Atrainability Blog

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

A renewed focus on NatSSIPs

NatSSIPs - National Safety Standards for Invasive Procedures 


Many of our prospective clients often tell us that they are working successfully towards a safer culture, and yet never-events and avoidable harm do not appear to be diminishing on a National basis.* 

Let's look at NatSSIPs and LocSSIPs on which there is a renewed focus at this time. Otherwise known as the Five Steps to Safer Surgery. 

LocSSIPs is a topic that we have masses of experience in, helping Trusts develop their own best practice in briefing, checklist and debriefing . We are privileged to witness many excellent demonstrations using Natsipps techniques but sadly, we occasionally meet individuals who think they don't need such aids to safety. 

Very recently I was disappointed to witness a Clinician quite deliberately reading news reports on his Smartphone while a Safer Surgery Checklist was being read. Sadly his clinical colleague said nothing. Rest assured that the situation was rectified at the time. However this is still not unique, though happily rare. 

We have a responsibility to ensure the importance of NatSSIPs and the reasons behind its introduction are understood. In our view (and others) the use of checklists and safety techniques is not a personal option, but a mandate and a necessary core function of professional surgical performance. 

NatSSIPs is built around the aviation based concept of threat and error management. This came out of the original NASA funded research at the University of Texas under the late professor Bob Helmreich. 


Threat and Error Management is three steps: 

•AVOID – in an ideal world you would avoid everything that could possibly go wrong

TRAP - But of course you can't avoid everything in the real World. What you haven't been able to avoid you would wish to trap, in order to minimise any errors resulting in potential harm. 

•MITIGATE (read definition)- Finally, one needs to reduce the effects if harmful but to stretch the meaning of 'Mitigate' – to learn from failure and of course success. 


How does this work in practice? 

In healthcare, as in aviation, the 'AVOID' phase is accomplished by having a briefing (Handover or Safety Huddle) normally performed at the start of a working shift or day. This is where the team get together, share plans for what should happen, build situation awareness (Plan A) across the whole team and prepare themselves for what they hope won't happen (Plan B, plan C etc). 

'TRAP' - The 3 steps of the WHO Safer Surgery Checklist fulfil this role.The checklist serves as a memory aid to ensure all necessary safety issues have in fact been completed. Note – it is a Checklist - not a TICK LIST. It is completion of the actual CHECK that is crucial and not the ticking of a box! 

Finally, 'MITIGATION'. Debriefing sits here as a tool for learning not blame. In the case of a successful outcome debriefing is the opportunity to discuss what went well, why it went well and how we will try to ensure it goes well tomorrow and thereafter. 

In the event that it has not gone well, rather than resorting to blame and finger pointing; this step serves to investigate why and how something went awry. How and why well-intentioned, well-trained people have perhaps made an error, with a view to genuinely learning lessons and moving forward effectively for the whole team and ultimately the organisation and the profession. 

Duty of Candour sits here too and is of course a legal, professional and a compassionate necessity. 

After all, quite apart from the safety aspect, who gains the most respect? Someone who accepts and owns up to their own fallibility or someone who seeks to hide it? 

Atrainability would be delighted to assist you in implementing LocSSIPs for your teams, please get in touch to arrange an informal phone chat at your convenience. 


*Source: Never events data, click here

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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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