1. Human Factors: Patient Safety Specialty Lead| NIHR CRN WM
& much more…
Dr Larissa Kerecuk
Rare Disease Lead for BCH
Renal Research and Transition Lead
Consultant Paediatric Nephrologist
@BCH_Rare
Specialty Lead| NIHR CRN WM

2. Terema and Birmingham Children's Hospital
Basingstoke Prizewinners
Human Performance and Limitations
A pervasive mind-set: The vulnerability of the human condition and the realisation that even outstanding clinical knowledge and skill may not be enough to deliver safety
We have to deal with people as they are – rather than as we would like them to be.
We have to accept that human performance is variable
We have to accept that we are programmed to learn by trial and error so human error is a fact of life
We have a responsibility to manage that variability and propensity to error even though we will not be able to overcome them.
Spring 2014

3. Human Performance and Limitations

4. Terema and Birmingham Children's Hospital
Behavioural Human Factors and Teamskills
Human Factor Topics
Situation
Awareness
Situation
Awareness
Leadership Followership
and
Motivation
Risk
Management
Safety
Feedback
Communication
Communication
Choosing Behaviour
Choosing
Behaviour
Spring 2014

5. Human Factor Principles
Error is normal
Performance is variable
System and Process interact with People and Culture
System and Process
People and Culture

6. Terema and Birmingham Children's Hospital
Behavioural Human Factors and Teamskills
The Error Chain
Safe
Unsafe
A combination of events, circumstance, activities and decisions which lead to an unsafe outcome
Spring 2014

7. Terema and Birmingham Children's Hospital
Behavioural Human Factors and Teamskills
‘No system is foolproof to a sufficiently inventive fool’
(Mark Twain)
The Vulnerable Human
We have to deal with people as they are – rather than as we would like them to be.
We have to accept that human performance is variable
We have to accept that we are programmed to learn by trial and error so human error is a fact of life
We have a responsibility to manage that variability and propensity to error even though we will not be able to overcome them.
Human Performance and Limitations
Spring 2014

8. Terema and Birmingham Children's Hospital
March 2011 for Basingstoke
Arousal
Performance
Personal
Best ZZ ZZ Z
In everyday life all things that we experience provide stimulation whether work related or domestic. We have an assumption that the more arousing things are the better we get. There is a linear progression between the level of stimulation and our performance. The problem is that this only goes so far because we peak and become so stimulated that we experience what pilots refer to as droop. At this point we become incompetent and our judgment goes. Z
Workload
© Terema Ltd 2007
Spring 2014

9. Terema and Birmingham Children's Hospital
March 2011 for Basingstoke
Arousal
Performance
Danger
In everyday life all things that we experience provide stimulation whether work related or domestic. We have an assumption that the more arousing things are the better we get. There is a linear progression between the level of stimulation and our performance. The problem is that this only goes so far because we peak and become so stimulated that we experience what pilots refer to as droop. At this point we become incompetent and our judgment goes.
Workload
© Terema Ltd 2007
Spring 2014

10. Arousal
Performance
Personal
Best
Workload

11. Arousal Physiology Psyche Interpersonal Performance Environment
Technology
Arousal
Performance
Workload

12. Terema and Birmingham Children's Hospital
Behavioural Human Factors and Teamskills
NASA / UT Teamskills
Briefing
The effective briefing will be operationally thorough, interesting and will address co-ordination, planning and potential problems.
Leadership / Followership /
Concern for the Task
The extent to which appropriate leadership and followership are practiced..
Communication and Decision
Reflects the extent to which free and open communication is practiced. Active participation in decisions encouraged.
Interpersonal Relationships / Group Climate
Reflects the quality of relationships among the team, the overall climate in the workplace
Team Self Feedback
The extent to which a team recognises the need to give and receive feedback.
Preparation / Planning / Vigilance
Reflects the extent to which teams plan ahead, maintain situation awareness and anticipate contingencies.
Enquiry / Advocacy / Assertion
Team members advocate, with appropriate persistence, the course of action they feel is best, even if it involves disagreement.
Workload / Distractions
This is a rating of time and workload management. It reflects how the team distributes tasks, avoids overload and distractions.
Spring 2014

13. Terema and Birmingham Children's Hospital
Behavioural Human Factors and Teamskills
Situation Awareness
Making sense... (1.Take in information) (2. Make decisions……)
Situation awareness is a process of making sense
Having taken in information (really data) you make decisions on the basis of your interpretation of that data
Spring 2014

14. The Mental Model

15. Brainwork

17. Professional Communication
Handover
(Continuity of Care)
Call For Help
Briefing
(Sharing Mental Models)

18. THE SPOKEN WORD
Social
Professional
Crisis
Jargon

19. Terema and Birmingham Children's Hospital
Behavioural Human Factors and Teamskills
ATTENTION
Transmission
Listening
Listening
Formulating
Response
We listen in chunks just like sleep.
Listening is a conscious function, not a passive. It requires a lot of mental resources to be an effective listener. It requires the listener to actively enquire and respond, confirming to the transmitter that the message has been received and understood.
It is difficult to listen effectively;
we speak at 125 words per minute and have the capability to listen at 900 words per minute. Consequently our brains spends it’s spare time, when listening, in anticipation as to what will come next, wandering and debating. These are not conducive to effective listening
So we should genuinely want to understand the transmitter’s perception, while retaining sensitivity to their thoughts and feelings.
Evaluating
Reflecting
Decreasing
Attention
Challenging or Unwelcome News
Time
Spring 2014

20. Mehrabian % weight of message Words used 7% Body Language 55%
Tone used
38%
% weight of message

21. One Brain - The effect of Stress and Workload
Demands
to Think
Out of Control
Limit of Capacity
In Control
Demands to Act
Amalberti

22. The Bucket

23. Elaine Bromiley video

24. Thank you very much