Human Factors: Patient Safety Specialty Lead| NIHR CRN WM & much more… Dr Larissa Kerecuk Rare Disease Lead for BCH Renal Research and Transition Lead Consultant Paediatric Nephrologist @BCH_Rare Specialty Lead| NIHR CRN WM

Terema and Birmingham Children's Hospital Basingstoke Prizewinners Human Performance and Limitations A pervasive mind-set: The vulnerability of the human condition and the realisation that even outstanding clinical knowledge and skill may not be enough to deliver safety We have to deal with people as they are – rather than as we would like them to be. We have to accept that human performance is variable We have to accept that we are programmed to learn by trial and error so human error is a fact of life We have a responsibility to manage that variability and propensity to error even though we will not be able to overcome them. Spring 2014

Human Performance and Limitations https://www.youtube.com/watch?v=qmaY9DEzBzI

Terema and Birmingham Children's Hospital Behavioural Human Factors and Teamskills Human Factor Topics Situation Awareness Situation Awareness Leadership Followership and Motivation Risk Management Safety Feedback Communication Communication Choosing Behaviour Choosing Behaviour Spring 2014

Human Factor Principles Error is normal Performance is variable System and Process interact with People and Culture System and Process People and Culture

Terema and Birmingham Children's Hospital Behavioural Human Factors and Teamskills The Error Chain Safe Unsafe A combination of events, circumstance, activities and decisions which lead to an unsafe outcome Spring 2014

Terema and Birmingham Children's Hospital Behavioural Human Factors and Teamskills ‘No system is foolproof to a sufficiently inventive fool’ (Mark Twain) The Vulnerable Human We have to deal with people as they are – rather than as we would like them to be. We have to accept that human performance is variable We have to accept that we are programmed to learn by trial and error so human error is a fact of life We have a responsibility to manage that variability and propensity to error even though we will not be able to overcome them. Human Performance and Limitations Spring 2014

Terema and Birmingham Children's Hospital March 2011 for Basingstoke Arousal Performance Personal Best ZZ ZZ Z In everyday life all things that we experience provide stimulation whether work related or domestic. We have an assumption that the more arousing things are the better we get. There is a linear progression between the level of stimulation and our performance. The problem is that this only goes so far because we peak and become so stimulated that we experience what pilots refer to as droop. At this point we become incompetent and our judgment goes. Z Workload © Terema Ltd 2007 Spring 2014

Terema and Birmingham Children's Hospital March 2011 for Basingstoke Arousal Performance Danger In everyday life all things that we experience provide stimulation whether work related or domestic. We have an assumption that the more arousing things are the better we get. There is a linear progression between the level of stimulation and our performance. The problem is that this only goes so far because we peak and become so stimulated that we experience what pilots refer to as droop. At this point we become incompetent and our judgment goes. Workload © Terema Ltd 2007 Spring 2014

Arousal Performance Personal Best Workload

Arousal Physiology Psyche Interpersonal Performance Environment Technology Arousal Performance Workload

Terema and Birmingham Children's Hospital Behavioural Human Factors and Teamskills NASA / UT Teamskills Briefing The effective briefing will be operationally thorough, interesting and will address co-ordination, planning and potential problems. Leadership / Followership / Concern for the Task The extent to which appropriate leadership and followership are practiced.. Communication and Decision Reflects the extent to which free and open communication is practiced. Active participation in decisions encouraged. Interpersonal Relationships / Group Climate Reflects the quality of relationships among the team, the overall climate in the workplace Team Self Feedback The extent to which a team recognises the need to give and receive feedback. Preparation / Planning / Vigilance Reflects the extent to which teams plan ahead, maintain situation awareness and anticipate contingencies. Enquiry / Advocacy / Assertion Team members advocate, with appropriate persistence, the course of action they feel is best, even if it involves disagreement. Workload / Distractions This is a rating of time and workload management. It reflects how the team distributes tasks, avoids overload and distractions. Spring 2014

Terema and Birmingham Children's Hospital Behavioural Human Factors and Teamskills Situation Awareness Making sense... (1.Take in information) (2. Make decisions……) Situation awareness is a process of making sense Having taken in information (really data) you make decisions on the basis of your interpretation of that data Spring 2014

The Mental Model

Brainwork https://www.youtube.com/watch?v=JiTz2i4VHFw

Professional Communication Handover (Continuity of Care) Call For Help Briefing (Sharing Mental Models)

THE SPOKEN WORD Social Professional Crisis Jargon

Terema and Birmingham Children's Hospital Behavioural Human Factors and Teamskills ATTENTION Transmission Listening Listening Formulating Response We listen in chunks just like sleep. Listening is a conscious function, not a passive. It requires a lot of mental resources to be an effective listener. It requires the listener to actively enquire and respond, confirming to the transmitter that the message has been received and understood. It is difficult to listen effectively; we speak at 125 words per minute and have the capability to listen at 900 words per minute. Consequently our brains spends it’s spare time, when listening, in anticipation as to what will come next, wandering and debating. These are not conducive to effective listening So we should genuinely want to understand the transmitter’s perception, while retaining sensitivity to their thoughts and feelings. Evaluating Reflecting Decreasing Attention Challenging or Unwelcome News Time Spring 2014

Mehrabian % weight of message Words used 7% Body Language 55% Tone used 38% % weight of message

One Brain - The effect of Stress and Workload Demands to Think Out of Control Limit of Capacity In Control Demands to Act Amalberti

The Bucket

Elaine Bromiley video http://chfg.org/articles-films-guides/films/just-a-routine-operation-teaching-video

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