technical faults.

Non-technical skills are defined as cognitive, social, and personal resources that complement technical skills, which are crucial for safety, collective performance, and well-being at work.

The document articulates these skills with organisational and human factors (OHF) in a systemic approach, which sees humans as reliability actors rather than weak links.

It is aimed at health students, practising professionals, managers, multi-professional teams, patient representatives, as well as training structures and institutions wishing to integrate non-technical skills into their curricula.

The stakes are to embed non-technical skills in a learning and sustainable organisational approach, to strengthen the safety culture (reporting, feedback, just culture, teamwork) and to explicitly bring together technical and non-technical skills in training and assessment.

1.2. Operational contributions for field actors

The framework proposes a continuous pedagogical engineering model, from initial training to continuing education, based on representative care situations, objectives formulated in observable behaviours, and an evaluation focused on actual activity.

It provides 13 thematic educational sheets covering the fundamentals (OHF, safety culture, neuroscience, fatigue, stress), team functioning (effective team, patient involvement) and key skills (leadership, self-awareness, communication, workload management, situational awareness, decision-making).

Each sheet clearly outlines learning objectives, content, active teaching methods (simulation, role-playing, feedback, case studies, briefing/debriefing) and assessment methods (MCQs, observation, self-assessment, action plans).

The document also provides guidelines for integrating non-technical competencies into initial training (two modules: concepts then action) and continuous training (CRM programming, DPC, EPP, in situ training) by anchoring them in risk situations and the real constraints of teams.

Finally, it offers keys to associate human factors, safety culture, and reliability methods (checklists, cognitive aids, sterile cockpit, feedback) in order to transform feedback from EIAS into collective learning and shared improvement actions.

2. Key points of the document 

1. The framework clearly defines non-technical skills as cognitive, social, and personal resources (decision-making, situational awareness, communication, teamwork, leadership, stress and fatigue management) and links them to human factors within a systemic perspective of healthcare safety. (p. 5-8, 16-18)

2. A continuous pedagogical engineering model is proposed: it provides for a common interprofessional foundation, a spiral progression from initial training to continuous education, and the alignment of learning situations, observable objectives, and assessment methods. (p. 9-14)

3. Initial training is structured into two complementary modules: "appropriating the concepts" (FOH, safety culture, neuroscience, fatigue, stress, effective team, patient involvement) and "acting" (leadership, self-awareness, communication, workload, situational awareness, decision-making), with a strong emphasis on simulation and internships. (p. 12‑13, 15‑16, 23‑31, 35‑39, 43‑61)

4. Each educational sheet details general and specific objectives, theoretical content, active teaching methods (health simulation, RETEX, RMM, workshops, role-playing, self-assessments) and evaluation methods (pre/post-tests, observation, structured feedback, action plan), making the framework immediately usable by trainers. (p. 16‑31, 35‑39, 43‑61, 66‑69)

5. The document explicitly links the development of CNT, safety culture, and quality of work life: fatigue, stress, workload, psychological safety, and interprofessional cooperation are addressed as major determinants of EIAS and well-being, with updated references and tools (including the Patient Safety Flash on "fatigue of healthcare professionals" from 2026). (p. 4‑8, 27‑31, 66‑69, 110‑115)

3. Action points for local stakeholders 

1. Systematically integrate CNT into training plans and educational projects in the field, starting from the two proposed modules (concepts + acting) and aligning the content with the 13 sheets, rather than creating isolated or ad-hoc training sessions. (p. 9‑16, 23‑31, 35‑39, 43‑61)

2. Use the FOH sheets, safety culture, and neuroscience (sheets 1 to 3) as supports for RMM, CREX, or feedback groups, in order to bring out non-technical contributory factors and co-construct improvement actions rooted in the reality of the teams. (p. 16‑23, 20‑22, 23‑26, 66‑69)

3. Develop in situ simulation sequences focused on teamwork, secure communication, leadership, and situational awareness (sheets 6 to 8, 10, 12, 13), with structured briefing/debriefing, and link them with the action plans resulting from EPP/DPC. (p. 35‑39, 43‑47, 50‑54, 57‑61, 66‑68)

4. Establish, with the teams and governance, concrete measures to prevent fatigue and overload (organisation of schedules, rest areas, culture of 'daring to say' one's fatigue), relying on sheet 4 and recent national recommendations. (p. 27‑31, 66‑69, 110‑115)

5. Include patients and user representatives as full members of the training and evaluation systems of CNT (the patient's role in the team, safety culture, participation in RETEX), in order to strengthen the partnership dimension and the relevance of improvement actions. (p. 4‑7, 35‑39, 39, 66‑69)

4. Additional References 

🔍➕ For more information, see the articles referenced by "Pratiques en Santé" on the topic of quality of care ➡️🔗https://pratiquesensante.odoo.com/7-6-qualite-et-securite-des-soins

1. Buljac‑Samardzic M, Doekhie KD, van Wijngaarden JDH. "Interventions to improve team effectiveness within health care: a systematic review of the past decade". Human Resources for Health, 2020.

   Recent systematic review on team work enhancement interventions, useful for complementing the scientific evidence section and choosing pedagogical approaches.https://pubmed.ncbi.nlm.nih.gov/31915007/

2. OECD (by Bienassis K, Klazinga N). "Comparative assessment of patient safety culture performance in OECD countries: Findings based on the Hospital Survey on Patient Safety Culture versions 1 and 2". OECD Health Working Papers no. 168, 2024. Provides international comparative data on safety culture, directly linked to the sections of the framework on safety climate, FOH, and governance steering.https://www.oecd.org/en/publications/comparative-assessment-of-patient-safety-culture-performance-in-oecd-countries_d0552328-en.html

5. Cross-sectional analysis — values of Health Practices

• Literacy: the document remains technical, but the educational sheets and examples of active methods facilitate adaptation to varying levels of understanding among professional students and teams. (p. 15‑18, 23‑31, 66‑69)

• Empowerment: professionals are encouraged to analyse their own practices, develop action plans, and adapt tools to their context; beneficiaries/patients are recognised as team members, but few tools are provided to directly enhance their agency. (p. 4‑7, 35‑39, 66‑69)

• Participation: co-construction is mainly described for teams (working in sub-groups, RETEX, value charter, simulation scenarios), with user participation suggested more than equipped. (p. 16‑22, 35‑39, 66‑69)

• Community health: the collective dimension is strongly present through the team, safety culture, and learning organisation, but the framework remains focused on healthcare establishments and structures rather than on territorial community dynamics. (p. 4‑9, 35‑39, 66‑69)

• Ethics: cognitive biases, the effects of stress and fatigue, just culture, and psychological safety are addressed, which helps to limit moralistic judgments about errors and to promote a systemic analysis rather than one that induces guilt. (p. 5‑8, 16‑22, 23‑26, 27‑31)

• Human rights: the document promotes equity and inclusion through just culture, the role of the patient in the team, and the recognition of the well-being of professionals as a condition for the quality of care, without explicitly detailing the rights/gender/disability frameworks. (p. 4‑7, 35‑39, 27‑31)

• Intersectorality: links are made with other high-risk sectors (aerospace, nuclear, transport) and with universities, medico-social structures, and quality organisations, but the articulation with the social/community sectors remains implicit. (p. 5‑8, 9‑14, 16‑18)

• Partnership: models of collaboration are formalised around teamwork, shared leadership, CRM programmes, and safety meetings between teams and governance. (p. 9‑14, 35‑39, 43‑47, 66‑69)

• Combating discrimination: the document emphasises just culture, psychological safety, respect for roles, and recognition of each individual, but does not explicitly address discrimination (gender, origin, disability, sexual orientation). (p. 20‑22, 35‑39, 43‑47)

Points of vigilance in facilitation

The main theme (human factors, non-technical skills, fatigue, stress, medical errors) is sensitive as it relates to patient safety, the experiences of caregivers, and the issue of error.

Risks of emotional triggering:

• Accounts of serious adverse events, errors in care or accidents, which may revive painful experiences in participants. (p. 16‑18, 27‑31, 66‑69)

• Discussions on chronic fatigue, burnout, workload and loss of meaning that may reactivate discomfort or feelings of guilt. (p. 27‑31)

• Analysis of cognitive biases and individual errors that may be experienced as personal blame if the framework of a 'just culture' is not explicitly established. (p. 20‑22, 23‑26)

In facilitation, it is necessary to:

• Establish a framework of psychological safety and confidentiality from the outset.

• Allow for temporary withdrawal, plan for breaks and emotional debriefing.

• Emphasise a systemic approach and a just culture to avoid blame. (p. 20‑22)

6. Evaluation of the reliability of the resource

• Scientific relevance:

  • Document produced by the HAS, validated by the College, with a multidisciplinary working group, declaration procedures and management of conflicts of interest publicly accessible.

  • Abundant and recent bibliographic references, including systematic reviews, WHO reports, OECD work, international literature on non-technical skills, occupational health, safety culture and neuroscience. (p. 110‑115)

  • Strong grounding in evidence on teamwork, fatigue, human errors and training interventions.

    → High scientific relevance.

• Operational relevance:

  • Clear structure in educational sheets with objectives, content, methods, and evaluations, directly reusable by trainers, managers, and quality officers. (p. 15‑31, 35‑39, 43‑61, 66‑69)

  • Taking into account field constraints (over-specialisation, complexity, fatigue, workload, multi-professionalism) and articulation with EPP, DPC, simulation, and periodic certification. (p. 9‑14, 27‑31, 66‑69)

  • Limit: generic framework not tailored to specific professions, requiring local contextualisation work for different professions and sectors (urban, medico-social, social). (p. 4‑7)

    → High operational relevance, subject to local contextualisation.

7. MCQ – 5 questions

Part 1 — Questions (without answers)

Question 1 (p. 5‑6):

In this framework, non-technical competencies (NTC) are primarily defined as:

a) Standardised care protocols

b) Cognitive, social, and personal resources mobilised in situations

c) Complex technical gestures with high added value

d) Indicators of institutional performance

Question 2 (p. 9‑14):

The proposed pedagogical engineering model for NTC is characterised in particular by:

a) The addition of an optional module disconnected from other teachings

b) The organisation of occasional training focused on serious mediated errors

c) The alignment of learning situations, observable objectives, and evaluation methods

d) The exclusive delegation of NTC to only occupational psychologists

Question 3 (p. 20‑22):

According to James Reason, which of the following propositions is part of the components of safety culture?

a) The culture of competition between services

b) The culture of reporting (reporting adverse events)

c) The culture of financial results

d) The culture of strict regulatory compliance

Question 4 (pp. 27‑31):

Regarding the fatigue of healthcare professionals, the framework highlights that:

a) It is mainly an individual problem with no impact on patient safety

b) It is rare and mainly related to psychiatric conditions

c) It is trivialised even though it is a recognised contributory factor of adverse events

d) It only concerns night professionals in intensive care

Question 5 (pp. 43‑47):

Regarding leadership in healthcare, the framework states that:

a) Effective leadership relies solely on formal hierarchical authority

b) Leadership and teamwork are innate personality traits

c) Effective leadership contributes to psychological safety and teamwork

d) Leadership is reserved for senior doctors and facility directors

Order of the chosen correct answers: 1‑b / 2‑c / 3‑b / 4‑c / 5‑c.

Part 2 — Commented correction

Question 1 (p. 5‑6):

✅ Correct answer: b) Cognitive, social, and personal resources mobilised in situation

📝 Explanation: the framework presents the CNT as cognitive, social, and personal resources that complement technical skills and contribute to safety and performance in tasks, without creating new professional skills but by making these dimensions visible. Source: p. 5‑6.

Question 2 (p. 9‑14):

✅ Correct answer: c) The alignment of learning situations, observable objectives, and assessment methods

📝 Explanation: the engineering model aims to align learning situations representative of real activity, objectives formulated as observable actions, and assessment methods focused on the activity of students and professionals, within a spiral progression logic. Source: p. 9‑11.

Question 3 (p. 20‑22):

✅ Correct answer: b) The culture of reporting (reporting undesirable events)

📝 Explanation: according to Reason, the safety culture is based on four components: reporting culture, feedback culture, just culture, and teamwork culture; the framework precisely incorporates these elements to structure action on safety culture. Source: p. 20‑21.

Question 4 (pp. 27‑31):

✅ Correct answer: c) It is trivialised even though it is a recognised contributory factor of EIAS

📝 Explanation: fatigue, often trivialised in the daily lives of caregivers, is described as a contributory factor to undesirable events associated with care, with effects on vigilance, judgment, communication, and long-term health, justifying individual and organisational measures. Source: p. 27‑29.

Question 5 (pp. 43‑47):

✅ Correct answer: c) Effective leadership contributes to psychological safety and teamwork.

📝 Explanation: the framework emphasises adaptive and shared leadership, which clarifies objectives, regulates tensions, encourages everyone's expression and psychological safety, moving away from a purely hierarchical or innate view of leadership. Source: pp. 43-45.

8. FAQ (7 questions/answers)

1. What is the main objective of this framework for health structures?

   It aims to support the development of non-technical skills among students and professionals, to promote a shared culture of quality and safety in care, and to provide a pedagogical framework for integrating FOH and CNT into initial and continuing training. Ref.: pp. 4-7, 9-14.

2. Who is this framework specifically aimed at?

   It targets health students, professionals in all fields (both clinical and non-clinical), managers, multi-professional teams, patients/user representatives, as well as training structures, health establishments and professional organisations wishing to develop programmes integrating CNT. Ref.: pp. 4-7, 9-14.

3. What are the main families of non-technical skills identified?

   The framework adopts Flin's classification: cognitive skills (decision-making, situational awareness, workload management), interpersonal/social skills (communication, teamwork, leadership) and personal skills (stress management, fatigue management), highlighting their interdependence. Ref.: pp. 5-7, 61.

4. How are non-technical skills integrated into initial training?

   Initial training is organised into two modules: the first to grasp the concepts (Human Factors, safety culture, neuroscience, fatigue, stress, effective teams, patient involvement) and the second to learn to act with specific skills (leadership, self-awareness, effective communication, workload management, situational awareness, decision-making), through active methods and placements. Ref.: pp. 12-13, 15-16, 23-31, 35-39, 43-61.

5. How can teams use this framework in continuing education?

   They can rely on the sections dedicated to continuing education and active pedagogical methods to design CRM programmes, in situ simulation sessions, feedback sessions, and EPP focused on the CNT, contextualising the themes to local risk situations and identified needs. Ref.: pp. 13-14, 66-69.

6. Does the framework provide tools to measure or improve safety culture?

   It recalls safety culture models (Reason), measurement tools such as the HSOPSC, and describes action levers: safety meetings, diagnosis and action plan on safety culture, work on just culture, feedback and teamwork. Ref.: pp. 20-22, 66-69, 110-115.

7. How does this framework take into account the fatigue and well-being of professionals?

   A whole section is dedicated to fatigue and its management, with contributions from chronobiology, consequences on vigilance and safety of care, individual and organisational prevention strategies, as well as suggestions for evolving the representation of fatigue and integrating it into safety culture. Ref.: pp. 27-31, 66-69.

9. Rewriting in Easy-to-Read Language 

9.1. Summary in Easy-to-Read Language

Document Title

This document discusses 'human factors' and 'non-technical skills' in healthcare.

It explains how these skills help make care safer for patients.

Context and Issues

Errors often arise from communication, coordination, or fatigue issues.

Non-technical skills include: decision-making, communication, teamwork, stress management.

They complement technical skills; they do not replace them.

The document is aimed at students, healthcare providers, supervisors, and associated patients.

It aims to help teams work better together to avoid serious errors.

Contributions for the Field

The document provides a model for organising training, from the start of a career onwards.

It offers 13 practical sheets to work on each major non-technical skill.

Each sheet outlines: objectives, content, training methods, and evaluation.

The methods are active: role-playing, simulation, case studies, feedback.

The document also emphasises fatigue, stress, and safety culture within teams.

9.2. Key Points FALC

• Non-technical skills are ways of thinking, speaking, and cooperating.

• They are essential for patient safety and the well-being of healthcare providers.

• The document proposes 13 simple sheets to train teams in these skills.

• Training should use real situations and practical exercises.

• Fatigue and stress must be recognised and managed to avoid care errors.

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