1. Human Factors Awareness : The Foundations for compassionate safe care Professor Jane Reid 1 Compassionate safe Care

2. Focus Explore compassionate care in context and the emotional labour of caring Examine compassion and care as a shared right of the cared for and theircare givers Discuss how human factors awareness/understanding (Board/frontline) can build emotional and organisational resilience, to support staff in their care giving role Outline the recent work of the NQB to establish ways of integrating human factors understanding and application at scale in the NHS 2 Compassionate safe Care

3. 3 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 Catchpole 2010 Compassionate safe Care

4. 4 Care is our business Compassion Competence Communication Courage Commitment CNO focus on 6Cs for Nursing. …but can policy direct compassion and what of the rest of the workforce ? Compassionate safe Care

5. Compassion, or caring is nursings (healthcares) most precious asset (Schantz, 2007) a fundamental element of nursing/health care one of the strengths of the professions (Dietze and Orb, 2000) 5 Compassionate safe Care

6. Six essential elements of caring confidence competence compassion conscience commitment comportment (attitude) Roach (2002) 6 Compassionate safe Care

7. 7 Production science and systems engineering can enhance the way we organise care delivery but misused, misunderstood or cherry picked lean tools to contain cost vs driving continous quality patient experience can be catastrophic People are not widgets Compassionate safe Care

8. What is compassion? Empathy, respect, a recognition of the uniqueness of another individual, and the willingness to enter into a relationship in which the knowledge, intuitions, strengths, and emotions of the patient and the physician can be fully engaged Lowenstein (2008) A deep awareness of the suffering of another coupled with the wish to relieve it Chochinov (2007) 8 Compassionate safe Care

9. One of our challenges is that everyone will have their own personal, subjective definition Personal definitions fit in with our own view of the world, but may have little in common with the views of others. 9 Compassionate safe Care

10. 10 Compassionate safe care Compassion & Quality

11. Human Factors : shared mental models The perception of, understanding of or knowledge of a situation or process, that is shared among the team through communication Teams with shared mental models perform well Rouse et al 1992 Orsanu 1999 Mathieu et al 2000 Salas 2010 11 Compassionate safe Care

12. Compassion involves Generosity and kindness Valuing otherness Awareness and recognition (self and situation awareness) Honesty Dialogue 12 Compassionate and safe Care

13. 13 Compassionate and safe Care Self & Situation Awareness

14. compassionate care is more than the competent execution of clinical skills it involves a doing role and a being role. it is vital to patients that they are cared for and cared about (National Nursing Research Unit, 2008) 14 Compassionate and safe Care

15. Compassionate safe Care Expressive Caring = Compassionate Caring

16. Emotional Labour of Caring Compassion Fatigue 16 Compassionate and safe Care

17. Discussion Point Identify the factors that contribute to compassion fatigue and the potential to avoidable harm 17 Compassionate and safe Care

18. Organisational Factors Conditions of work Nature of the work Poor Design Lack of standardisation Flawed systems and processes Inability to give of ones best Staff Factors Experience Training and preparation Supervision Morale Mental and physical health Tiredness Distraction Multi-tasking Resilience 18 Crucial Board Conversations Factors that increase potential for error/harm/compassion fatigue

19. Discussion Point If we were designing a quality service would we advocate 12 hour shift patterns ? 19 Compassionate safe Care

20. Schwartz Center Rounds® 20 Compassionate safe Care The Point of Care Foundation Transforming the experience of healthcare for patients and staff The failings at Mid Staffordshire NHS Foundation trust were an extreme example of what can go wrong when there is a poor organisational culture. But seeing the person in the patient, and supporting staff in the difficult work of care, even when it is delivered on an industrial scale with tight resources and competing demands is always going to be a challenge. Director Jocelyn Cornwell

21. Strengthening compassionate quality care-giving Communicating commitment Acknowledging the challenges and the costs to our care givers Active visible leadership for safety and compassionate care Strengthening patients and relatives voice in the system Actively developing managers relational skills Investing in Human Factors awareness and understanding for the workforce 21 Compassionate safe care

22. Compassionate Care Requires 1) Nurture an Essential Mindset Not on my watch ! 2) Create the conditions for Action ( Empowerment) Choosing to act choosing to be counted ! 3) Foster Leadership commitment …………to the conditions/context and carer/care giver to make it easier to do the right thing Compassionate safe care

23. The synergies of Safety Science/Human Factors/ Nursing Theory Nursing Theory Being present The art of being therapeutic engagement Non-technical skills Self awareness Situation awareness System awareness 23 Compassionate safe Care

24. Recognise the contribution of non technical skills Compassionate safe Care

25. We engage with/respond to patients, relatives and our colleagues by serving committing (individually and corporately) advocating and challenging following through delivering Being Present and therapeutic engagement is about social, emotional, ethical, professional conscience? Compassionate safe Care

26. better performance under pressure (you're focused) improved listening and memory skills (you're "present-minded", not "absent-minded") better conflict resolution (you don't get emotionally 'triggered') awareness of system flaws and the organisational barriers to giving good care Performance benefits of being present/therapeutic engagement Compassionate and safe Care

27. more persistence and ability to learn (you are more patient and tolerant of difficulties) wiser, clearer decisions (you don't react out of habit) Performance benefits of being present/therapeutic engagement Compassionate and safe Care

28. 28 Maintain Identity: See who I am Compassionate safe Care

29. 29 Creating Communities: Connect with me Compassionate safe Care

30. 30 Share Decision Making: Involve me Compassionate safe Care

31. 31 Care is our business Compassion Competence Communication Courage Commitment Exercise What are you doing in your organisation to 1)integrate human factors awareness in all that you do ? 2)to build compassionate caring cultures ? Compassionate and safe Care HUMAN FACTORS

32. 32 There are two primary choices in life; to accept conditions as they exist or accept the responsibility for changing them Denis Waitley Compassionate safe care November 2013

33. 33 Concordat Signatories Care Quality Commission Department of Health Health Education England NHS England NHS Employers NHS Trust Development Authority Monitor National Institute for Health and Care Excellence General Medical Council HealthWatch England Nursing and Midwifery Council Public Health England Social Care Institute for Excellence NHS Leadership Academy NHS Litigation Authority The Parliamentary & Health Service Ombudsman for England Compassionate safe Care

34. 34 Commitment The NQB believes that a wider understanding of Human Factors principles and practices will contribute significantly to improving the quality of care for patients. will support the NHS to optimise leadership, systems and processes, design, education and training, regulation and quality assurance, to build a high preforming, resilient and efficient healthcare system will provide leadership and oversight for embedding Human Factors principles and practices at all levels of the system Compassionate safe care

35. 35 What is happening Compassionate safe care Developing expertise in human factors science and root cause analysis to help providers learn from Complaints through better understanding of why mistakes Happen Developing a safety and learning service and library of resources including human factors so that organisations can get to the heart of why claims occur and how they can be prevented in future Ensuring Human Factors approaches are embedded in all of its programmes and online materials and included in conversations with partners, participants and patients

36. 36 Acknowledgements The Concordat is the starting point For our ambitions to become a reality Human Factors principles and practices must inform all aspects of the healthcare system Not just about one thing, but multiple actions at multiple levels Commitment of organisations to embed in business as usual and when things go wrong/require investigation to maximise the potential of human factors Compassionate safe care

37. 37 It isnt rocket science !! Value and take care of staff Equip the front line with human factors awareness and understanding Encourage and reward leadership for safety/care/caring Role model professional behaviours Value communication at every level Identify and correct flawed systems Remember that little things make a big difference! Compassionate safe Care

39. Human Factors Awareness : The Foundations for compassionate safe care Professor Jane Reid 39 Compassionate safe Care