parallel session 3.5 crossing boundaries to improve outcomes

HUMAN FACTORSDr Rona Patey

Consultant Anaesthetist NHS GrampianHead of Division of Medical and Dental Education

University of Aberdeen

Who are we?

11%

11%

11%

11%

11%

11%

11%

11%

11%1. Nursing

2. AHP

3. Medicine

4. Healthcare education – undergraduate

5. Healthcare education – postgraduate

6. Healthcare management

7. Human factors research

8. Human resources

9. Other

0of100

Are you currently working on a human factors initiative?

20%

20%

20%

20%

20%

1. Yes – still in planning stage

2. Yes – within my team

3. Yes – across institutions

4. No – but I would like to

5. No

0of100

Have you had previous education / training around human factors?

20%

20%

20%

20%

20%1. No, not really thought about it

2. No, but would be keen to know more

3. Yes, a one off session

4. Yes, as part of a larger programme

5. Don’t know

0of100

Things don’t always go right!

Human Factors

• ‘the scientific discipline concerned with the understanding of interactions between humans and other elements of the system, and the profession that applies theory, principles, data, and methods to design in order to optimise human well being and overall system performance’

International Ergonomics Association 2000

Human Factors

• Organisational / management– Safety culture– Management

leadership– Communication

• Work environment– Work environment and

hazards (ergonomics

• Workgroup(s) / Team (s)– Team structures / processes– Team leadership

• Individual worker– Cognitive

• Situation awareness• Decision making

– Personal resources• Management of stress• Management of fatigue

Exercise

• A picture will appear on the screen for around 15 seconds

• Examine the picture closely and look for a change

• Raise your hand when you spot a change

Safety

• Error is inevitable and ubiquitous!– Humans are fallible

Helmreich 1996

• Critical incident students reveal that around 80% of underlying issues relate to human factors– Frequently avoidable

Admitted with UTI

On 5 Medications

Wrist fracture six months ago

Mobilises with a frame

Patient Condition

Drug ChartMedical Records Ward

Environment Workforce &Communication

Lack of staff training

The latent failure model of complex system failuremodified from James Reason, 1997

AccidentTrajectory

Safety

• 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

Lessons from other industries

• Human factors & safety integrated to the core curriculum– undergraduate– continuing professional development

• Compulsory adverse event reporting with investigation and learning (organisation and industry)

• Briefing and debriefing part of the culture

Lessons from other industries

15/1/2009

Flight 1549

Routine flight from New York to Charlottesville

What about healthcare?

ANTS System

Example behaviours for poor practice

Example behaviours for good practice

Categories Elements

Task Planning and preparing

Management Prioritising

Providing and maintaining standards Identifying and utilising resources

Team Co-ordinating activities with team members

Working Exchanging information

Using authority and assertiveness

Assessing capabilities Supporting others

Situation Gathering informationAwareness Recognising and understanding

Anticipating

Decision Identifying optionsMaking Balancing risks and selecting options

Re-evaluating

Reduces level of monitoring because of distractions Responds to individual cues without confirmation Does not alter physical layout of workspace to improve data visibility Does not ask questions to orient self to situation during hand-over

Confirms roles and responsibilities of team members Discusses case with surgeons or colleagues Considers requirements of others before acting Co-operates with others to achieve goals

Taking a human factors approachA healthcare example?

Human Factors

http://www.chfg.org/

‘about making it easier to do the right job’

Martin Bromiley

Human factors training should be incorporated as a core skill?

20%

20%

20%

20%

20%1. Strongly Agree

2. Agree

3. Neutral

4. Disagree

5. Strongly Disagree

0of100