An evaluation of non-technical skills development through Emergency Preparedness, Resilience and Response exercises for health sector personnel

  • Vanessa Middlemiss

Student thesis: Doctoral ThesisDoctor of Health (DHealth)


History has shown that civilisations are vulnerable to emergencies, whether they are natural or man-made and the actions taken in the initial stages of a response to an emergency are critical. To prepare for these events, the UK National Health Service (NHS) practises its emergency response through Health Emergency Preparedness Exercises (HEPEs).

There is a generally accepted premise that HEPEs impart an array of benefits to participants with respect to their capability and capacity to respond in large scale / high consequence emergencies. Crichton and Flin (2004) note that effective emergency response requires personnel to include competence in both normal technical elements and an array of non-technical skills, e.g. team work, communication and leadership skills. While there is widespread recognition of the importance of non-technical skills (NTSs). There is limited consensus over the set of relevant skills for this area (Reedy et al., 2017). Personnel with well-developed emergency response NTSs potentially increases the effectiveness of the collective response (Chalwin and Flabouris, 2013). Kodate et al. (2012) notes that although NTS taxonomies exist, they need augmenting with data from the relevant domain. With a view to addressing this issue, a panel of emergency response experts was recruited and tasked with reaching consensus over defining the set of non-technical skills that NHS emergency personnel should possess. The resultant NTS taxonomy for health emergency response was categorised and named ‘Health Emergency Response Integrated non-technical Skills’ or HERIS.

Having determined the skill set of core NTS, the research moved to assessing the extent to which these skills are reflected in contemporary emergency preparedness exercises; specifically, the NHS’s Emergo Train System (ETS) course. The effectiveness of the current NHS ETS course in enhancing participant NTS skills was assessed, using a pre and post design (n=50). Findings revealed that the ETS courses make a positive contribution to elements characterisable under three new skill categories of personal effectiveness, assertiveness and self-awareness.
The research examined the effectiveness of current NHS health emergency preparedness exercises in developing NTS of NHS personnel, the research suggests that HEPEs do impart a level of development of NTS in NHS personnel. Recommendations based on the advancement from the research are advocated to enhance NTS elements within future NHS major incident exercises.
Date of Award24 Jun 2020
Original languageEnglish
Awarding Institution
  • University of Bath
SponsorsPublic Health England
SupervisorAndrew Weyman (Supervisor)


  • Emergo Train System (ETS)
  • Emergency Preparedness, Resilience and Response (EPRR)
  • Health Emergency Preparedness Exercise (HEPE)
  • Non-Technical Skill (NTS)

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