Introduction: Patient safety depends on excellent practice of anaesthetists’ non-technical skills (ANTS). The ANTS framework has been validated in developed countries but there is no literature on the practice of ANTS in low-income countries. This study examines ANTS in this unexplored context.

Methods: This qualitative ethnographic study used observations of Rwandan anaesthesia providers and in-depth interviews with both North American and Rwandan anaesthesia providers to understand practice of ANTS in Rwanda.

Results: Communication is central to the practice of ANTS. Cultural factors in Rwanda, such as lack of assertiveness and discomfort taking leadership, and the strains of working in a resource-limited environment hinder the unfettered and focused communication needed for excellent anaesthesia practice.

Conclusion: Despite the challenges, anaesthesia providers are able to coordinate activities when good communication is actively encouraged. Future teaching interventions should address leadership and communication skills through encouraging both role definition and speaking up for patient safety.