Human Factors in the Healthcare Setting: A Pocket Guide for Clinical Instructors

114 Pages·2013·0.993 MB·English

Human Factors in the Healthcare Setting
Human
Factors in the
Healthcare
Setting
A Pocket Guide for Clinical
Instructors
Advanced Life Support Group
Edited by
Peter-Marc Fortune, Mike Davis,
Jacky Hanson and Barbara Phillips
A John Wiley & Sons, Ltd., Publication
This edition fi rst published 2013 © 2013 by John Wiley & Sons, Ltd.
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Library of Congress Cataloging-in-Publication Data
Human factors in the healthcare setting: a pocket guide for clinical instructors / Advanced
Life Support Group; edited by Peter-Marc Fortune et al.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-118-33970-1 (pbk.: alk. paper)
I. Fortune, Peter-Marc. Advanced Life Support Group (Manchester, England)
[DNLM: 1. Patient Safety. 2. Cognition. 3. Communication. 4. Decision Making.
5. Medical Errors – prevention & control. 6. Patient Care Team – standards. 7. Stress,
Psychological – prevention & control. WX 185]
613–dc23 2012022777
A catalogue record for this book is available from the British Library.
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Cover designed by Nathan Harris
Set in 9.25/12pt Meridien by Toppan Best-set Premedia Limited
1 2013
Contents
Working group, vi
Contributors, vii
Foreword, viii
Preface, ix
Acknowledgements, xii
Contact details and further information, xiii
Chapter 1 Introduction to human factors in medicine, 1
Chapter 2 Human cognition and error, 10
Chapter 3 Situation awareness, 20
Chapter 4 Leadership and teamworking, 28
Chapter 5 Personality and behaviour, 36
Chapter 6 Communication and assertiveness, 42
Chapter 7 Decision making, 51
Chapter 8 Fatigue and stress, 61
Chapter 9 Key elements in communication: briefi ng and
debriefi ng, 71
Chapter 10 Organisational culture, 79
Chapter 11 Guidelines, checklists and protocols, 85
Anthology, 91
Index, 97
v
Working group
Associate editors
Peter -Marc Fortune
Mike Davis
Jacky Hanson
Barbara Phillips
Working group
Simon Carley, Emergency Medicine, M anchester
Brian Carlin, Pre- hospital Care, Dublin
Trevor Dale, Human Factors, C ranleigh
Mike Davis, Medical Education, Blackpool
Pete Driscoll, Emergency Medicine, Manchester
Peter -Marc Fortune, Paediatric Intensive Care, Manchester
Jacky Hanson, Emergency Medicine, Preston
Ralph Mackinnon, Paediatric Anaesthesia, Manchester
Sue Norwood, Human Factors, Cheshire
Barbara Phillips, Paediatric Emergency Medicine, Cheshire
Felicity Plaat, Anaesthesia, London
John Rutherford, Anaesthesia, Dumfries
Stephanie Smith, Paediatric Emergency Medicine, Nottingham
vi
Contributors
Simon Carley
Trevor Dale
Mike Davis
Peter -Marc Fortune
Jacky Hanson
Sue Norwood
John Rutherford
Reviewers
Pete Driscoll
Jane Mooney, Medical Editor at ALSG, M anchester
Barbara Phillips
vii
Foreword
In my early aviation career‘human factors ’ was taught as a stand-
alone subject. We endured an examination in ‘human performance
and limitations ’ and had to attend courses focusing on human
factors and‘crew resource management ’. But the hard part was just
trying to learn the basic technical stuff!
As my career has progressed I’ ve come to see things a little dif-
ferently. Yes, the basic technical skills are critical, without those
you’re as good as useless. But quite often I’ m reminded, luckily in
a very minor way, that it’ s the human in the system that has the
greatest chance of leading us to an early demise.
Professor Jim Reason, whose work is quoted in this book, talks
about humans as‘hazards and heroes ’. We have the ability to screw
things up, no matter how experienced and knowledgeable we are;
but we also have the ability to save the day, more often than not
by working as a team. And nowhere is this more evident than when
something unexpected happens. The team dealing with my late
wife’s ‘routine’ operation were very good; but when the routine
became the emergency they were not as prepared as they could
have been. Much of this book would have been completely new to
them.
For experienced crews we now routinely train both technical
skills and non -technical skills side by side. After all they are part of
everything we do, whether clinician or pilot. But to start, you need
to understand what it ’s all about. This book should be your guide
and window into a new realm of professionalism that, one day very
soon, will be seen as part of a clinician ’s essential skills.
Martin Bromiley
Chair, Clinical Human Factors Group
Airline Pilot
Husband of the late Elaine Bromiley
viii
Preface
The purpose of this book is to introduce readers to the study of
human factors and how these impact on patient safety and the
day-to-day practice of doctors, nurses and other health profession-
als. Our aims for readers are that they will acquire:
• an understanding of the contribution of training in human factors
on patient safety
• an awareness of how this might impact on practice in a variety
of settings
The study of human factors had its origins in extensive work by
the aviation industry to improve its safety profi le. They have
achieved this over the last 20 years by developing an understanding
of how complex systems fail, and used this information to alter their
protocols and behaviours in order to minimise these failures.
It was realised that the idiosyncrasies of interactions between
humans and between humans and their environment were at
the root of the majority of both suboptimal performance and,
indeed, major disasters. Furthermore and most importantly, it was
not technical competence in the crew that was triggering failure,
rather it was non -technical, human behaviours and psychology that
lay at the source of the problems which had appalling outcomes.
Although other complex, high- risk industries have seen and learned
from this work over the last two decades, it is only in the last 5
years that the healthcare sector has woken up to the importance
of human factors in achieving optimal patient safety. This short
book has been written to meet the needs of busy clinical profes-
sionals who, nevertheless, need to be exposed to some ideas beyond
medical science.
The medical and nursing professions are, by defi nition, scientifi c
in interests, orientation and preferred methods of building knowl-
edge. Accordingly, a research paradigm has grown up that claims
rigour and a clear scientifi c method. As Ben Goldacre ( 2008), a
doctor and journalist, writes:
. . . evidence - based medicine, the ultimate applied science, contains some
of the cleverest ideas from the past two centuries, it has saved millions of
lives . . .
ix
x Preface
In a more recent article, he goes further (Goldacre 2011):
We all know one atom of experience isn ’ t enough to spot a pattern; but
when you put lots of experiences together and process the data, you get
new knowledge.
These positions might be true in the laboratory or in statistical
analyses of very large data sets, but they do little to account for, or
explain, the single disastrous event that arises from an unfortunate
combination of circumstances. It is from an understanding of these
that the‘science’ of human factors has emerged. Accordingly, what
follows in this introduction to the study of human factors is based
on careful consideration of those single behaviours, in unfortunate
combination, in an effort to learn from them and avoid them in the
future. This book should provide the initial building blocks for
healthcare workers to understand the relationship human factors
have to patient safety and to heighten awareness of them in clinical
practice.
Aggregations of ideas have not always been thought of as a source
of‘truth’ and the 19th century author of E xtraordinary Popular Delu-
sions and the Madness of Crowds (Mackay 1 852/1995) wrote:
Of all the offspring of Time, Error is the most ancient, and is so old and
familiar an acquaintance, that Truth, when discovered, comes upon most
of us like an intruder, and meets the intruder ’ s welcome.
Early responses to the conclusions drawn by psychologists were
often sceptical and commentators continued to look for technical
causes for disasters, or, failing that, to look for individuals to blame.
More often than not, however, errors were the product of the
numbers of people and the variety of their roles and responsibili-
ties,converging problematically, as this report concludes (Flin e t al.
2008):
The NTSB (1973) attributed the crash to ‘ the failure of the crew to
monitor the fl ight instruments during the fi nal four minutes of the fl ight,
and to detect an unexpected descent soon enough to prevent impact with
the ground’ . Furthermore, the report commented on the ‘ preoccupation
with a malfunction of the nose landing gear position indicating system
[which] distracted the crew ’ s attention from the instruments and allowed
the descent to go unnoticed’ .
Preface xi
Human factors are not science, in the Goldacre sense of the word.
Its study, however, does give us some useable theory, and an appre-
ciation of this in the context of medical practice is what is being
sought here.
References
Flin,R.,O’Connor, P. &Crichton,M. (2 008)Safety at the Sharp End: A Guide
to Non - technical Skills.Ashgate Publishing, Aldershot, UK.
Goldacre,B. (2 008)Bad Science.Fourth Estate, London.
Goldacre, B. (2 011) The deeper the dataset, the better. The Guardian 11
June.
Mackay , C. (1 852/1995) Extraordinary Popular Delusions and the Madness of
Crowds.Wordsworth Editions, Ware, UK .
Peter - Marc Fortune
Mike Davis
Jacky Hanson
Barbara Phillips