Part 1

Watch this short video demonstrating aspects of leadership and teamwork other than just the authority gradient.

Just A Routine Operation from thinkpublic on Vimeo.

It highlights a range of aspects of leadership and teamwork, other than just the authority gradient. For example, it illustrates what can happen when we lose sense of time and perspective, how communication can dry up under stressful circumstances, how we return to ‘first learned responses’ to a situation and how we can easily become fixated on a task to the detriment of our overall purpose – tunnel vision. Above all, it demonstrates how mistakes are almost always to do with the 'whole system' and not just about individuals.

In the field of patient safety, all these aspects are known as 'human factors' and are, increasingly, becoming recognised as key to maintaining safe and high -quality health and social care. The scenario presented in this video forms the beginning of Matthew Syed’s book, Black box thinking, and is discussed in far more detail. However, to also help your thinking around human factors in health and social care, you may want to take a look at the NHS Patient Safety Strategy which was launched in July 2019. It has been recently been updated post Covid (Strategy update, 2021), however much of it remains in place – particularly the focus on the importance of Human Factors.

https://www.england.nhs.uk/patient-safety/the-nhs-patient-safety-strategy/

To help better understand Human Factors in Health and Social Care, the World Health Organisation (WHO) define Human Factors as, “the study of all the factors that make it easier to do the work in the right way.”

Catchpole (2010) was cited in the Department of Health and Social Care Human Factors Reference Group Interim Report stating it as “Enhancing 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.”

It is important to address one of the major misconceptions in Human Factors - it is all about Human Error, which contradicts the intentions of human factors as a science to support human performance and investigate unanticipated events.

It is about understanding human limitations, alongside designing the workplace and the equipment we use to allow for variability in humans and human performance.

Knowing how fatigue, stress, poor communication and inadequate knowledge and skills affect health professionals is important because it helps us understand predisposing characteristics that may be associated with adverse events and errors (think back to the story shared by Martin Bromiley in the short film). There is one particular area of Human Factors that especially affects those in positions of leadership, versus those in the positions of followership: Work as Imagined versus Work as Done.

A popular way to consider this is by considering the knife analogy – the blunt end and the sharp end.

Those at the sharp end are the clinicians – doctors, nurses, porters, surgeons, care workers – anyone who is interacting directly with patients and communicating with their families and carers. The further up the hierarchy – the knife blade – you go, the less you are actually ‘doing’ the job, yet the more influence you have over the strategy and design of the systems, processes, policies, regulations, guidelines, training, equipment, etc. In the public sector, some of these are implemented by people who used to undertake work at the sharp end, but quite often they are implemented by politicians and civil servants who have never actually done the work at the sharp end.

Therefore, an element of how we view Human Factors as leaders is also a case of those at the blunt end prescribing work as imagined, not understanding how things are actually undertaken with regards to work as done. People working at the sharp end are quite often adapting ‘work-as-prescribed’ to make it fit with ‘work-in-reality’.

Part 2

Discuss what you have learnt about human factors with your manager.

Which one aspect of human factors seems to be most relevant to your area of work? Focus on this and agree one thing you will do to raise awareness among your staff and colleagues about what needs to be done differently. Record this in your learning journal. 

References:

1. Topic 2: What is human factors and why is it important to
   patient safety? https://www.who.int/publications/m/item/topic-02---what-is-human-factors---2009 and https://www.who.int/patientsafety/education/curriculum/who_mc_topic-2.pdf
2. Catchpole (2010), cited in Department of Health Human Factors Reference Group Interim Report, 1 March 2012, National Quality Board, March 2012.
   Available at: https://web.archive.org/web/20210512121954/https://www.england.nhs.uk/wp-content/uploads/2013/11/DH-rep.pdf