Human Factors in Healthcare: Trainer’S Manual Edited by Patrick Mitchell
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SAFER CARE Human Factors For Healthcare Trainer’s Manual Edited by Patrick Mitchell Swan & Horn SAFER CARE Human Factors for Healthcare TRAINER’S MANUAL Edited by Patrick Mitchell Prepared on behalf of the North East Strategic Health Authority Patient Action Team NHS North East Safer Care—Human Factors in Healthcare: Trainer’s Manual Edited by Patrick Mitchell First published 2013 ISBN: 978-1-909675-00-1 Copyright © 2013 Swan & Horn All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publisher on behalf of the NHS Commissioning Board, or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London, W1T 4LP — except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by fair use in copyright law. For permission requests, contact the publisher Swan & Horn, phone: (44) 1436 842749, fax: 07092 373804 or email: [email protected]. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. Notice Clinical practice is constantly evolving in terms of standard safety precautions, responsibility of practitioners, and treatment options. While every effort has been made to ensure the accuracy of information contained in this publication, no guarantee can be given that all errors and omissions have been excluded. Neither the publisher nor the authors assume any liability for any injury and/or damage to persons or property arising from this publication. The Publisher For information and orders, contact Swan & Horn: Swan & Horn • Woodside Tower • Cove • Argyll and Bute G84 0NT Tel: (44)1436 842748 • Fax: 07092 373804 Email: [email protected] www.swanandhorn.co.uk Cover artwork by Virginia Brailsford Editorial and production by Shoreline BioMedical Printed in England by Ferguson Print, Keswick Contents[/]Contents Preface iii Contributors v Introduction vii List of Figures xi TRAINING MODULES 1 Thinking About Thinking—Cognitive Processing 1–21 2 Decision Making 23–40 3 Situation Awareness 41–58 4 Personality Type 59–85 5 Team Working 87–104 6 Leadership 105–122 7 Communication 123–143 8 Stress and Fatigue 145–167 Index 169–178 i With special thanks to: Professor Graham Towl, Professor David Crighton and Durham University Department of Psychology ii Preface Safer Care is a training course on human factors for healthcare professionals. It was developed by the Safer Care Action Team, NHS North East of England. It consists of eight modules dealing with cognitive processing, decision-making, situation awareness, personality types, teamwork, leadership, communication skills, and stress management; these can be delivered in separate sessions or as a single intensive course. This Manual gives detailed and referenced accounts of each subject, and other components of the course are provided in an e-learning package (www.safercare.eu/human/) and a Handbook for participants. Human factors training is widely used in safety-critical industries, but healthcare is a relative late-comer to the field. There are two main differences from other industries that must be addressed. The first, and more obvious one, relates to those issues that are specific to healthcare as opposed to those of primary relevance in other industries. The second is less obvious, but more important. It relates to the fact that healthcare professionals tend to be more sceptical than workers in many other industries – they are disinclined to accept statements of benefit without seeing the evidence. This course has been specially designed with this important difference in mind. iii iv Contributors CLIVE BLOXHAM Clive Bloxham is a consultant pathologist at County Durham and Darlington Hospitals with an interest in cognitive factors in medical practice and how errors occur. GUY HIRST Guy Hirst was a pilot with British Airways from 1972 until 2006 and was one of the pioneers of Human Factors Training in the airline culture. Since 2001 he has been writing and presenting courses in healthcare and is involved in research on healthcare safety. PHIL LAWS Phil Laws is a consultant in intensive care medicine and anaesthesia in Newcastle, and medical lead for the Advanced Critical Care Practitioner Programme and Outreach, with an interest in com- munication, crisis communication for junior doctors and mandatory training for critical care staff. PATRICK MITCHELL Patrick Mitchell is a consultant neurosurgeon in Newcastle upon Tyne with a research interest in surgical safety and decision-making. EMMA NUNEZ Emma Nunez is a registered midwife who now works in patient safety. She is the Safer Care North East Programme manager and chaired the Human Factors Faculty responsible for developing this course. NANCY REDFERN Nancy Redfern is a consultant anaesthetist in Newcastle upon Tyne specialising in obstetric and neuro-anaesthesia, with an interest in medical education, appraisal and mentorship. GAVIN THOMS Gavin Thom is a consultant anaesthetist with interests in perioperative and operative safety, and related human and cultural factors. He is currently joint lead on Project OASIS on surgical safety in South East Asia and recently led the international Global Oximetry Project aimed at improving anaesthetic safety. v vi Introduction Being human, by its very nature, makes us all fallible. The additional titles we bear – doctor, nurse, midwife, pharmacist, dentist, chief executive, non-executive director (the list is endless) as a result of our education, training and technical ability – will never change the fundamental imperfections found among humans. Our day-to-day lives provide numerous opportunities to make mistakes that generally have limited adverse consequences. You might forget to put the bin out on collection day because of some distraction, or you might walk down the stairs with the intention of emptying the washing machine, only to forget what you came down for when you reach the kitchen. These lapses are only minor, no more than an irritation, meaning that you have to make alternative plans for refuse disposal or you have to stop in your tracks and retrace your steps to work out what it was you had meant to do. These kind of mistakes do not harm anyone. However, some lapses carry greater risks. A midwife, for example, driving home in the early hours after finishing her nightshift, pulled to a stop at a red traffic light. As she sat and waited for the lights to change, the CD she was playing came to the end and the player automatically changed to the next disc in the library. At this point she drove off again, right through the red light. She had confused the change in what she heard with the change she was waiting to see in the traffic signals. She laughed about it at the time, but she was well aware of how easily she could have killed or seriously injured herself or someone else. Let us not make the error of thinking that the processes we experience that lead to mistakes in our personal and social lives are any different from the processes we experience that lead to mistakes in our professional life. Why do we tend to think that the title of our professional group removes our fallibility? Why is it that we forget such risks when it comes to delivering some of the most technologically advanced and effective healthcare in the world? What has led us to think this way? When we talk about improving safety and reliability in healthcare, we make regular references to the aviation industry. The aviation industry has considerable knowledge and learning that can be shared with and applied to healthcare, but the industry embarked on a difficult journey when it first introduced human factors training. The following quote is from Jeremy Butler, the General Manager of Flight Training in British Airways at that time. We thank him for allowing us to use his comments here, which reveal a rational, balanced view based on both his own experience and expertise in aviation, and latterly in healthcare. “Flight Ops in British Airways (BA) had for a few years been considering, rather idly, the issues of what we might now call non-technical skills on the flight deck. I had become interested in Human Factors, both at the managerial and front-line levels, and became informed through attending seminars and conferences in the USA. I participated in the United Airlines CRM programme (called something else but I can’t remember the exact name). I was asked by vii Introduction Operating Standards Group (OSG) in BA whether this had any relevance to us. I enjoyed the experience but it was a very psychological course at that time, and I concluded that British pilots were not ready for ‘psychobabble’. Also I believed that the Standard Operating Procedures of BA were greatly superior to those of the manufacturer, which are usually adopted by airline operators. It seemed to me that the principles of the ‘monitored approach’ with workload distribution and shared responsibilities were conducive to achieving safe flight and that Crew Resource Management (CRM) was not necessary in BA. “I believe the Kegworth accident changed the thinking in BA (there was probably active consideration prior to Kegworth, and this confirmed the thinking, but I can’t remember the exact sequence). The Board Air Safety Committee (not sure of the exact name now), decided that we would develop and introduce a CRM programme. The responsibility for this fell to me. This was devolved to various managers and interested flight crew, and we recruited a number of CRM instructors. It is noteworthy that CRM was introduced in BA well before the Civil Aviation Authority (CAA) had made it a requirement (even though it was hugely expensive).