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Atrainability Blog

Here we share some thoughts, insights and ideas related to Human Factors Training

Magic words

Being a pilot has been described as being 99% boredom and 1% sheer terror, but it is rarely both – honest! However, like healthcare, it is fundamentally about managing risk and therefore managing workload.

In the world of aviation, we have a magic word - "unable" for those rare occasions when we cannot comply with, for instance, air traffic control instructions.

If air traffic control instructs the pilot to turn left, or climb, or descend, and for any reason, the pilot can't do it (for a technical or weather-related reason, for example), then the pilot will say "unable".

If you've watched the movie 'Sully' the miracle on the Hudson, you might remember Captain Chesley "Sully" Sullenberger using the magic word "unable" when requested to turn to Teterboro airport. He uses the magic word, and nobody questions it.

Here at Atrainability, we've been introducing this Magic or Safeword concept to healthcare for some time. Critical teams could usefully have a magic word in place so that they can communicate effectively during procedures.

Of course, there needs to be a degree of sensitivity in choosing this magic word. It might upset a conscious patient to hear "Gorilla on the loose" or similar.

Some teams use the phrase "stop the line." This approach comes from the Toyota production line, where any member of staff is empowered to halt production if they see someone unsafe, inefficient, or ineffective taking place.

Some are using "10,000 feet", a reference to the other much-used aviation phrase that signifies no distraction or interruption for the time being. It comes from standard practice when commercial planes are near the ground – below 10,000 feet altitude. That's roughly the first and last 10 minutes of a typical flight.

We have the evidence from countless 'black boxes' that you're more likely to have an incident when not focused on the job in hand. In aviation, either enjoying the view "ooh look there's my house!" or discussing something inconsequential.

But "stop the line" or "10,000 feet" can be quite cumbersome and perhaps a little imported. It's preferable, I believe, for teams to devise their magic word.

There's a surgeon I know in one NHS hospital, as part of his daily team briefing, he asks what magic word they will use that day. That's a great approach to get teams to engage with magic word principle, but of course, if members of the group switch over during the day, it can be potentially problematic if someone new doesn't know the magic word of the day.

Some hospitals have a magic word at an organisational level. But that could feel like it's being imposed upon them. There's so much in healthcare where people need their independence, for their motivation and empowerment.

What matters is that every member of the team should feel able to stop what is taking place if they think anything is unsafe, or something needs to be clarified. They might say "unable" or "stop".

My wife and I have a magic phrase in case of emergency.

During a recent holiday, she said to me, "Trevor, I need you to help me!" She had caught her finger in a sunbed, causing a nasty injury and lots of blood when it was released. By saying, "need!", there was no doubt she need help Now. No confusion, no uncertainty.

Clarity is so important.

When you're piloting a plane and taking off or landing, your focus is quite reasonably ahead of you, so you're not making eye contact with your colleagues on the flight deck. Naturally, that means you can't detect non-verbal language like shifting in your seat with concern, as we would in ordinary life.

The same could apply if masked and gowned in a complicated or stressful clinical procedure.

When you use a Magic or Safeword, it's essential its use doesn't result in resentment from colleagues. We've got some way to go within the healthcare profession to understand this. Some cultures find it harder than others to accept the use of a magic word without associating it with disrespect or failure to follow a hierarchical structure.

So, to summarise, have you ever experienced a situation where someone either didn't speak up and challenge or wasn't heard or was misunderstood. With hindsight would a Magic or Safeword possibly have helped? I know some of you have got this already. Please spread the word!

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