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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.

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


Recent comment in this post
Guest — Angela cassin
I am Levi-blus Nan and I have just read your blog. Firstly the police never failed to pass on information it was never requested, ... Read More
Monday, 10 October 2016 20:37
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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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