The quality and safety of care are not only based on technical skills but also depend on the way professionals communicate, work together, make decisions and adapt to complex situations, so-called non-technical skills (NTS). The High Authority for Health (HAS) offers a framework for developing these skills throughout initial and continuing training.
Soft skills are defined as “the cognitive, social and personal resources that complement technical skills and contribute to safety and performance in the task”. According to Flin et al. (2008)2, CNT are skills which are not purely technical but which directly influence the performance of professionals. In health, where uncertainty, urgency, the complexity of care and collaboration are omnipresent, These skills are decisive for preventing and recovering from adverse events associated with care (AEIS), promoting coordination and optimizing individual and collective performance.
What are the main CNTs?
The work of Flin et al. (2008)(1) made it possible to propose an operational classification around three axes.
Cognitive skills
‒ Decision making (decision making): ability to analyze the options available to act appropriately
‒ Situational awareness (situation awareness): ability to perceive clinical elements and the environment, to understand their meaning and to anticipate developments
‒ Workload management: prioritization, planning, adaptation to unforeseen events
Interpersonal or social skills
‒ Effective communication: understanding and being understood without ambiguity
‒ Teamwork (teamwork): ability to work effectively in a team, including
coordination and cooperation, mutual assistance, mutual trust
‒ Leadership: capacity for guidance, accountability and conflict management
Personal skills
‒ Stress management (managing stress): maintaining control and efficiency under pressure
‒ Fatigue management (coping with fatigue): knowing how to recognize signs of fatigue and implement individual or organizational strategies
These skills are interdependent: the same situation mobilizes several CNTs simultaneously.
A skill is a whole!
By fully recognizing the role of organizational and human factors in the quality and safety of care, it affirms that the performance of the health system can no longer be considered solely from the perspective of individual technical skills. Strictly speaking, a skill is a whole! It is a complex skill that must take into account not only the technical aspect, but also the way of carrying it out. The dissociation of non-technical skills and technical skills (the gesture itself) is carried out solely for educational purposes. Of
Similarly, soft skills are interconnected. Making a decision involves most soft skills. The aim of individualizing a non-technical skill is to facilitate its understanding during the learning process.
Non-technical skills – communication, teamwork, leadership, stress management, situational awareness, decision-making and collective learning – now constitute an essential foundation for professional practice, whatever the profession, mode of practice or context of care.
They contribute to the reliability of care, the prevention of adverse events, the recovery from risky situations, but also the well-being and sustainability of the teams’ work.
This framework offers a common, structuring and shared framework, intended to promote a culture of safety and cooperation at all levels of the health system.
It enriches existing professional standards by complementing them, offering a common language and educational benchmarks that can be used both in initial training and in continuing training.
Its implementation is based on a strong conviction: non-technical skills are acquired, developed and maintained throughout professional life, through contact with real situations, through active and reflective teaching methods, and within committed groups. It requires a joint commitment from training stakeholders, establishments, managers, national and territorial institutions, as well as patients and users. This non-technical skills framework opens the way to a safer, more learning, more cooperative and more sustainable health system, for the benefit of professionals and patients alike.
Le référentiel met à disposition :
- un socle de concepts clés sur les facteurs humains et organisationnels ;
- 13 fiches pratiques pour développer les compétences en facteurs humains ;
- des méthodes pédagogiques actives (simulation, débriefing, retour d’expérience).
(1) Flin R, O’Connor P, Crichton M. Safety at the sharp end: A guide to non-technical skills. Aldershot: CRC Press; 2008 .
Human factors skills framework for the quality and safety of care (non-technical skills), HAS, April 2026
