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Development and reliability of the explicit professional oral communication observation tool to quantify the use of non-technical skills in healthcare
  1. Peter F Kemper1,
  2. Inge van Noord1,
  3. Martine de Bruijne1,
  4. Dirk L Knol2,
  5. Cordula Wagner1,3,
  6. Cathy van Dyck4
  1. 1Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  3. 3The Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands
  4. 4Faculty of Social Sciences, Department of Organizational Science, VU University, Amsterdam, The Netherlands
  1. Correspondence to Peter F Kemper, Department of Public and Occupational Health, EMGO+ Institute for Health Care and Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands; p.kemper{at}vumc.nl

Abstract

Background A lack of non-technical skills is increasingly recognised as an important underlying cause of adverse events in healthcare. The nature and number of things professionals communicate to each other can be perceived as a product of their use of non-technical skills. This paper describes the development and reliability of an instrument to measure and quantify the use of non-technical skills by direct observations of explicit professional oral communication (EPOC) in the clinical situation.

Methods In an iterative process we translated, tested and refined an existing checklist from the aviation industry, called self, human interaction, aircraft, procedures and environment, in the context of healthcare, notably emergency departments (ED) and intensive care units (ICU). The EPOC comprises six dimensions: assertiveness, working with others; task-oriented leadership; people-oriented leadership; situational awareness; planning and anticipation. Each dimension is specified into several concrete items reflecting verbal behaviours. The EPOC was evaluated in four ED and six ICU.

Results In the ED and ICU, respectively, 378 and 1144 individual and 51 and 68 contemporaneous observations of individual staff members were conducted. All EPOC dimensions occur frequently, apart from assertiveness, which was hardly observed. Intraclass correlations for the overall EPOC score ranged between 0.85 and 0.91 and for underlying EPOC dimensions between 0.53 and 0.95.

Conclusions The EPOC is a new instrument for evaluating the use of non-technical skills in healthcare, which is reliable in two highly different settings. By quantifying professional behaviour the instrument facilitates measurement of behavioural change over time. The results suggest that EPOC can also be translated to other settings.

  • Communication
  • Patient safety
  • Team training
  • Teamwork
  • Quality measurement

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