1. Getting to grips with the human factor: Strategic actions for safer care “The fundamental purpose and priority of hospital (and general practice) management, from the board down, should be the nurturing of a professional and organisational culture which unequivocally puts the needs of patients first, expects optimal outcomes, performance and patient experience, and publishes the results in the most accessible way possible for the public.” Sir Donald Irvine (2012)

2. What are human factors? “the factors that enhance clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture, and organisation on human behaviour and abilities, and application of that knowledge in clinical settings.” Dr Ken Catchpole, Human factors expert

3. How do human factors manifest themselves at work? How many safety concerns does your CEO receive directly from staff each month? What ‘work-arounds’ have you observed in your organisation? News articles © www.telegraph.co.uk

4. GOAL CONFLICT Why are human factors important? OK – but how can we do the SIGN OUT if the surgeon has left ? I am needed next door to start the anaesthetic for the next patient. SOMEONE ELSE can do Sign Out Need to check in with my pa to confirm tomorrow’s schedule.. NO TIME for Sign Out I need ALL the boxes ticked Now we need to complete the needle & swab count Sign in Compliance100% 60%

5. Why are human factors important? 83% radiologists did not see the gorilla Gorilla = 48X size of nodule on a CT scan Don’t see what you are not expecting to see Drew, Vo and Wolfe (2012) Inattentional blindness

6. Experience from safety critical industries, such as oil, rail and nuclear power, has shown that systems, facilities and equipment are safer if they are designed to match the abilities and behaviour of the people who use them, to help prevent human error Why are human factors important? What examples do you know about in your organisation where something has been designed to match the abilities and behaviours of the staff in order to prevent human error?

7. Business benefits of human factors provides a different lens/science to examine your organisation pre-empts costly disasters reduces error encourages a positive reputation

8. Business benefits of human factors safety effectiveness patient satisfaction staff productivity, morale & retention costly errors

9. The Board’s role in human factors Prioritise safety and quality Have a strategy and accountability for human factors - show your commitment to it Shape the safety culture to be a ‘just’ culture Have the right sorts of conversations within the board and at all levels of the organisation Provide visible leadership and listen to your staff Make resources - time, money and people - available Where is responsibility for human factors located? Would you be happy if responsibility for financial performance was located in the same place?

10. Reflective questions for Board members Am I confident that I have the right skills, knowledge and expertise in relation to human factors to fulfil my responsibilities? Does the Board have a culture where constructive challenge is encouraged and where everyone feels confident about speaking up about quality of care issues?

11. Reflective questions for Board members How might we improve and develop our system of induction, training and assessment of board members drawing on human factors principles? How might we improve and develop our decision-making about patient safety in board meetings through enhancing our understanding of human factors?

12. Assurance – not reassurance How is safety intelligence about potential human factors issues presented within the safety and quality information the Board receives? Are you getting appropriate, timely and reliable data ? How are you individually and collectively interrogating the data you are provided with? Do you use the data provided to hold the organisation/and each other to account? Are you ready to receive negative data about things that need improvement?

13. Taking action The public expects openness and transparency - the only exceptions being matters that must remain confidential such as personnel or commercially sensitive information. How do staff decide… - when the clock starts and stops in A&E? -a trolley becomes a bed? -room/bed numbers are used instead of identity bands to identify patients when administering medication -How would you find out? As a Board do you operate a compliance or an improvement culture? What happens when ‘targets’ and rules are breached? What more could your board do to increase openness and transparency?

14. Want to know more about how you and your board can... raise awareness and stimulate dialogue about human factors? demonstrate how human factors impact on quality, safety and productivity in healthcare in your organisation? encourage your Board to invest time and resource in human factors? identify the contribution your Board and individual members can and should be making in this area? www.chfg.org