Customisation of an instrument to assess anaesthesiologists' non-technical skills

OBJECTIVE The objectives of the study were to identify Danish anaesthesiologists' non-technical skills and to customise the Scottish-developed Anaesthetists' Non-Technical Skills instrument for Danish anaesthesiologists. METHODS Six semi-structured group interviews were conducted with 31 operating room team members: anaes-thesiologists, nurse anaesthetists, surgeons, and scrub nurses. Interviews were transcribed verbatim and analysed using directed content analysis. Anaesthesiologists' non-technical skills were identified, coded, and sorted using the original instrument as a basis. The resulting prototype instrument was discussed with anaesthesiologists from 17 centres to ensure face validity. RESULTS Interviews lasted 46-67 minutes. Identified examples of anaesthesiologists' good or poor non-technical skills fit the four categories in the original instrument: situation awareness; decision making; team working; and task management. Anaesthesiologists' leadership role in the operating room was emphasised: the original 'Task Management' category was named 'Leadership'. One new element, 'Demonstrating self-awareness' was added under the category 'Situation Awareness'. Compared with the original instrument, half of the behavioural markers were new, which reflected that being aware of and communicating one's own abilities to the team; working systematically; and speaking up to avoid adverse events were important skills. CONCLUSIONS The Anaesthetists' Non-Technical Skills instrument was customised to a Danish setting using the identified non-technical skills for anaesthesiologists and the original instrument as basis. The customised instrument comprises four categories and 16 underpinning elements supported by multiple behavioural markers. Identifying non-technical skills through semi-structured group interviews and analysing them using direct content analysis proved a useful method for customising an assessment instrument to another setting.