1. Human Factors for Enhanced Performance
Dr Harriet Nicholls Associate Medical Director L&D NHSFT
Miss Manjula Samyraju Consultant Obstetrician, Peterborough NHSFT

2. Human Factors definition
Human factors encompasses all of those factors that can influence people and their behaviour. In a work context, human factors are the environmental, organisational and job factors and individual characteristics which influence behaviour at work.
Clinical Human Factors Group. 2009
Carayon et al., 2006

3. Maternity L&D 2008 -2010 Growing awareness Raising awareness Living it
Use of risk management cases
Complaints
Maternal death
Talks
L1 – Influencing for followers is time well spent

4. Programme design Immersion event L2 Human Factors training day
Human Factors principles
Simulation Non technical skills
Train the multi-disciplinary trainers
Multi-disciplinary steering group
Implementation of team based practices
Evaluation

5. Team based practices Briefings De-briefings Closing the loop SBAR
L3 – different contexts are ripe for different solutions
PDSA
Measuring compliance
Measuring quality

6. Cultural Survey Results for Delivery Suite

7. Sustaining / lessons learnt
Introduced PROMPT and blended HF into it
Change requires regular fuel injection
Surface work is not the whole story
Leaders who walk the talk
Continual audit by direct observation
Cultural health checks
L4 – coaching and mentoring for change leaders
L5 – prophylaxis is always better than treatment

8. Spread EAHSN funding Client Peterborough NHSFT Process similar
Coaching added
Alterations to training

9. Why did we start this? - Background
Action being undertaken to address increasing incident rate of PPH
Different Units are using different thresholds for reporting PPH with many hospitals using 1.5L and 2.5L
All units confirmed that “red flag” limits on maternity dashboard set at 2% for PPH >2L and 8% for PPH>1
5.2%
7.9%
7.2%
8.7%
4.4%
5.7%
6.5%
5.6%
8.3%
9.0%
8.4%
4.9%
1.4%
1.0%
0.9%
1.5%
0.7%
1.2%
2.1%
2.0%
0.3%
1.3%

10. PPH working group
Claire Petz
Theresa Mccarthy
Kerri Bennett
Manjula Samyraju
PROMPT trainers

11. Depends on who is on call
Morning labour ward handovers
SBAR is not utilised
Depends on who is on call

12. 2012 2013 2014 7.4% 0.9% 0.8% 1.2% % of women with PPH >1000 - 1999
5.2%
2.9%
9.2%
7.0%
5.8%
5.7%
6.2%
6.3%
6.1%
6.7%
: Target is <5%
4.9%
% of women with PPH >=2000
1.4%
1.2%
0.6%
1.0%
0.9%
1.5%
1.3%
1.7%
2000: Target is <=1%)
5.2%
7.9%
7.2%
8.7%
4.4%
5.7%
6.5%
5.6%
8.3%
9.0%
8.4%
4.9%
1.4%
1.0%
0.9%
1.5%
0.7%
1.2%
2.1%
2.0%
0.3%
1.3%
2012
5.3%
7.6%
7.2%
6.3%
8.6%
6.0%
7.5%
6.5%
6.8%
5.6%
7.1%
6.2%
4.9%
1.4%
1.6%
0.5%
0.8%
2.1%
1.0%
1.2%
1.5%
1.8%
2013
6.0%
7.5%
7.3%
7.6%
6.8%
5.4%
4.8%
5.7%
3.7%
7.4%
4.9%
1.7%
0.3%
0.5%
1.4%
1.0%
1.6%
2.3%
0.9%
0.8%
1.2%
2014

13. Human Factors for Cultural change
A vision of teamwork
Raising awareness
Goal setting
Measurement
Training options
Coaching
Maternity L&D
ED L &D
Maternity Peterborough
Hospital wide L&D
Mental Health; safer care pathways