The rise of human factors: Optimising performance of individuals and teams to improve patients’ outcomes

Gianluca Casali*, William Cullen, Gareth Lock

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

11 Citations (Scopus)
275 Downloads (Pure)


The improvement of surgical outcomes has been achieved working under the assumption that they are mainly the result of technical skills. This model, although correct, is not exhaustive and has left out many variables that affect outcomes, of which a number can be grouped under the label of non-technical skills, which is a subset of human factors. Non-technical skills are developed to facilitate a shared mental model between team members, teams and their operational environment. They include situation awareness, decision-making, communication, teamwork, leadership and performance-shaping factors. The importance of these non-technical skills has been highlighted during the investigations of severe accidents in many high-risk industries and healthcare. There is an almost untapped opportunity to improve outcomes focusing on non-technical skills because until recently there has been an under-investment of time and resources in this area compared with technical skills. This theoretical paper supports the adoption of a broader model of human performance as a function of technical and non-technical skills and the cultural and organisational context where these are at play. We also aim to highlight a pathway to increase the investment in nontechnical skills following the most updated evidence.

Original languageEnglish
Pages (from-to)S998-S1008
JournalJournal of Thoracic Disease
Issue numberSuppl 7
Publication statusPublished - 1 Apr 2019


  • Adverse events
  • Errors
  • Non-technical skills
  • Safe surgery
  • Safety culture


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