Atrainability Blog

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

Trevor is a specialist in human factors teamwork training since its introduction in commercial aviation in 1990. Since 2002 when he formed Atrainability he has been working extensively in healthcare, with extensive experience in training and coaching clinical teams in a multitude of operating theatres across the UK in NHS and private hospitals.

Trevor enjoyed a full career as a pilot with British Airways, retiring as a senior Training Captain flying Boeing 747 aircraft in 2005. By then he had been a trainer in classroom, simulator and aircraft for over 12 years. In this time he had extensive experience in facilitating learning and with a small team developed a range of innovative train the trainer courses that have gone on the become mandated internationally in commercial aviation. It is these skills which have been widely recognised in healthcare and have been utilised in courses for such as the Royal College of Surgeons and a variety of research programmes conducted with teams at the RCS and the University of Oxford.

As a result of these he was approached to tender successfully for the development and design of the Productive Operating Theatre teamworking modules for the NHS Institute. His experience across healthcare is wide and far-reaching, including a specialty in Surgery, Radiology as well as Primary Care, Emergency Care, Critical Care, Mental Health and Secondary Care.

He is widely sought as a conference speaker internationally on the subject of human factors training in healthcare. Trevor is an active member of Lions Clubs for over 30 years and has been President of his local club twice.

What stops experienced medical staff caring?

Following on from my previous post on the Francis report...
 
What are the key elements of the Francis report? Care and compassion of course but what stops experienced medical staff caring? Demotivated, dis-empowered and feeling unloved by their own senior management perhaps? In failing healthcare establishments the staff on the shop floor are not listened to and they are anything but encouraged to report unsafe practice and dangerous practice.
 
When aberrant behaviour goes unsanctioned and is effectively tolerated the effect permeates the whole culture. It becomes one of not caring about poor performance, non-adherence to safe working practice  and inappropriate behaviour. It is corrosive and standards slip away. 
 
Today I have been to a private hospital where the long arm of the CQC has recently been felt. The  bosses are worried about potential legal action, but that is hardly the point. Care for patients who place their trust in healthcare professionals is what it is all about not the legal threat. It should be accepted that best possible safe care practice is the only way. What could possibly be argued against?
 
So I hear of senior clinicians who adopt slack practice that they admit would not be accepted in their NHS Trust. They shout, rant, rage, act like children if not allowed to run 'their' operative list in their preferred order without argument. They also act, dare I say it, like tenage lads - egging each other on to see how far they can stretch things. Actually I experience this in NHS hospitals as well, from people who preach professionalism but don't walk the talk and furthermore have no intention of doing so.
 
What is so utterly amazing is that they think that no-one in their teams notices.  Yet as an outsider when I visit everyone knows who the awkward so-and-so's are. Guys - it is no secret, everyone knows who you are. It is not too late to change, just try asking the people you work with for some honest feedback. 
 
Here is how to do it, referring ideally to behaviour not technical performance:
 
  • Tell me one thing I do well 
  • Tell me one thing I should do more of
  • Tell me one thing I should do less of 
 
If the only answers you get back are technical and not non-technical, perhaps this might be a message. 
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Guest — Sree
I agree with the expert comments that what we need is change in our NHS culture. It's not going to happen by employing yet an anot... Read More
Sunday, 17 February 2013 12:07
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Celebrating success 2

Celebrate success 2
 
What a great afternoon, enjoying the company of 20 Foundation doctors and their tutor. 
One had experienced a Human Factors issue with wrong patient, wrong notes where she had been handed notes for a patient and what she was seeing didn't match. Correct presentation, wrong side (leg). Initial thoughts 'oh no the patient has developed the same problem on the other leg and I had previously missed it'. However this prompted a second look at notes and ID and of course they were for a different patient. Fortunate that the problem was apparent or who knows what might have developed, under conditions of doctor fatigue, time pressure etc. Small success but saved a major potential problem. Learning point - check the classic Loss of Situation Awareness Red Flags' - in this case differing information from two sources. The notes and mark one eyesight.
 
In the morning I had met a Medical Director who actually deals with unacceptable behaviour by his team members. He operates what is apparently a genuine Just Culture and receives emails and other contacts reporting bad behaviour, rudeness to staff and patients, non-adherence to protocols and checklists and poor hygiene.
 
 I thought at first it was too good to be true, but it seems not. He has removed three senior consultants who would not or could not mend their ways. What prompted this exemplary behaviour by the MD seems to have been a tragic error that he made many years ago. I don't know the details and don't need to, but this is not unique as a motivation. Now he presides over a multi-site Foundation Trust which has had publicly acknowledged problems in the past but seems to be well on the way to safe practice.
 
We are being engaged to conduct theatre team training shortly because despite best attempts a couple of never events have recently occurred. One in particular was down to the surgeon leaving theatre before completion of Sign Out. The swab count was incorrect and a small swab had been left in the operative area. The theatre team had tried to no avail to keep the surgeon present but he had declined and left. This is what checklists are about - checking quite literally that things are not omitted or forgotten. It is not an insult to professionalism, but quite the reverse. Simply an aid to safety and fallibility.
 
Lesson - cross check, swallow pride and act professionally, not like a spoilt child.
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Francis Report 1

Francis Report 1
Will Francis be the 'sentinel' event that changes the healthcare culture in the UK to one of  patient safety-centred learning? This is the big chance to really refocus and eliminate the old-fashioned views around working practice.
As an outside observer and trainer in healthcare for almost 11 years I have been amazed at the attitudes espoused by people from  nurses to senior clinicians and above. It is as if nothing can be learned from safety-critical industries and this attitude is still highly prevalent. Thank goodness the number of enlightened individuals and in some cases, organisations is growing. I sincerely hope that the current impetus to change the culture of blame and over-regulation can build. 
W hat does Francis have to say? "They will do everything in their power to protect patients from avoidable harm" - and how exactly does that translate to the real World? How does a HCA deal with a Doctor who tells him where to place his checklist? Will management support? Will non-adherence to safety tools be dealt with? It all sounds great but how? Not more regulation please!
We treat professionals as intelligent adults but I wonder if they have been treated not so for too long. Consider the 'mandatory' WHO-led Safer Surgery checklist. I believe the reason that it is incorrectly understood and therefore not properly used is lack of education. How many hospitals introduced the WHO checklist by email? Quite a few, and the result is we are invited in two years down the line to try and improve understanding and adherence to safety guidelines and procedures. Three hospitals in the last month, all of which have had recent serious incidents or 'never events'. 
I have recently heard of an emergency ectopic pregnancy procedure carried out in the early hours where the wrong side was operated on. The problem of course had to be dealt with and the young mother is now unable to conceive ever again. Tragedy. The team said they would have used the checklist had it been daytime. Bizarre. The use of the checklist should be everytime such that it becomes 'the way we do things here' - everywhere. Another I heard of yesterday - injection in the wrong eye. What made that one so bad was the alleged statement by the clinican that it was 'just one of those things'. 
We must not tolerate avoidable harm. There is simply no excuse.
We want to celebrate success. We want to hear when the team have insisted on the correct protocol whatever it is - checklist or not. 
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Celebrating Success 01

Celebrating Success 01
 
Why is it so hard to get journalists interested in the good news stories? I mentioned this  to the editor of a health publication recently and he grinned and said "not good journalism". Really? They tried it recently on breakfast TV and made a joke out of trying to find good news. Well if we continue in that vein we have no chance of really saving the NHS. So we are going to start publishing success stories about individuals and teams where people have saved the day and indeed lives.
 
A laparoscopic procedure went wrong when one of the ports punctured the patient's aorta. The scrub nurse immediately called for the Crash Team  and disregarded standard protocol of counting swabs, because they were being used so rapidly. Instead she announced loudly that she was just counting the strings. This is termed a 'situational violation' - breaking the rules for an exceptional problem. I believe this can be quite supportable in exceptional circumstances, provided the perpetrator announces the action. This should save other team members using limited spare cognitive resources wondering what is going on. It also gives the chance for someone to offer a different opinion and maybe challenge the logic. In this case the patient was saved and was sitting up in ITU the following day. Great save team.
 
So what could we learn? Well who was the ‘leader’? Some teams and individuals get quite hung up with hierarchy issues. I believe the leadership should move around the team depending on the situation. The worst option would be no functioning leader at all! Here you have a scrub nurse who may be quite senior and certainly appears experienced, who is prepared to take the lead at a critical stage. How do you debrief afterwards?  Let’s try this:
What did the team do well? They reacted quickly and called for help when needed. A member of the team was prepared to step up and make a swift crucial decision.
What could they do more of? Discuss possible problems and practice emergency drills - in this case if the worst happened and we punctured a critical organ, who would do what?
What could we do less of? Perhaps start a procedure without appropriate planning – in this case double checking port location?
 
Please note the focus on learning rather than blaming whoever pranged the aorta. For plenty of successful organisations within and outside the NHS celebrating success is a given. How do successful organisations succeed and keep on doing so? They encourage, empower, listen and ..... learn.

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Medical Protection Society

Medical Protection Society

Atrainability and MPS have forged close links and have developed 'Understanding Human Error in General Practice', a bespoke training course for healthcare professionals across the UK and Ireland.Understanding Human Error in General Practice aims to improve the way teams work together. The objective is to gain an understanding of the importance of human factors in reducing healthcare professionals’ exposure to complaints and improving patient safety.

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SafeGuarding

Teams involved with safeguarding children and vulnerable adults suffer from the identical human fallibilities such as are prevalent throughout healthcare.

Typical failings are:

  • Cognition errors leading to erroneous situation awareness – failing to recognise symptoms of abuse
  • Intuitive decisions which would benefit from analytic review
  • Hierarchy challenge issues
  • Interagency communication problems
These same issues are present in other high reliability professions and are most highly developed in aviation.
Atrainability have structured training programmes for:

These same issues are present in other high reliability professions and are most highly developed in aviation.

Atrainability have structured training programmes for:

  • Training Safeguarding practitioners
  • Training Safeguarding ‘Champions’
  • Training Safeguarding Trainers
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Staff Grade and Associate Specialist Doctors

Atrainability are the premier providers of Human Factors training for Staff Grade and Associate Specialist Doctors. The two day highly popular interactive course attracts 12 external CPD points 

Course Overview

The programme is designed to be interactive throughout and result in practical skills developed from those mandated in over 40 countries to enhance commercial and military aviation safety. The tutors will make use of video clips and case studies from various industries to highlight specific issues and encourage group discussion and self-motivated learning. The course is designed for up to 20 team members

 

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Ward Teams Training

HF Foundation course

An understanding of the patient safety issues involved with human fallibility
Practical tools for leadership of the patient care team
Handovers – avoiding the threats to safe handovers
Communication skills aimed at levelling the unnecessary hierarchy
Assertiveness skills
Avoiding interruptions and distractions
Effective decision making
Tools to help avoid and trap misdiagnosis and delayed diagnosis
Briefing the team to gain optimal high quality efficient work distribution
Debriefing the team to capture the first hand learning
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Guest — Andrew
Looks like a great course will be in touch regarding dates
Friday, 25 January 2013 12:36
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EPICC –Error Prevention In Complex Care course

This course in clinical team leadership has been designed to provide emergency physicians with the skills to manage and lead an unrehearsed multidisciplinary team who assemble in the resus room to manage critically ill patients and receive ambulance alerts.

The course is classroom and simulated role-play based with opportunities to put practical lessons into play.

Human Factors experts working together with emergency physicians have created this one-day course to give emergency physicians the practical skills to manage competing interests, challenging personalities among team members and to maintain control in the resus room to ensure the delivery of optimum multi-disciplinary team care to critically unwell patients.

Feedback evaluations of the course have been highly positive and repeat courses have been delivered at two venues.

Contact Atrainability for booking information. Please note the course is not currently run on an open basis, but only for Trusts. 

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