Course attendee comment

This short 2 minute video testimonial is from a Doctor of Emergency Medicine reflecting on how she has seen the significant benefits of Atrainability Human Factors training

 

 

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.

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

Continue reading
1785 Hits
0 Comments

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.
Continue reading
4065 Hits
0 Comments

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.

Tags:
Continue reading
2538 Hits
0 Comments

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?

Continue reading
3222 Hits
0 Comments

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.


Continue reading
3045 Hits
0 Comments

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.

Continue reading
2982 Hits
0 Comments

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

Continue reading
3246 Hits
0 Comments

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

Continue reading
3298 Hits
0 Comments

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

Continue reading
2707 Hits
0 Comments

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

Continue reading
3272 Hits
0 Comments