Changing Behaviours & The Human Factors Approach

1. Changing Behaviours & The Human Factors Approach Jenny Ingram Head of Service Improvement NHS Grampian

2. ✔ • Appreciation of a System • Complex system of interaction between people, procedures and equipment • Success depends on integration, not performance of individual parts ✔ • Theory of Knowledge • Change is prediction of improvement • based on knowledge of the system • Learning from theory, experience • Operational definitions are the basis • for improvement with PDSA cycles for • learning • Psychology • Interaction of people with systems • Motivation & will of individuals & teams • Situation awareness/decision making • Managing stress and fatigue • Helps planning for change management Improvement ✔ • Understanding Variation • Variation is to be expected – everything we measure varies • We make decisions based on interpretation • Data over time – data story of what has been happening Aims & Values

3. Human Factors • Critical incident studies reveal that around 80% of underlying issues relate to human factors. • Systems should be designed with ‘defenses in depth’ • Organisational, management, equipment design, workspace layout • Should provide the human in the systems with the necessary knowledge and skills to deal with threats in their environment to act as hero • Technical skills are not enough! (Reason 1997))

4. Human Factors Approach Focus on behaviours that contribute to safe & effective performance • Situation Awareness • “mindfulness” • Detection and recognition of threats • “Chronic Unease” / Attention to weak signals • Decision Making • Balancing competing pressures • Ability to make “sacrificial decisions” • Communication • Handover • Between Professions • Organisationally

5. Human Factors Approach • Teamwork • Recognise the contribution of individuals to the success of the team. • Work to peoples strengths as well as supporting developments. • Leadership • Required at all levels but needs organisational direction if it is to make a difference. • Managing Stress • High stress is recognised but low levels of ongoing stress are equally important. • Managing Fatigue • Prolonged work has shown the same deterioration in performance as making it illegal to drive.

6. Lessons from other industries • Human factors & safety integrated to the core curriculum • Compulsory incident reporting, investigation and learning • Briefing and debriefing part of the culture • Expect things to go wrong and plan for it • 15/01/2009 • Flight 1549 • Routine flight from New York to Charlottesville • Landed safely in the Hudson River • All passengers and crew alive & well • Lessons shared across the world

7. Relevance To Healthcare?

15. How Many “Fs” 6

16. Human Factors A common language “Enhancing clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture and organisation on human behaviour and abilities and application of that knowledge in clinical settings.” (Catchpole 2010) “Not only knowing but doing.”(HF SLWG 2012) “Making it easy to do the right thing.” (Bromiley 2010) Organisational Management • - Safety Culture • - Managers’ Leadership • - Organisationcommunication Work • - Environment • - Hazards • - Ergonomics Work Group • - Teamwork • - Structures & processes • - Team Leadership • - Communication Individual • - Cognitive skills • - Situation awareness • - Decision making • - Personal resources • - Management of stress • - Management of fatigue (Flin & Patey 2011)

17. Can We Assess Non-Technical Skills?

19. Are You Convinced That You Need To Consider Human Factors?.... Let Me Try More!!!! • I am taking you to a strange planet with a very strange atmosphere. • In this atmosphere they cannot speak, as sound does not travel. • The planet also has a very weird gravity system. Only four people can stand up at once. It is also impossible to stand for more than ten seconds. • The challenge for survival on this planet is for the group to keep four people standing up all of the time, for not more than ten seconds each.

20. Solutions • Use human factors to plan work and minimise “surprises” • Avoid reliance on memory • Make things more visible • Review and simplify processes • Standardise common processes and procedures • Routinely use checklists • Decrease reliance on vigilance

21. www.lmq.co.uk

22. So What’s In It For You And Your Patients? • Reduced hospitalisation and costs • Increased effectiveness and innovation • Increased well-being of team members • Multi-disciplinary teams deliver high quality patient care and implement more innovations • Lower patient mortality • Reduced error rates • Reduced turnover • Lower and sickness absence • Increased organisational commitment and engagement Lyubovnikova, J., & West, M.A. (2013)

23. In Summary “ Where is the randomised trial?” is, for many purposes, the right question for many others it is the wrong question, a myopic one. A better one is broader: “What is everyone learning?” Asking the question in that way will help clinicians and researchers in navigating towards improvement. Berwick (2008) Berwick, D.M. (2008). The Science of Improvement. JAMMA. Vol. 299, 10: 1182-1184 Berwick, D.M. (2008). The Science of Improvement. JAMMA. Vol. 299, 10: 1182-1184

24. And Finally………..