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Atrainability Blog

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

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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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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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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