Nathalie Delaney, Improvement Lead in our Patient Safety team, shares her experiences of trying to explain what she does at work and, trickier still, what on earth is human factors…
“So, what do you do?” It’s the question we all get asked at parties.
Explaining Academic Health Science Networks is hard enough to people inside the NHS so I usually go with: “I work for the NHS,” as my opening line. Generally in my social circle there’s a one-in-four chance that I’m speaking to a fellow NHSian so we move onto “Where do you work?” and try and figure out people we both know.
“As a nurse?”
This is the usual follow-up question the other three times. Not sure why people’s minds jump to this conclusion – there are hundreds of job roles in the NHS, all working as part of the team. (If you want to take a test to find out what role you are suited for, Step into the NHS is great fun.) Anyway, I go on to explain that I work in projects in the patient safety team to get us on more familiar ground.
“Ok, what are you working on at the moment?”
So I explain I’ve been working with community providers in the region on training staff in human factors, and we’re now expanding this into GP practices and giving talks as part of the local maternity network too.
“Human factors? What’s that?”
Now human factors is a difficult topic to define, I usually start my sessions with a prompt question – “What makes your working day easier or harder?” and from there gather a variety of human factors that can affect us, ranging from physical things (like being hungry or tired), emotional things (stressful situations), the environment and design of our kit (frustration with computers is a really common issue people raise). But essentially my cocktail party definition is that “human factors are what mean we can’t be replaced by robots – but also mean that we are fallible and can make mistakes.” Sometimes I’ll give a few examples of human factors in practice.
“Surely that’s just common sense… the NHS needs people to train them in this?!”
Well, yes and no. A lot of human factors are common sense, but often our systems are designed for people who think like robots, rather than individuals with all our quirks and eccentricities.
For example, we all know what we need to do to keep healthy, but who can honestly say they do exercise for 30 minutes, drink eight glasses of water, eat five pieces of fruit and get enough sleep every day? (Maybe that is you, in which case, well done and keep going!) An awareness of human factors can help you notice where you might be at risk of making an error, or why the design of a task is frustrating you, and from there you can start to change it.
Recently the University Hospitals of Leicester launched an excellent series of videos was raising awareness of human factors in maternity care, “The Little Voice Inside”, and the original human factors video “Just a Routine Operation” still has much to teach us today.
“I don’t agree with this – if someone makes an error then they just need to be trained to do the right thing next time.”
That’s the old way of thinking, and the NHS has made a massive culture change over the last decade or so to turn this around into understanding that often it is the system around people that creates the conditions for error. The old way of thinking is about giving people remedial training, or even worse, putting signs on everything. Because, of course, that works…
As an aside, I love spotting signs that people have added onto things. Usually it is because of some previous behaviour that they want to change or poor design (as in the image at the top of this post). Signs are a really good way of finding where your system can be improved. I also like to spot “emotionally intelligent” signs which use an understanding of human factors to get a better result.
Another question I ask participants is, “What workarounds do you use at work to get things done?”
“Ok, so you just systemise everything and then it will be fine.”
Well, if we could do that, then we could replace everyone with robots. And as I’ve explained, frustration with technology is a big issue for people, so I don’t think it’s the best solution at the moment (although my colleagues in the Enterprise team may have a better idea about the future of technology – I’ve heard intriguing things about robot trousers being developed at the University of Bristol).
And actually the special thing about healthcare is the human connection – the compassion of staff caring for patients and each other. As Helen Bevan tweeted the other day, “Kindness is a superpower.” Human factors is about the people within the system too, and there are some brilliant movements in the NHS which are appreciating this, starting with Kate Granger’s #hellomynameis campaign, Sign Up To Safety, Civility Saves Lives, and the Circle of Care video.
Organisations are starting to move away from focusing on safety by avoiding harm to looking at excellent practice and where we can learn from what goes well too, for example Learning from Excellence, which our colleagues at the West Midlands AHSN helped to develop and which won an HSJ Patient Safety award in 2017 or the #MatExp movement (read this great blog post from Florence Wilcock).
As Suzette Woodward has said, it is about “noticing, understanding and learning from small moments of organisational life.”
“This all sounds very fluffy. Where’s the evidence?”
The two best sources are the Clinical Human Factors Group and the Chartered Institute of Ergonomics and Human Factors who have lots of case studies, resources and research evidence on their websites. It’s an academic subject; some people do PhD studies in human factors, and I don’t claim to be an academic expert – only as lived experience in being human and not a robot. Bleep bloop!
For more information on our human factors project, including a step-by-step guide to implementing in your own organisation, please visit www.weahsn.net/human-factors.