Human Factors for Enhanced Performance Dr Harriet Nicholls Associate Medical Director L&D NHSFT Miss Manjula Samyraju Consultant Obstetrician, Peterborough NHSFT

Human Factors definition Human factors encompasses all of those factors that can influence people and their behaviour. In a work context, human factors are the environmental, organisational and job factors and individual characteristics which influence behaviour at work. Clinical Human Factors Group. 2009 Carayon et al., 2006

Maternity L&D 2008 -2010 Growing awareness Raising awareness Living it Use of risk management cases Complaints Maternal death Talks L1 – Influencing for followers is time well spent

Programme design Immersion event L2 Human Factors training day Human Factors principles Simulation Non technical skills Train the multi-disciplinary trainers Multi-disciplinary steering group Implementation of team based practices Evaluation

Team based practices Briefings De-briefings Closing the loop SBAR L3 – different contexts are ripe for different solutions PDSA Measuring compliance Measuring quality

Cultural Survey Results for Delivery Suite

Sustaining / lessons learnt Introduced PROMPT and blended HF into it Change requires regular fuel injection Surface work is not the whole story Leaders who walk the talk Continual audit by direct observation Cultural health checks L4 – coaching and mentoring for change leaders L5 – prophylaxis is always better than treatment

Spread EAHSN funding Client Peterborough NHSFT Process similar Coaching added Alterations to training

Why did we start this? - Background Action being undertaken to address increasing incident rate of PPH Different Units are using different thresholds for reporting PPH with many hospitals using 1.5L and 2.5L All units confirmed that “red flag” limits on maternity dashboard set at 2% for PPH >2L and 8% for PPH>1 5.2% 7.9% 7.2% 8.7% 4.4% 5.7% 6.5% 5.6% 8.3% 9.0% 8.4% 4.9% 1.4% 1.0% 0.9% 1.5% 0.7% 1.2% 2.1% 2.0% 0.3% 1.3%

PPH working group Claire Petz Theresa Mccarthy Kerri Bennett Manjula Samyraju PROMPT trainers

Depends on who is on call Morning labour ward handovers SBAR is not utilised Depends on who is on call

2012 2013 2014 7.4% 0.9% 0.8% 1.2% % of women with PPH >1000 - 1999 5.2% 2.9% 9.2% 7.0% 5.8% 5.7% 6.2% 6.3% 6.1% 6.7% 1000 - 1999: Target is <5% 4.9% % of women with PPH >=2000 1.4% 1.2% 0.6% 1.0% 0.9% 1.5% 1.3% 1.7% 2000: Target is <=1%) 5.2% 7.9% 7.2% 8.7% 4.4% 5.7% 6.5% 5.6% 8.3% 9.0% 8.4% 4.9% 1.4% 1.0% 0.9% 1.5% 0.7% 1.2% 2.1% 2.0% 0.3% 1.3% 2012 5.3% 7.6% 7.2% 6.3% 8.6% 6.0% 7.5% 6.5% 6.8% 5.6% 7.1% 6.2% 4.9% 1.4% 1.6% 0.5% 0.8% 2.1% 1.0% 1.2% 1.5% 1.8% 2013 6.0% 7.5% 7.3% 7.6% 6.8% 5.4% 4.8% 5.7% 3.7% 7.4% 4.9% 1.7% 0.3% 0.5% 1.4% 1.0% 1.6% 2.3% 0.9% 0.8% 1.2% 2014

Human Factors for Cultural change A vision of teamwork Raising awareness Goal setting Measurement Training options Coaching Maternity L&D ED L &D Maternity Peterborough Hospital wide L&D Mental Health; safer care pathways