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Interest in human factors within healthcare has increased exponentially over the last decade (Catchpole, 2013a), but much work to embrace this concept has been misinformed,

misguided or misdirected (Bleetman, Sanusi, Dale & Bruce, 2012; Cahan et al., 2011; Ross, Rothnie, Parmalee, Masta-Gornic & Pohl, 2009; Turner, 2012). As is often the case when work is extrapolated from another field (Carroll, 1997), the tenants of such work in other technology advanced industries do not hold water in this context. This is not to say that the human factors revolution is wrong, but that change is needed (Russ, Fairbanks & Karsh, 2013).

Catchpole (2013a) calls for a greater presence of human factors in the design of clinical systems and technologies, the field to develop accreditation for professionals working in healthcare and the need to deliver training programmes in behavioural change

and in system-level human factors, non-technical skills and appropriate analytical

techniques. Whilst this first item is very much the realm of the psychologist, the last two need educators to embrace the issue. And in there lies the problem. Human factors and non-technical skills is vastly under discussed in the medical education literature, as reflected in the limited citations in this body of work. The values and ideals of quality in educational innovation were found to be almost completely absent in the published literature within

several of the studies in this programme of works (Gordon & Findley, 2011; Gordon,

Darbyshire and Baker, 2012).

The aim of these works was to address this gap in the literature. Through the works of this thesis, some of the key educational matters that arise when discussing new interventions have been addressed. Of particular note is the shifting of focus from effectiveness issues such as ‘whether’ education is effective and asking deeper and more useful questions (Cook,

Bordage & Schmidt, 2008; Gordon, Darbyshire & Baker, 2013). These deeper questions that

meeting the objectives of this thesis, representing a new and important contribution to the field. :-

 Why does non-technical skills learning impact on the core skills identified? – the

conceptual frameworks identified discuss theories that may explain why non-

technical skills learning is needed (Gordon & Findley, 2011) and why education

underpinned by these elements may be effective (Gordon, Darbyshire & Baker,

2012)

 How should such education be constructed? – grounded theory works have

investigated how professionals learn non-technical skills (Gordon, Catchpole &

Baker, 2012) and how key theoretical elements can be used to allows this to happen

in a structured educational intervention (Gordon, 2013b; Gordon 2013b).

 When should such education be delivered? – the issues of safety and how this

impacts on the timing of such education has been considered (Gordon, 2013a)

 Who should such education be delivered to? – the role of the multi-professional

team has been investigated (Gordon, Holt, Lythgoe, Mitchell & Hollins-Martin,

2012) as well as considering different learning groups within the interventions

produced (Gordon, 2013b)

 What should be delivered? – Education elements have been designed, piloted and

tested, with clear reporting of pedagogy to allow replication and dissemination (Gordon & Bose-Haider, 2012; Gordon, 2013b)

Additionally, whilst clearly not the focus of this work, the question of effectiveness has also

been considered through application of elements of the SECTORS model (Gordon & Bose-

Haider, 2012; Gordon, Holt, Lythgoe, Mitchell & Hollins-Martin, 2012) as well as the

complete model (Gordon, 2013a) to educational design with assessment of key outcomes.

These include demonstration of a effectiveness at several levels of kirkpatrick’s hierarchy (Yardley & Dornan, 2012) in several groups of learners in a number of environments,

including Level 1, satisfaction with education (Darbyshire, Gordon & Baker, 2013; Gordon,

2013a) , level 2a, change in patient safety attitudes (Gordon & Bose-Haider, 2012; Gordon, Holt, Lythgoe, Mitchell & Hollins-Martin, 2012; Gordon, 2013a) and level 3, change of

behaviour (Gordon & Bose-Haider). Clearly, much of the justification for the unique and valuable contribution of this programme of study to the wider literature has been based on

the limited importance of such outcomes in informing educators (Dornan, 2008).However,

when addressed in combination with the outcomes investigated, the result is a significant multi-modal package of investigation that supports readers in educational innovation in the future.

The SECTORS model is the culmination of this work and illustrates the paradigm shift in focus that is needed. This is the first piece of work that considers non-technical skills in healthcare from an educational perspective. This evidence based, conceptually

underpinned, theoretically driven model for learning allows those planning such educational innovations to ensure consistency and appropriate educational design. As the field

develops, the model will be refined, rejected or accepted. Whichever occurs, the synthesis of this model will support scholarly developments in this vital area of healthcare and patient safety education.

SECTORS can be applied for a number of purposes in a number of settings. SECTORS can be used at the curriculum planning stage for all health professionals to support the integration of appropriate learning outcomes within varied areas of a curriculum. As the skills it

identifies are usually addressed in a number of areas, ensuring that opportunities to support acquisition of non-technical skills are identified and then taken is a key strength of the model. SECTORS also forms a framework for educators looking to design new educational components in areas pervaded by non-technical skills, such as handover or prescribing. In this context, the SECTORS model would be used to underpin teaching methods and content and so maximise the potential for key non-technical skill outcomes to be addressed. For example, in the context of medicines safety, SECTORS would support awareness of local error data that grounds itself in consequences for care. SECTORS would also support education that took a situated cognition approach, in this example through practical simulation and observation within the learners setting and modelling of behaviour change through enhanced non-technical skills. SECTORS also forms a framework for designing assessment, by identifying relevant areas of learning and so a conceptual framework to underpin the testing of acquisition of these areas of learning. Finally, SECTORS forms a foundation for further scholarly discourse (Bordage, 2009). It allows the discussion to move

to one of clarification of theory and as such supports further scholarly endeavours that may illuminate and magnify the questions as hand (Cook, Bordage & Schmidt, 2008).