Atrainability Blog

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

Walking the Tightrope...

Self-Confidence is vital but Self-Awareness is Key to Learning Success.

Confidence is a vital commodity when it comes to delivering safe, effective performance in any job, sport or profession. One must have a degree of self-belief in order to fly a plane full of people, compete in sports or indeed perform medical treatment. However, a simple, basic facet of being human is that we are all fallible.


Are we aware of our response to our own errors?

Firstly, we have to realise that we have indeed made an error, because initially whatever action was taken was likely done with the expectation that it was correct. The dawning realisation that we have indeed committed an erroneous act can trigger a response, which could be fight, flight or freeze. Once confidence is damaged, it can manifest in a variety of ways. If we have a critical voice in our head, telling ourselves off; compounded by friends, family or colleagues also berating us, we can spiral downwards into depression. Often if we are unable to accept that we're responsible for a mistake we can respond defensively by directing our responses outwards;


                                                          "Why didn't YOU tell me!"

                                                         "Why didn't YOU stop me?"

                                                         "YOU didn't tell me…"


…in other words, if I can't accept my own fallibility it must be yours. This in some cases leads to arrogant behaviour, and does not make for safe, effective teams.

We as individuals need to work on our self-awareness, take responsibility and manage our responses, but we also need a team around us who don't continue the cycle of berating and instead supports and learns when mistakes are made.

How has aviation dealt with this? By embedding Human Factors principles at all levels from Board to the frontline.

The Board must walk the talk or any transformation program will fail, because it is perception at the individual level of the safety culture that is crucial to success.

Pre-1980's aviation training focussed purely on the technical skills of flying a plane. Effective communication, team-work, situation awareness – these were not considered important. However, with the improved use of black box recordings and analysis of significant aircraft accidents it became apparent that it was the human element that was mostly at fault. What is now known as – Human Factors.

How was it dealt with? By educating flight crew and then embedding effective human factors practice in ALL technical training. Although it took time, it is now completely accepted as part of the culture. Furthermore regular refresher training, feedback and assessment is given to flight crew on their flying skills and their interpersonal and cognitive skills to keep best practice at the forefront of their daily practice. In terms of appraisals these are taken very seriously.

If a pilot fails to meet the standards in either category of technical or non-technical skills he/she will be given further training and ultimately he/she can be removed from service. Just imagine if this took place to the same extent in healthcare and some other professions.

The fundamental point though is to understand error and the causes of error, and to accept them and to work with them. Humility is an essential part of professionalism. One of our clients (a large critical care unit in a major trauma centre) has recently contacted us to say how our training has had an impact on their team.

Furthermore we've been told that staff turnover has been reduced to a very low level indeed. These changes have been visible after in-depth Human Factors training and coaching, although they cannot be directly attributed of course.

Atrainability would be delighted to help any team or organisation delve further into their own short-comings and help to highlight their areas of success. Contact us for an informal, confidential discussion or alternatively enrol for our upcoming Open Courses listed here.
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ITV Tonight - Medical Blunders & other updates

ITV Tonight - Medical Blunders & other updates

Here at Atrainability, we're pleased to say it's been an eventful few weeks.

ITV Tonight: How Health & Social care can learn from Aviation.

I recorded an interview with ITV Tonight, Click here for Catch Up.or alternatively watch here. The programme is focused on Patient Safety and my suggestions were aimed at helping explain some of the elements that increase the chances of human error in health and social care. Part of the interview was filmed in-flight to demonstrate why checklists are a vital and completely accepted aspect of safety in aviation.

Fallibility is of course an inevitable, though sad facet of the Human Condition. Accepting that and helping to avoid, trap and/or mitigate error is fundamentally what we at Atrainability are concerned with. Although the programme focussed on the NHS, we would like to be clear that we know and understand that private providers make mistakes to. We'd be interested in hearing your thoughts on the subject. Tweet #ITVTonight @atrainability or get in touch.

The Glasgow Emergency Surgery and Trauma Symposium

It was a great pleasure to be invited to take part actively in the 2017 Glasgow Emergency Surgery and Trauma Symposium where I gained so much valuable insight into complex post trauma care from some truly World-leading experts in both clinical and non-clinical skills. The latter involved Professor Rhona Flin from Aberdeen University. All the faculty were honoured, in my case by the award of Membership of the Royal College of Physicians and Surgeons of Glasgow.

Coaching and Mentoring in the Operating Theatre

Now we are helping an NHS Trust further develop their non-technical teamworking in association with their LocSSIPS, by coaching and mentoring in operating theatres.

One aspect of this has been debriefing a successful emergency C-section. On first asking "why did it go well?" the answer from one of the senior nurses was that it has "just worked well". However, so much more learning is available with careful encouragement.

In brief, the team had been widely scattered across a large area of the hospital when they received the 'Crash Call'. They clearly moved rapidly and had no time to lose. They didn't do a formal briefing but had in fact accomplished one which they set to work. They shared plans, updated Situation Awareness and allocated tasks to the appropriate team member. A good job achieved and a healthy baby delivered safely.

The work is continuing with debriefing and feedback on specific areas such as checklist design, development and implementation with guidance on how to maximise safety. Much effective work is being pointed out and reinforced as well as some corrective advice.

The Society of Radiographers - 'Putting Patient Safety First'

"When it comes to developing and changing a culture...simple changes can make things better." - Naomi Burden, Quality & Governance Radiographer at Royal Cornwall Hospitals. Atrainability are very proud to have helped progress Human Factors awareness in Radiography. Read the full article.

New Masterclass

We're now offering An Introduction to Coaching and Mentoring workshop which has been developed by Atrainability's Ben Tipney. More information will be available shortly on our website but if you'd like to find out more please contact us.

As always, we're happy to discuss any challenges you are currently facing or answer any questions you might have about our Human Factors training.

Trevor and the Atrainability Team.

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Where is the evidence that 'blame' works?

If so many medical people profess to be evidence based and blame is so rampant within health and social care where is the evidence that blame works?

Atrainability have just been asked to help a major NHS trust to sort out their blame culture which is proving very damaging to an already over-stressed, over-worked, under-resourced Emergency Department.

The atmosphere is apparently poisonous and learning from error consists of pointing the finger at a colleague who didn't do something appropriate. Learning from success isn't an option it seems simply because no one even considers it.

We believe strongly that explaining human fallibility is a crucial aspect of building an understanding and an awareness that most error is not caused by bad people but by genuine, hard-working, caring people, working under difficult conditions.

We ask the question – if we provide training for you, what would success look like?

One answer would be that team members started looking after themselves and each other. Although working conditions are typical of an over stressed department, the benefits of taking even short breaks to refresh, clear the mind and to replenish fluids and blood sugar levels cannot be overestimated. Furthermore, appreciating how knowledge-based, skill-based, rule-based errors originate is the route to an open reporting culture, where people feel safe both personally and collectively.

Other signs of success could be:

  • A team that shows compassion, not just to its patients but to each other.
  • A change in the flavour of incident reporting from finger-pointing to understanding, learning and providing solutions.

What would success look like for you?

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Compassion Costs Nothing?

Compassion Costs Nothing?

Compassion; to empathise for others, to show you care; what does this cost in psychological and emotional terms? 

At my great age I just fell into a trap at a conference of agreeing that compassion costs nothing. How could I do that? The emotional cost of true empathy (as opposed to simple 'passive' listening) can be huge. It can be draining for those in caring professions - constantly feeling compassion and empathy for service users, patients and relatives - it takes its toll. This may explain why front line teams sometimes seem so dispassionate. Would they really have entered into such professions if that was what they truly felt?

What could have happened?

Well when we say "physician heal thyself" we tend to think of the physiological; food, water, putting ones feet up – if you like, the most obvious, visible signs of wellness. But when we consider the emotional and psychological toll that caring for others exerts it is in fact, blindingly obvious. What are we doing to provide our front line workers with the awareness and tools to handle the inevitable stress that comes with caring for unwell people? Do we even encourage ourselves or others to 'tune in' to our own emotional state, let alone put strategies in place for our own well-being?

We neglect our psychological and emotional wellness at our peril.

Atrainability have developed training to help deal with all aspects of wellness and stress. We're always available for an informal, empathetic chat to discuss your specific needs. Click here to contact us today.


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You don't have to put up with it.

You don't have to put up with it.

We recently ran a successful Open Course in Birmingham and the mix of participants that attended all shared their Human Factors challenges; which included typical problems such as not cross-checking adequately and some good situation awareness stories.

The best part about our Open Courses is that we get a good combination of people attending; recently we've had a room of blood bank teams, Ophthalmic surgery teams, Junior Doctors and Occupational Therapists - to name a few! All from different healthcare providers; travelling to our classes, openly sharing their experiences without fear of judgement and leaving with new found confidence and solutions that they can implement as individuals and within their teams.

For us as trainers, it's always interesting to have open discussions about the difficulties different individuals and teams are facing, but the reason we keep doing this is because we can see the changes in people after our training. 

For some, it's in the class; we call this 'the light-bulb moment' (more on this here) and for others it's a few days later, when they get in touch to tell us they just avoided an error because of our training techniques or they've found their confidence in speaking up to the staff member they were having communication issues with.


You may find it comforting to know that there are always similarities in each story, which is how we know we can help you.

Typical problems include: communication issues, dealing with difficult behaviours, poor attitude, situational awareness, briefing and debriefing effectively, stress and time management, poor leadership, hierarchy barriers, lack of feedback and confidence. All amount to how to learn from inevitable errors and successes without unnecessary blame.


So whatever challenge you are facing, know that there is a solution. Don't keep putting up with it, talk to us today about our next Open Course.

There's still time to book a last minute space on our London Open Courses next week and we're also taking bookings for London in February 2016. You can book a space for either of these through our website here or alternatively email us or call Trevor on 01483 272987 and we can discuss how we can help you further.


We look forward to hearing from you.

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Who is the best person to train you – a colleague or an external ‘expert’?

Who is the best person to train you – a colleague or an external ‘expert’?

This is an interesting question and is of course quite complex with a multitude of variables to consider. If it is a purely technical or clinical matter then I believe another similarly qualified expert with knowledge of the issues and techniques is generally preferable. However I believe that when it comes to Human Factors (non-technical, non-clinical, non-medical) concepts there is an argument that says an outside 'fresh pair of eyes' can have a significant advantage.

I can understand why you may disagree with this statement. How can someone who hasn't done the job themselves possibly have any in depth understanding of the pressures, stresses and nuances of your decision making? How could they, an outsider, achieve that essential experience gained through days/weeks/ years of hard graft?

Let me confess that in my 'old' life as a pilot in a major airline, we chose to go down the 'peer' training route. However it must be said that I now believe this meant we had to learn the lessons from scratch and went down a few unhelpful blind alleys. One was failing to grasp, for some years, that describing technical and non-technical skills as being separate was erroneous and unhelpful. What woke me up was when one of our senior managers said "it was such a high-workload that we didn't have time for any of that 'Human Factors stuff'! This demonstrated a complete misunderstanding that human cognitive and social skills are present at all times and are an integral part of all performance as an individual and team member. It wasn't his fault, it was ours.

Fast forward 25 years later and Human Factors is completely embedded in aviation – ask my son who is 6 years into his commercial aviation career.

As peer instructors we also had to blend training and debriefing of Human Factors non-technical skills into our colleagues 'technical' training. This proved a hard obstacle. It is acknowledged that the optimum method of encouraging behaviour change is by facilitation – helping students and peers to find their own solutions. This style of facilitative training and coaching was alien to aviation 'instructors' who were used to telling people what to do and how to do it.With behaviour change this rarely works, consider interaction with teenagers!

People have got to want to make changes and have to truly understand how and why. Many instructors focus on the technical problem and/or focus on blame and this can mean they often struggle to see the underlying Human Factors issue beneath, such as communication, hierarchy, or overload.

Now we come all the way back to the advantages of an outsider expert. There is no in-house hierarchy barrier. The outsider expert doesn't know the technical, clinical, medical issues in depth and hence don't get confused, or distracted by them. Another advantage is that they also bring with them a wide diversity of experience from other health and social care provider sites and teams. Finally, an outsider expert can also easily observe and debrief on the human factors issues and ask those awkward but telling questions about team interaction which can help facilitate learning and positive change quicker.

Understanding the concepts, the routes to normal error making and the ways in which human factors training can and does genuinely improve all human behaviours is what we can help you achieve.

We'd like to hear your thoughts and experiences. Please let us know.

Trevor Dale

Tweet @atrainability

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Why we need to be more serious about acknowledging human limitations. (Guest blogger)

Hello, I'm David Wood – Associate Director of Safe Services at Cheshire and Wirral Partnership NHS Foundation Trust (CWP).

As a provider of Mental Health and Physical Health Community Services, healthcare of the types we deliver are essentially based on face-to-face human encounters; which are relatively low technology.This means that the people who deliver our services regularly manage risk autonomously and in environments which are anything but controlled.Now that's a challenge!

My working environment, on the other hand, is much more controlled (even if my day-to-day work is less so).Recently I found myself making a number of ill judgements which, whilst they did not cause any harm, troubled me greatly as I could not rationalise why; in effect, I had "lost control".Only days later, after attending an NHS Leadership Academy event, did I realise I needed to apply a degree of self compassion and accept that it was the pressured situation I was in; which included being distracted by factors at home, that compromised my decision making and my performance (having exacting standards and expectations of myself does not help, as anyone who works with me will tell you!).None of us has an internal switch; we bring our whole selves to work.

So, Human Factors are exacerbated by high pressure situations and mental workload, where we are all fallible.My learning was that to mitigate potential adverse impacts of this, you need to be self-aware. If you have distractions, in your work or home life (or both) even if you think you have "parked them", consider yourself at a greater risk of making a mistake. There are some tactical steps you can take; why not read Implementing human factors in healthcare for some tips.

The important thing to acknowledge here, as in my situation, is that the vast majority of people do not act with the intention to make a mistake, to cause harm, or not wanting to do the right thing – quite the contrary.The hazards that apply in working in either controlled environments or not, are making decisions in dynamic and intense situations.In a complex working environment like health, this problem is not going away!

There needs to be a coherent plan (to embed Human Factors training) underpinned by, as we'd argue in CWP, a long-term patient safety cultural campaign; in order to develop a positive patient safety culture.Both these things require high level leadership.We invested in our very own campaign called #CWPZeroHarm, to tackle unwarranted variation and improve reliability; supported by cultural change to empower us to put patient safety, clinical excellence and patient-centred care at the heart of all we do.The campaign promotes the idea that everyone, before they act, should "Stop, Think, Listen".These same principles of "stopping", "thinking" and "listening" happen to be one way of looking at mitigating the potential adverse impacts of Human Factors.

Part of our investment was in Human Factors training from the Board to those providing direct care.We have also recently invested in our own simulation suite, which will include mock-ups of care settings like people's own homes, to predict "what could go wrong". We have done this as we know simulation is highly effective in creating learned responses to situations, where pressure may affect a person's ability to think as clearly as they normally would. Key to this is training as teams wherever possible - Human Factors based team working is essential to promote safer care.

We have achieved many other things by applying Human Factors principles and practices.In the main these have come from the pledges made by what we call our Human Factors "culture carriers" – people who attended Human Factors awareness sessions and pledged to implement changes in their workplace.Examples include simple changes such as implementation of briefing, debriefing and safety case reviews; through to more ambitious changes such as enhancing clinical audits and reflective review processes, to capture the impact of Human Factors practices and therefore demonstrably improve safety in a number of critical areas - for example reducing the incidence of physical restraint by well over 50% and on a sustained basis.

Why do we need to be more serious about acknowledging human limitations? Well, when decision making is compromised this can significantly impact on the quality of care, clinical outcomes and potentially cause harm to both people who access and deliver healthcare.This all increases costs.This is where Human Factors offers ways to minimise and mitigate human limitations, and so reducing error and its consequences.

Healthcare has a lot to learn from systems which promote safety in high reliability industries like the aviation and nuclear industries.I'd like to see a system-wide adoption of Human Factors concepts to empower the whole care system. I was therefore pleased to be a consultee of Health Education England in exploring how Human Factors practices and principles can be included in the curricula and training frameworks for health professionals.This resulted in what I think is a milestone publication Improving Patient Safety Through Education and Training.

I will be working again with HEE's "Learning to be safer" programme on 14 July (2016) to develop plans to implement the Commission on Education and Training, for Patient Safety's twelve far-reaching recommendations, on improving patient safety through education and training.I hope that the key output will be tactical steps to ensure that Human Factors is not something that's standalone, rather it's something "we all do around here", as part of the design of processes, jobs and training.

The HEE cannot do this alone; all of us, no matter what level we are in the system need to commit to embedding an understanding of Human Factors.

We're in this together.Human Factors awareness has improved, but more needs to be done to make it our everyday business in delivering reliably safe healthcare.Good luck on your Human Factors journey!


Tweet @DavidWood_CWP #CWPZeroHarm #ATRblog


About our guest blogger:

David Wood is currently Associate Director of Safe Services at Cheshire and Wirral Partnership NHS Foundation Trust.His role is to lead the Trust strategically in relation to a portfolio of clinical and corporate governance, compliance, assurance and regulation which effectively contributes to the Trust's delivery of safe services.

He graduated from Keele University with a first degree in Biomedical Sciences and his career since has spanned 15 years during which time he has been employed in many diverse areas within the NHS, substantially in senior clinical governance lead roles (including North Staffordshire, Cambridgeshire, Cheshire/ Wirral) within mental health and learning disability services, primary care and community physical health services.

David has professional interests in strategic approaches to healthcare quality, and more recently professional practice including leadership, development and change as part of his Master of Science degree in Professional Studies.His dissertation was on early warning and pre-emptive systems to improve the safety of patients and reduce avoidable harm, graduating from the University of Chester in 2013 with a distinction.

David has a demonstrable track record in clinical quality and governance with extensive experience of quality improvement and change through strategy development and implementation.He was a former longstanding member of the Department of Health hosted National Audit Governance Group, is a professional reviewer of the standards of inpatient mental healthcare through the Royal College of Psychiatrists' Accreditation for Inpatient Mental Health Services initiative, and a regular Healthcare Quality Improvement Partnership consultee. David has recently become a director of assurance representative on the NHS Providers Quality Reference Group.



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How compassionate care can reduce mistakes.

One of the questions we ask on many of our courses is "who is in your team?"

It is always fascinating to see how long it is before someone mentions the patient or service user in amongst all the doctors, nurses, porters, ODP's, managers, HCA's, therapists, allied healthcare professionals etc.

On one memorable occasion with a roomful of a particular group of specialist surgeons (no clues) the mere suggestion that the patient could be part of the 'team' was like a grenade going off. "They are the task, how can they be part of the team?"

My next question was "Could the patient save you making a mistake?"

"Yes of course" came the reply.

It is obvious. If you treat people like a task, you might inhibit them speaking up and potentially stopping calamity happening – wrong leg etc (there's a clue!). Compassion, empathy and demonstrating a genuine interest of the patients main concerns will reduce stress and empower your patients to have their voices heard.

During our time working with the Medical Protection Society we learned that there is compelling evidence that the initial interaction between medical professional and patient affects the willingness to complain and sue if things subsequently go wrong. If they feel valued and listened to, they are more likely too forgive, and vice versa.

"Empowered patients can communicate changes and observations that can make a real difference in their medical care…many times patients are intimidated, or sometimes bewildered, by the medical world around them. Also, it can be hard to speak up if the doctor or nurse is perceived to be rushed and ready to move on to the next patient." - Elizabeth Cohen, CNN senior medical correspondent and author of The Empowered Patient

The book 'If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently' by Fred Lee also makes interesting reading. Describing staff at Disney theme parks as 'actors' is in fact exactly what we would expect a 'professional' healthcare worker to do. We all adopt a cloak of professionalism at work don't we? Well, clearly some do better than others, judging by the evidence about abusive and inappropriate behaviour we hear about."Patients judge their experience by the way they are treated as a person, not by the way they are treated for their disease."

It's also well acknowledged that patients recover quicker if they feel cared about. If bed blocking is as much of a problem as it is reported; then anything that can be done which helps patients to recover, have a positive experience and get home again fast, has got to be worked on.

Treating patients like numbers – "go check the BP on bed 5" is entirely different to "pop along to Mrs Smith in bed 5 and check her BP".

It's clear that many providers are becoming more aware of compassionate care, and implementing training to help staff achieve this. Many staff may feel that this is something they do every day naturally; caring for people after all, was perhaps one of the main reasons for choosing their profession, but it is easy to become complacent.

I was recently admitted to a private provider where everyone who came into my room started with "Hello my name is .." However it was quite clear that because every single person used exactly the same form of words it had all the sincerity of concrete. Why couldn't one of them at least say something like "Hi Mr Dale, I'm Bill .."

You can reduce error by treating your patients as part of the team. However it is important that compassion, empathy and a genuine interest come across as sincere.

We have developed "The Keys from Courtesy to Compassion" course which covers the aspects of helping staff deliver compassionate care on a regular basis and it is clear that some places would benefit from it.

Here is a testimonial from one of our recent clients:

"Atrainability was wonderful to work with. They took our needs for instilling 'Disney' values into healthcare, and they worked closely with us to develop and deliver an enjoyable training session for our senior midwifery leadership team. The team enjoyed the fresh concepts and attuning these to their daily practice." - Amy Maclean, Head of Patient Experience at Birmingham Women's NHS Foundation Trust

"Thank you for helping us…and giving us some really useful strategies to complete our journey and make our business all about people." – Helen Young, Director of Nursing & Midwifery at Birmingham Women's NHS Foundation Trust.

To enquire about this course, click here to contact us for further information.

Trevor

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Sharing the Learning

I had never really thought about situational awareness in the past. I'm a pharmacist myself. I know that I've made mistakes. None of my mistakes have been life threatening; in fact, they've probably been near-misses, but this (course) made me think about how situational awareness affects the way we do things- Julie Jones, Birmingham Healthcare NHS Trust

Atrainability has provided Human Factors training for over 14 years and during that time our team has spoken to lots of people at various stages in their career, and across a range of different disciplines.

We've always been grateful when participants are open about sharing their learning experiences with us. One thing that seems to occur often is that during or shortly after the training sessions there is a moment of clarity when dots are joined and suddenly that person understands how and why those near-misses happened and more importantly what they can do to avoid future errors. There are many stories we could share, but here are a couple :

I was talking about having compassion for patients as well as colleagues on a course recently, and a Dental Surgeon who was attending said: "Quite a lot of patients are just awkward with unrealistic expectations" he went on to say that he'd received a significant number of complaints and some claims. I asked him if this was just something which he encountered or did his colleagues also find the same? After the course, he thanked me and said that moment had made him realise he was perhaps playing a part in the problems he was experiencing, and he would be more aware of his communications with both patients and colleagues when he returned to work. – Trevor Dale

During the coffee break of a course I was running an F2 Doctor approached to thank me, and explained the Situational Awareness module was a light bulb moment for her. During a night shift, she had a difficult hand-over at a time of high workload. The nurse had handed over a patient with a verbal description of a dosage of a respiratory drug, there was a mistake made but the Doctor was clear of the dosage in her mind. The Doctor was working very hard and so did not acknowledge the dosage handover to the nurse. She told me she now understands why she did not read back the instruction. She was stressed and her speech had been degraded due to an overload of information. Although she was cleared of any wrongdoing, she was troubled why she made the mistake. The Doctor was delighted to understand that her mistake was just an indication of her human fallibility; not incompetence, and that now she felt she had the tools to help her avoid repeating that error. – Matt Lindley


As you may be aware, Atrainability has been running Human Factors Open Courses this year at key locations in England. We can't promise Light bulb moments for all, but we can promise a course which will help you find solutions and gain a greater awareness of how you and your teams' behaviour, communication, leadership and briefing and debriefing skills can improve outcomes for everyone. 

If you can't make the dates listed on our Open Course page, or if we haven't announced new dates yet, do get in touch to discuss how our bespoke in-house courses can help your team. 


Trevor

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The Remarkable Truth about 'People Stuff'

​If you ask the question "What makes a difference to your every working day?" and other than the weather, your IT systems and somewhere to park your car, you begin to realise that everything else is about PEOPLE.

So if 'people stuff' has the most impact on your performance, how can we ignore it? Human Factors may be considered a 'buzz word' for some, but the fact is; it's an unavoidable part of everyday life. If you gain an understanding of why colleagues and patients behave the way they do and understand why some communications turn out to be 'Chinese whispers' you can also gain insight into why some of your processes are failing and what you can do to avoid repeating mistakes. This is why Human Factors is so important.

I recently had a morning session with the board of an NHS Mental Health Trust, where they have been fortunate to apply for and gain funding for a coherent training programme to embed Human Factors principles in their organisation.

Virtually all of the Board were completely unaware of the term 'Human Factors', what it meant and of course how important it is to ensure the safe, effective, efficient performance of their Trust.

There are still many organisations that are seemly unaware of the crucial importance of factors that affect their Front Line staff and in fact everyone in the organisation. Notwithstanding the publication of the HF Concordat ( link -  https://www.england.nhs.uk/wp-content/uploads/2013/11/nqb-hum-fact-concord.pdf ) in 2013.

We have helped a number of NHS and private healthcare providers improve their performance and the CQC positively encourages Human Factors initiatives. We are very keen to come and help your organisation be it already successful or indeed in need of some improvement or help. All of our work is bespoke and our experience stretches all the way across the entire health and social care spectrum from acute through to community and primary care.

Don't ignore your 'People Stuff'. People are the lifeblood of your organisation.

Trevor

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More of the same? Don’t limit yourself

​The New Year: a time of self-analysis; looking back and looking ahead. 'New Year, New You' is an overused line that you will probably see almost everywhere.

So here's our piece of advice. Let's look beyond ourselves and reflect on your teams work environment too.

If we concentrate on our model of Whirlwind Debriefing – what is one thing we do well? What is one thing we could do more of or indeed less of ?

In general it is accepted that few of us emphasise our successes and share what we do well. Let's try and change to doing that.

That doesn't work for us

In aviation it is mandatory to have an in depth initial course with each new company that a crew member joins and by international law it must be refresher trained and assessed 2 or 3 times a year. Even then our human frailty and fallibility is still susceptible to error.

Human Factors training is about transforming behaviour to create safer more efficient staff. You cannot completely error-proof the human but you can provide the right training and support to give them the best chance to get it right and be safe under quite trying and stressful conditions.

This can't always be achieved in one brief intervention. In order to see noticeable effects your team should be allowed the time to fully digest the learning points from the training sessions and attend refresher sessions so that they can begin to embrace a new way of thinking.

Make achievable targets

Do you want your team to be part of the solution? We don't need to tell you that motivation is one of the first steps to making positive changes.

If you're struggling to make a New Year's resolution that's achievable for you and your team, here are a few suggestions:

This year we will:

  • Gain the confidence to raise issues
  • Be more motivated and effective
  • Find long term solutions to recurring issues and everyday challenges

Once you've decided on your resolution, we can help you stick to it.

Start your team on the journey to a successful New Year...

We offer help for individuals and small teams in the form of Open Courses click here to visit the page on our website. We can also provide training and support for departments and larger teams click here.

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Safer Solutions that support staff relationships

​One of the most popular subjects when we talk about Human Factors is the understanding of behaviour and personality types. The differences in how individuals react and see things especially in high stress, high risk situations can result in a strong team but sometimes they can cause misunderstandings or communication errors.

The relationship between team members is an important one. If individuals feel secure and supported within the team it will promote better communication and reporting long term.

" The importance of everybody having a say in safety situations and feeling able to speak up "
 - Mr Andrew Aldridge (BMI Eastbourne, June 2015)

" We have the right to make mistakes and learn from them "
- Erica Rapaport (SAS Ipswich, November 2015)

We regularly receive feedback from course participants which highlight how our training helped them to go back to work and find solutions to what seemed insurmountable problems.

Understand the facts

Understanding Human Factors principles better will help you recognise the facts underlying human behaviours and stresses. This includes identifying stress in yourself and others and using techniques to remain calm in stressful situations; enabling you to be more aware of your own behaviour and see other persons point of view.

Put aside hierarchical barriers

Intimidation and fear of reporting errors can lead to recurring problems. Human Factors training can equip you with the ability to cut through whichever side of the hierarchical barrier you are on. This will help your team to maintain a focus on safe, compassionate care for colleagues, patients and relatives, which is the upmost priority.

Don't skip on the briefing and debriefing

We can't stress the importance of these enough. Briefings and debriefings will ensure better communication between staff, more detailed handovers and give staff the support and confidence to raise issues, which will help to reduce unnecessary errors. Furthermore debriefings are a simple, often underutilised aspect of learning from success and near-misses. Our training will provide you with the skills to ensure you create the opportunity to maximise team-working during this time.

Promote learning, avoid inappropriate blame and make your team more effective

Communication and behaviour can be an ongoing challenge. Our Human Factors Open Courses are the perfect introduction for both front line staff and managers who want to improve communication, enhance performance and increase safety. Discounts are available for early bird bookings. 

If you can't make the dates listed on our Open Course page, or if we haven't announced new dates yet, do get in touch to discuss how our bespoke in-house courses can help your team.

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How can we help minimise errors in Child Protection?

​What does safeguarding have in common with flying Boeing 747s? Well in terms of why things go wrong, perhaps more than most people realise.

No matter what walk of life you work within, human fallibility interferes. A brief examination of many serious case reviews shows comments about missed signs of abuse, missed opportunities to intervene. The recent SCR into Levi-Blu Cassin refers to serious failings and 'professional optimism' http://www.bbc.co.uk/news/uk-england-birmingham-34416644 . Professor Eileen Munro in her report subtitled 'A child-centred system' published in May 2011 wrote "errors and mistakes should be accepted as to some degree inevitable and to be expected, given the complexity of the task and work environment."

Of course it is never quite so easy to spot things when perpetrators are concealing the harm. Consider Baby P where his Mother concealed his facial bruising under chocolate. Furthermore the paediatrician who examined him before his death had not been told he was on a child protection plan. This was an apparently simple communication error that had immense consequences because she was not aware of the background.

Very few of us work with colleagues who intend harm, but error is rife. Much of it is due to our being asked to work in ways which we are simply not designed for, such as extreme workload, interruptions and distractions. Also this case as I write http://www.bbc.co.uk/news/uk-england-somerset-34547660 demonstrates the importance of shared information to build Situation Awareness. The police failed to pass on vital information that the father had a relevant record of domestic abuse. Situation Awareness is a crucial concept referring to the 'mental model' we all have of what we are expecting now and what happens next. When this conflicts with what we see and experience there is clearly a problem.

There is a potential danger sign anytime you hear yourself or others say "Oh, I thought this or that was what we are doing" or perhaps "I am seeing this and you are not". There are classic signs that Situation Awareness is being lost, such as conflict between 2 sources of information. However to simply blame 'being human' is not good enough for the professional. To us it is incumbent to recognise how and why we all make mistakes and adopt methods that help keep us, our colleagues and our clients safe.

These non-technical skills are well understood and can be trained and coached. They encompass social skills such as Leadership, Followership, Cooperation and Management of others and cognitive skills of Situation Awareness and Decision making.

The culture is also riddled with blame, but what does it achieve? High reliability organisations recognize blame is mostly inappropriate and counter-productive. If it drives near-miss and error reporting underground it is useless.

The frontline teams know where the barriers to safety are, which procedures are not fit for purpose and where communication blocks occur. Their reports should be welcomed, responded to and acted upon. This is how commercial aviation has become safer and it can be adapted to safeguarding. Atrainability offers training solutions to address these issues.

Trevor Dale, Atrainability


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Human Factors – no longer an option

​The publication in September 2015 of the National Safety Standards in Invasive Procedures is a major positive move. http://www.england.nhs.uk/2015/09/07/natssips/

Dr Mike Durkin, NHS England Director of Patient Safety, said: "This is the first time that national safety standards have been set and endorsed by all relevant professional bodies". These include the royal colleges, the Care Quality Commission, the Nursing and Midwifery Council, the General Medical Council, Monitor, the Trust Development Agency, and Health Education England.

Dr William Harrop-Griffiths, Consultant Anaesthetist at Imperial College Healthcare NHS Trust and chair of the group that developed the standards, said: "The NatSSIPs contain 13 key standards which cover all aspects of the patient journey throughout an invasive procedure, ensuring safety checks are performed by the team providing care at every critical step in the pathway."

"However, this work is not just about establishing a network of safety checks. It is about ensuring that safe care standards are harmonised both within and between hospitals, and that learning from the development of local standards based on these national standards is shared by all."

Now good Human Factors practice is no longer an option.

Indeed the GMC has recently run its own online discussion document focussing on Human Factors which will undoubtedly have a bearing on future accepted practice.

There is nothing new here, but just giving it the official stamp of approval makes a huge difference, especially by all the professional bodies. This is fantastic news and a real step change, at last. Now comes the challenge of how to ensure such good practice is adopted effectively, not just lip service.

Classroom teaching to raise awareness and understanding of Human Factors is the starting point as used to great effect in other high-risk, but resilient professions like aviation, but how do we embed the learning long term? E-learning certainly has its place in supporting and cementing knowledge, but is unlikely to create behavioural change in isolation.

By and large people learn through experience, through being able to put theories and practical tools into practice day to day, and the culture of an organisation has to support that learning.

The major point is that people have to want to change the way they do things. Coaching and mentoring can certainly help. Those organisations that have invested in training and role-modelling from the top have achieved high performance that has sustained. They are beacons for effective care.

These new standards are currently aimed at invasive procedures, but it cannot be long before all of Health and Social Care formally recognises the critical importance of safer working behaviours.

Atrainability have been a leading provider of Human Factors Solutions to the healthcare industry for well over a decade, with over 100 years of training experience in our delivery team across a range of safety critical/high performance industries. Many NHS Trusts and private providers have already recognised this and to we have trained thousands of professionals across the UK.

Atrainability offer a range of training and coaching options

  • Trust-wide programmes that are designed to cover all departments and embed safety Champions and train the front-line teams and individuals. This aspect also covers leadership specialised courses and Master-classes and supportive coaching
  • Train the Champion courses, minimum two days, ideally three or more. They offer an in-depth understanding of Human Factors principles and the tools and skills that help the front line teams to work safe. The by-product is sufficient understanding to look into Root Cause Analysis to see beyond what people did but to look into why
  • Human factors awareness modules for front line teams that can be delivered throughout the year in modular design
  • Supportive work-place coaching to cement the knowledge and skill.

As many of you know psychopaths are thankfully rare in health and social care but human fallibility is a given. Long term safety enhancements come from knowledge and demonstrable skills. We are here and ready to help.

Trevor Dale.

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I could have told you that

Many high-performing professionals make their job look easy. Well maybe not micro-surgery but aviation is a good example that it seems is widely misunderstood. I hear many people say "you pilots don't understand – we deal with sick people who aren't OK when we start treating them. You wouldn't get airborne in a plane that wasn't OK" 

Well pretty much of course not. But if only life were that simple! Pilots and for that matter cabin crew, are there for emergencies, generally unanticipated, often at periods of low arousal. Look at Kegworth – 1989 - routine flight Heathrow- Belfast - relaxed take-off and climb and suddenly an engine breaks apart. The crew, who must have been terrified, misidentify the problem and shut down the wrong engine. 47 people die.

Lessons learned? Well it is an imperfect World and the same essential error happened in Taiwan in January 2015. You will probably remember the horrific images of the plane with wings vertical crossing a bridge before plunging into the river killing 43. The error was the wrong engine shut down again.

However we all now accept that flying is significantly safer than any other form of transport taking into account the number of flights per annum. Things do go wrong but what helps prevent tragic potentially fatal accidents is training and preparation. Especially thinking ahead and discussing what could go wrong and having a plan in place for how it would be handled if it did. Think Captain Sullenberger and crew and the Hudson River successful outcome.

How often have you said with hindsight "I could have seen that coming" or "I could have told you that would happen"? Experience is a great learning tool but trial and error is simply not acceptable.

That seems to be what healthcare is doing though. There is still a general reluctance to learn day to day success, failure and near-misses.

This is what Human Factors training can aid such as how to share plans across the team and encourage input from everyone who might spot the impending threat and intervene for safety. Even more so when it comes to post-hoc debriefing discussions about what worked well and what could be improved.

When you get down to it aviation and health and social care is about risk management. Risk management is about Human Factors. Mental preparedness and appropriate hierarchy and open communication.

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Inappropriate hierarchy and what to do about it

BBC Radio 4 - From the Cockpit to the Operating Theatre

Why lessons learned from aviation psychology are starting to save lives in hospitals.

​Matt Lindley, trainer and coach with Atrainability, featured in a radio broadcast recently on the BBC, alongside Prof Rhona Flin and other eminent healthcare experts, speaking about the problems of dealing with inappropriate hierarchy when it comes to safety. 

Matt's background is Royal Air Force and now British Airways where he flies long haul around the World. He has an extensive training experience which for the most recent few years has expanded into Health and Social Care with Atrainability.

Clearly both military and commercial aviation enjoy the benefits and problems associated with hierarchy. Both have developed tools to try and get the message through when safety is paramount. In my case, starting flying in 1971, the hierarchy or Authority Gradient was a real problem. Captains were never called by their given name, but always 'Sir' or 'Captain' on and off the aircraft.

Just to explain the concept of the Authority Gradient this is the view from the top person versus the view from the junior. If you ever hear someone say "I could have told you that" the immediate question must be "why didn't you?" or perhaps "what is it about me that stopped you?"

How many of us believe we are very approachable but then find one of our team has hesitated to challenge what we are saying or doing? I've been there and it is a terrifying bit of personal feedback. In my case I was a Training and Checking Captain with real power over other pilot's futures. I was the veritable scary monster that triggered fear – irrational I hope, but perceived real in the moment nonetheless.

The one advantage aviation has, of course, is the 'Black Box' – real evidence of what was said and done. Thus we know that the various Human Factors are a problem. It is often said that 90% of air crashes someone is heard to voice concerns but not effectively enough to stop the ensuing accident. Aviation works very hard to deal with this and effective balanced assertiveness, perhaps using a 'Trigger' word to get attention.

We teach these techniques in Health and Social Care supported by coaching in the live or simulated workplace to get to those who, for whatever reason, find class too difficult to attend!

So the responsibility lies throughout the team – the leaders, recognising that they may not be as approachable as they think, should encourage appropriate questioning. Those more junior in status should never assume and always accept their role in checking the correct process is taking place. 'Trigger' words work very well in health and social care too. "Gorilla???"

Our Human Factors Open Courses are the perfect introduction for both front line staff and managers who want to understand how they can improve issues such as inappropriate hierarchy, among others. Discounts are available for early bird bookings, but please do get in touch if you'd like a more bespoke, in-house traininig soultion for your team. We'd be happy to help you.


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Human Factors Training – Published evidence that it works!

We all know how challenging it can be to find good quality hard evidence that training teams and leaders in Human Factors awareness and skills enhances Patient Safety. Health Education England are seeking such evidence now for all forms of training. Quite right too. We have worked with various teams over the years notably at the University of Oxford with varying degrees of success. There are a plethora of published papers out there with our names on them. One of the arguments has been what to measure and I believe firmly that the only real measure is patient outcome. We have taken part in other recent research and I am led to believe that some further positive results will shortly be published. 

Some of you who have been with us a while will know that we were invited in to Newcastle Neurosurgery unit by Patrick Mitchell, the clinical lead, in 2006 where after some in-house training they had reduced the wrong-side error rate for cranial and spinal procedures dramatically (from 1 in 300) but then had a recurrence. 
The training consisted of putting all the direct theatre team and their immediate leaders through a one day interactive training course in understanding the problems around human behaviour and fallibility and practical solutions. This was supported by coaching to help embed the skills in practice. I think it is fair to add that two senior team members found it difficult to attend.
The result is now over 5 ½ years without a side error from a pre-intervention rate of 1 in 300! That is over 21,500 sided procedures in the unit with essentially the same entire team, although one of the senior clinicians did leave a couple of years ago – to concentrate on private practice.
 
The results have been published and is available to download freely - Click here to view full report in PDF format
 
I don’t believe it is unfair to say that the fundamental issues were around behaviour, especially team briefings and checklist discipline. Incidentally this was before the WHO checklist was published. Patrick Mitchell is a private pilot himself and has a clear understanding of the importance of checklists in safe performance. 
I would like to emphasise that the Atrainability team didn't achieve this –we simply helped the front-line team to build and maintain the confidence and skills to deal with the problems successfully. 
We encourage all our clients, colleagues and prospective clients to continue to seek and share evidence and best practice to improve Patient Safety for everyone. 
The Atrainability team are of course, very happy to explore further opportunities to develop solutions to human error, poor behaviour and help teams avoid avoidable harm.
 
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Human Factors are not just for Christmas

The Festive Season is upon us again and thoughts turn to gifts. What finer gift than support for a Human Factors Training programme?

 

It is apparent that the importance of Human Factors training across all workplaces is being recognised after all this time. How pleased Martin Bromiley must be.

One of the most pleasing changes this year has been the growth in organisations that realise that short interventions are a waste of effort and money.

You don’t change the culture (whatever that means) with a few hours of classroom chat about how to avoid errors.

This year has seen a number of NHS Trusts and private healthcare providers come to us and ask for programmes that address deep-rooted issues. We have started programmes of in-depth training of managers and team leaders to help enable them to understand the flaws in the processes and procedures that their staff have to deal with - the error-provoking conditions under which the front-line staff work. These are the holes in the Swiss Cheese models!

One of the delightful comments we received was from a middle manager in a mental health Trust who had performed a disciplinary procedure quite differently after an Atrainability course. She said that beforehand the staff member would probably have been sacked for violating procedures. But she then realised that it had been done with the best interests of the service user in mind. There was no desire to harm, no malice. So they have kept their job, albeit with a comment on their personal file, but the lessons are shared with others. A palpable shift to a ‘Learning Organisation’.

I know the aviation comparisons are sometimes overplayed but please bear in mind that Human Factors are taken seriously enough that by law they must be refresher-trained each year. Once a foundation knowledge and understanding is embedded within the organisation, refreshing and updating is comparatively easy.

So like the proverbial puppy, Human Factors is not just for Christmas it is for life – literally!

May we at Atrainability wish you all a very Happy Christmas season and a safe, effective New Year.

 

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We promote what we tolerate.

It was very good to see so many old friends at NAMEM (National Association of Medical Education Managers conference) recently and particularly put faces to those names!

What will probably stick in all our minds was the talk by Dr Victoria Bradley on her culture-changing experiences and her successful challenge of an unsafe clinical department situation. It was a pleasure to hear that her bold actions brought real front-line improvements in staffing levels and patient care.

She had to overcome her concerns about ‘whistle-blowing’ and potential repercussions and having done so was rewarded and thanked by very senior management in her Trust. Quite right too. But sadly this is not a frequent occurrence regarding the happy ending.

Frequently we hear course delegates stating that they don’t feel confident in raising concerns and in some situations don’t feel anyone is listening and nothing will change.

However how does this fit with duty of candour? We promote what we accept and tolerate. Turning a blind eye is simply not professional.

However the multiple reasons why so many of us don’t challenge unsafe or unprofessional situations are understandable and often a facet of our very essence of being human, such as the Fight, Flight, Freeze response. We have recently run several courses when admissions of passive behaviour have been manifest. But we at Atrainability have found we can help rebuild that confidence and re-motivate team members to speak up with appropriate persistence.

Courses combined with individual and team coaching helps build more-effective safer team-working. We are constantly developing new material, with a focus on advanced Human Factors looking at Stress Solutions and dealing with difficult people – including colleagues!

 

 

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Human Factors - common sense made conscious

We have begun a major training programme at a large private healthcare provider in London where all staff are attending an initial very short introductory module on Human Factors. 
The content is limited to why the subject is relevant to them all, some explanations of why we are all fallible and a few practical takeaway tools on how to try and avoid things going wrong. The long term plan is to continue to work together and build a sustainable high reliability organisation with safety at its core. 
Later in the Autumn it will include training trainers and champions to embed safe policies and procedures and seek to support staff.
The Director of Nursing had been actively seeking such training and has been a fantastic advocate, but the clincher was getting to present to the Board. 
The Chief Executive is a smart no-nonsense lady. I asked her and her senior colleagues if they knew what Human Factors is. Her instant response "well it's just common sense". Of course it is, but the trick is how to bring that to the conscious brain when faced with all the pressures and hazards of everyday work life.
That is where we seem to be helping judging by the feedback from the attendees. They love the simple messages and that we are talking their language.
Mind you it's quite a challenge with each class containing up to 30 from every area in the Hospital from finance through reception to ITU and theatre teams.
It is fun, engaging and at first sight seems to be making a tangible difference. 
Here is an example of unsolicited feedback from an ODP in paediatric theatres:
 
"I just wanted to say how much I enjoyed the training session. I think Ben delivered a really good session and I personally learned a great deal. It has given me some good ideas of ways we can improve our day to day practice within our department and has inspired me to look further into the human factors training principals and background.
If you could pass my thanks on to him that would be appreciated."

The icing on the cake, though, is that the Executive Board are all attending alongside all the 600 staff. 
Now that shows what leadership should be and will undoubtedly have a profound positive effect.

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