Human Factors, should we be considering these more?

On Tuesday I travelled to a Royal Society of Medicine event in London to attend a very interesting CPD day. This day was titled ‘Human Factors in Patient Safety: Comparative lessons from human and animal healthcare’ It was joint collaboration between Vet Led, Med Led and the RSM.

What would be your first thoughts if you saw this as a course title?

I’ll let you know mine, the unedited version. I thought it would be about what humans do wrong that result in errors and how to avoid them. How wrong I was! It was so much more than this and I don’t want to sound clichéd, but it was truly inspiring and thought provoking. I have a list as long as my arm of points to talk about to Senior management. Plus, I think I drove everyone mad yesterday talking about it.

Here’s what I’ve learnt and why I think as a profession we have a lot of catching up to do.

What are Human Factors?

The first speaker that really fascinated me was Dr John Pickles, a trustee of the Clinical Human Factors Group (CHFG) He was so eloquent and had such an aura of confidence about him I was completely drawn in. Responsible for implementing safety checklists across the NHS I found the ‘Time out’ and briefing concepts intriguing. We use checklists where I work but the concept of a briefing before each procedure was slightly mind boggling. It makes total sense, when question as to how he ensured it was done he simply explained it was targeted at the surgeons and then once they were on board it was a lot easier. If a member of the team was not present, then the briefing would be repeated.

He explained how with all the best will in the world there will always be the human factor in any task. No matter how well you teach a clinical skill you cannot account for human ingenuity to a situation. One story was about an enteral feeding solution that was packaged in a special syringe, that would only fit into to the correct feeding tube. A member of staff had decanted the solution into another syringe in order to administer it intravenously!

After this discussion he highlighted that in order to maximise human well-being and have optimised function of the system we must have an understanding of the interaction amongst humans and the other elements. Within human factors there are many other points, mainly cognitive. These would include teamwork, situation awareness, communication, self-awareness and leadership. Skills that although will often develop with time should also be taught. Rather than people learning as they go should there be the imbedding of these within training.

Should we be embedding this into teaching?

As a profession the healthcare industry and the veterinary industry are moving away from the thoughts that success is based on the individual. Rather, success and clinical excellence are a result of a team effort. Therefore team work and communication skills are just as important as the clinical skill.

Many of us know of the ‘Communication module’ in the veterinary nursing syllabus but how many of us actually consider this to have an impact on the task and the end result? A full discussion of Human Factors is beyond the scope of this blog and also me. I am no expert. There are so many resources out there, these are aimed at the human medical industry but most of them are transferable. The charity Clinical Human Factors Group has many resources on their website and is well worth having a look.

What about human factors and our patients?

Prof Liz Mossop then gave us a brief summary of how much the veterinary industry has progressed. Indeed, when it was all put out in a relatively short timeline it truly is remarkable. Where we fall down is the lack of data, we have so many papers about clinical procedures but minimal evidence for patient safety. As Edwards Deming is quoted with saying, without data you’re just another person with an opinion. We are moving to an Evidence Based Culture though which is exciting. The Practice Standards Scheme (PSS) is also a huge step to ensuring the standards are consistent across the country.

A major flaw in this system though is the fact is it not compulsory. Whereas the NHS is extremely regulated and mandated the Veterinary Industry seems to have a lack of regulation. Now I don’t mean that people are doing castrates on conscious animals etc but more that there seems to be a lack of standardisation. In my mind the PSS should be mandatory, would you go and visit a ‘back street doctor’, probably not. Again, I am not implying that non-PSS inspected practices are poor practices or operating below correct clinical standards. Some may be but I suspect the most are not. So, is it a question of time or paperwork that stops them partaking? Is there a need for a consultancy service?

Human Factors: What next?

In my time teaching I had student nurses who were registered with the RCVS and abiding by the code of conduct with non-qualified head nurses. Personnel who had been doing it for a while and had never formally qualified, who is checking this?

Back to the case in point, yes, we have progressed at an astonishing speed, but we still have a fair way to go and must not get complacent. The fact that Vet Led, Med Led the RSM and other industry professional collaborated to deliver an excellent day is hugely encouraging.

Catherine Oxtoby spoke about the role the VDS Vetsafe has within identifying where these errors are occurring. Also, the role it plays in generating the data that is currently missing for us an industry. There is a huge amount of work to do in order to create a culture of reporting, reflecting and refreshing what we do. Vetsafe, I am sure, will play a pivotal role in this and it’s something I actively partake in and also look forward to seeing evolving. If your practices haven’t signed up, then I would urge you to do so.

Suzette Woodward

Suzette Woodward was another one I could have sat and listened to all day. A former paediatric intensive care nurse who now has the role of National Clinical Director for Sign up to Safety. Suzette resonated with me so much. She had been involved in the league tables and reflected on the effect that had on staff members within those practice. A highly personable person who was passionate about creating a caring culture in the workplace. She also shared some interesting stats, did you know that people are 43% more productive when they feel valued?

This takes so much more than sending a ‘well done’ email. It’s about how we work, it’s asking if that person is ok, it’s about ensuring the leadership is there and simply being kind. Yes, a thank you goes a long way but it’s also about creating the correct culture in the workplace. Someone on Instagram shared a picture to celebrate Nurse awareness week. In one box was lots of pizza and the text ‘day staff’. Next to it was a box with only 1 slice and some crusts, this had the text ‘night staff’. How would that make the night staff feel? How would that make you feel if you were the night staff?

Crucially she also pointed out that an act of kindness may also include finding a job role that actually suited a person if their current one did not.

Take home message

A favourite quote for me was that people do not come to work with the intention to make a mistake. This really made me stop think. Consider how you react, consider what you do when someone makes a mistake? I know I will be more mindful of this moving forward. Understanding Human Factors can only improve things in the veterinary industry. Both for our patients, ourselves and the team we work in.

1 thought on “Human Factors, should we be considering these more?”

  1. Hi Samantha,

    I have just come across your blog, thank you so much for taking the time to write this. I am really glad you enjoyed the conference and that Human Factors interests you.

    We really enjoyed putting it together and we are actually in the process of planning another next year focused on Human Factors in Veterinary practice.

    I would be very happy to discuss the topic further if you would be interested.

    Best regards,

    Dan Tipney

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