1. Loughborough Design School Is It Raining Out There? An exploration of culture, climate and safety. Dr Mike Fray

2. Loughborough Design School Overview Culture and Climate Safety I and Safety II Resilience Indicators for improvements

3. Loughborough Design School Few phrases occur more frequently in discussions about hazardous technologies than safety culture. Few things are so sought after and so little understood James Reason, 1997

4. Loughborough Design School Exploring socio-technical systems approach  Delivery of healthcare services via complex integrated systems  Systems Models:  SEIPS 1.0 and SEIPS 2.0 (Carayon et al 2014),  Dial F Model (Hignett 2013),  Dynamic risk and safe performance (Rasmussen1997)  Consider:  Role or absence of patient (Mitchell et al 2014)  Active vs passive  Compliant vs non-compliant  Treatment or rehabilitation (Boltz et al, 2012)

5. Loughborough Design School Culture is:  Emerges through a social process  Staff attach meaning to policy, practice and behaviour  Values, beliefs, assumptions  Created through story, myth and ‘believed success’  Is interpretive  Waterson, 2014,  Healthcare Foundation, 2013 5

6. Loughborough Design School Climate is:  Right here right now.  Measureable, observed  Process, practice and behaviour  Influenced by organisational culture  Influenced by organisational procedures  Influenced by individuals at the coal face 6

7. Loughborough Design School Characteristics of a Safe Culture  Managers engage with safety  Regular clear information on safety  Can raise concerns and will be listened to  Safety is always a top priority  Investigates all accidents and incidents  HSE 2002 7

8. Loughborough Design School Characteristics of a Safe Culture  Equipment and training is available if required  Everyone is involved in decision making  Rare for people to take short cuts  Honest and open about safety  Morale is generally high  HSE 2002 8

9. Loughborough Design School Consider these items against your organisation in healthcare, social care, education, community care? 9

10. Loughborough Design School Characteristics of a Safe Culture (For Patient Handling)  Managers engage with safety (???)  Regular clear information on safety  Can raise concerns and will be listened to (???)  Safety is always a top priority (Against all other priorities)  Investigates all accidents and incidents  Equipment and training is available if required  Everyone is involved in decision making  Rare for people to take short cuts(???!)  Honest and open about safety  Morale is generally high(?)  HSE 2002 10

11. Loughborough Design School Patient Handling Safety Performance TROPHI (Fray and Hignett, 2013) 11 OutcomeRank Safety culture12 MS health measures11 Competence compliance10 Absence or staff health9 Quality of care8 Accident numbers7 Psychological well being6 Patient condition5 Patient perception4 MSD exposure measures3 Patient injuries2 Financial1

12. Loughborough Design School Culture to Climate Organisational behaviour measures (1) Measures of safe or quality behaviour (3,5,6) Measures of effects on individuals (2,4,7,8,9,10,11) Financial outcomes (12)

13. Loughborough Design School Are we measuring Culture? Fray Waterson Munro (in press) Sextons Safety Culture Tool (SAQ) Vs TROPHI (IHI 2012) OMSCMSCScore% +ve TROPHI Total 0.500.20 1 Safety Climate 0.90**0.70 2 MS Health Measure 0.600.70 3 Competence & Compliance 0.100.00 5 Quality of Care -0.21-0.10 7 Psychological well-being 0.600.70 8 Patient Condition 0.90**0.70 9 Patient Perception -0.20-0.60 13

14. Loughborough Design School Are we measuring Culture? Fray Waterson Munro (in press) Sextons Safety Culture Tool (SAQ) Vs TROPHI (ICH 2012) OMSCMSCScore% +ve TROPHI Total 0.500.20 1 Safety Climate 0.90**0.70 2 MS Health Measure 0.600.70 3 Competence & Compliance 0.100.00 5 Quality of Care -0.21-0.10 7 Psychological well-being 0.600.70 8 Patient Condition 0.90**0.70 9 Patient Perception -0.20-0.60 14

15. Loughborough Design School Options to consider  Paper systems vs actual practice  Management Commitment  Work as perceived vs work as done  What makes a successful transfer  How do we measure the outcomes of safe patient handling  Are we creating positives or avoiding negatives? 15

16. Loughborough Design School Accidents vs safety work  What might the chart represent? The slice of the chart represents 1 in 10 000 actions 16 0.0001%

17. Loughborough Design School Accidents vs safety work Successful transfers Against Serious errors 17

18. Loughborough Design School  Safety I  Accident causation  Understand what goes wrong  Avoid errors  Reduce losses  Safety II  Understand what goes right  Repeat what goes right  Enforce successful behaviours  Develop the ability to create new process on successful behaviours  Gains  Comfort  Good position  Dignity  Perceived safety of patient  Efficiency  Rehabilitation  Clinical gains/maintenance Safety I vs Safety II 18 Safety I and Safety II, Erik Hollnagel. (2014)

19. Loughborough Design School Safety and Resilience  Oxford English Dictionary  Recoil or spring back into shape  Withstand or recover quickly from difficult conditions  Organisational Resilience (Vogus and Sutcliffe 2007)  ‘ positive adjustments under challenging conditions’  ‘vitally prepared for adversity which requires improvement in overall capacity’  Concept of ‘Brittleness’ (Prof Woods, Ohio State)  Boundaries of performance  Graceful extensibility  Sustained adaptability 19

20. Loughborough Design School  Outline  Operating Point  Acceptable Performance  Unacceptable workload  Boundary to economic failure Rasmussen’s Dynamic Risk Model (1997) 20

21. Loughborough Design School Patient Handling Risks (NBE 2014, Gallagher 2012) Responses: 21 1.Increase infrastructure 2.Increase staff numbers 3.Do nothing

22. Loughborough Design School Patient Handling Safety Climate Fray Waterson Munro (in press) 22 'Patient Handling Climate' Observed Intervention Measures. Communication systems, supervision, education and training, safe equipment and environments Outcome Measures. Specific measures showing the effects of the process e.g. levels of incidents, musculoskeletal losses, quality of care measures, productivity, throughput etc. Perception of Effectiveness. Recording the responses of all affected by the process, managers, supervisors, staff and patients

23. Loughborough Design School Looking wider for possible solutions.  Ergonomics and Human Factors Short courses.  Human Factors Concordat (2012)  Health Education England (2015)  Other providers  MSc Ergonomics (Health and Community Care)  Certificate, Diploma, Masters  Accreditation for Back Care Management  Update modules for all. 23

24. Loughborough Design School Ergonomics and human factors has some answers but as Johnny Nash once said ‘There are more questions than answers’ M.J.Fray@lboro.ac.uk