1. Presented by:

2. Foresight Training

3. Aims of the session Background and introduction to Foresight Training Foresight in action: Interactive workshop

4. Background and introduction to foresight training Foresight is the ability to identify, respond to, and recover from the initial indications that a patient safety incident could take place. It involves frontline healthcare staff recognising the potential safety risks in the healthcare system, and considering intervening to prevent an incident. Foresight skills include intuition, wariness, vigilance

5. An example of foresight Walking home at night constant awareness, ever watchful for danger, feral vigilance, safety is second nature

6. Examples of foresight training Non-technical skills training in aviation Western Mining Corporation. ‘Take time, take charge’ (Hopkins) Metropolitan Police: hazard awareness training ESSO’s ‘step back by five’ programme BP’s integrity management training Approach to scene training by London Ambulance NHS Trust Situation, Background, Assessment and Recommendation (SBAR) (Institute for Healthcare Improvement, 2006)

7. Adapted from REASON, 2005 People Environment Workspace Task Equipment Staff Patients The ‘system’ Factors within the healthcare system that could potentially lead to harm Staff act as harm absorbers Organisation

8. Concept of foresight training ‘Error wisdom on the frontline’ James Reason 2004

9. The ‘three bucket’ model for assessing risky situations (Reason, 2004) 1 2 3 SELFCONTEXTTASK The fuller your buckets, the more likely something will go wrong, but your buckets are never empty.

10. Assessing the risk Serious risk: If feasible don’t go there Moderate to serious: be very wary Routine to moderate: proceed with caution 3 5 7 9

11. Self Bucket Level of knowledgenewly qualified Level of skillcompetence and experience Level of experienceinvoluntary automaticity, under/over confidence Current capacity to do the task fatigue, time of day, negative life events

12. Equipment and devicesusability, not available Physical environmentlighting, noise, temperature Workspaceworking environment, writing space, Team and supportleadership, stability and familiarity, trust Organisation and management safety culture, culture, targets and workload Context Bucket

13. Errorsomission errors, primary goal achieved before all steps complete, lack of cues from previous steps Task complexity calculations Novel taskunfamiliar or rare events Processtask overlap, multi-tasking Task Bucket

14. What are the benefits of Foresight Training? Facilitates learning about patient safety risks from more experienced nurses. Improves nurses’ ability to recognise and intervene at the first signs of a problem. Raises awareness of patient safety incidents, and in particular, near misses. This in turn could lead to improved near miss reporting rates and therefore important learning opportunities.

15. Interactive Workshop 1.Read the scenario/watch the video 2.Think about the unfolding scenario 3.Contextualise in terms of the three bucket model

16. What is in the buckets? Work in small groups Discuss what was in the Self, Context and Task buckets Write one factor down on each ‘Post-It’ note 20 minutes to discuss as a group 15 minutes group feedback

17. Conclusions or key learning points from the session

18. Summary Foresight training aims to develop mental skills to identify, respond to and recover from risks It is a ‘live’ skill It seeks to develop ‘error wisdom’ at the frontline

19. For further information please contact the NPSA www.npsa.nhs.uk 4-8 Maple Street, London W1T 5HD 020 7927 9500