Next steps Bryn Baxendale bryn.baxendale@nuh.nhs.uk @gasmanbax - - PowerPoint PPT Presentation

Next steps

Bryn Baxendale

bryn.baxendale@nuh.nhs.uk @gasmanbax

How could, and should, Human Factors/Ergonomics be implemented in Health & Social Care?

How could, and should, Human Factors /Ergonomics be implemented in healthcare?

White Paper

October 2018

• Provides the authoritative

guide to aid understanding of how Human Factors can and should be used

• Clarifies the competence and experience

needed to manage effort, solve problems and make decisions

Vision for HF in Health & Social Care

• Promote the integration of HF to optimise human

(patients and staff) well-being and overall system performance

• Build and strengthen the relationship between CIEHF and

health / social care professional bodies, commissioners (care / education), policy forming bodies and regulators

• Create pathways for building HF capability and capacity

within health / social care in alignment with existing professional development pathways

Understanding how to use Human Factors

To investigate incidents

• HF approach takes a wider view to encompass

root causes such as poor product design

To think about systems

• HF may focus on optimisation of a micro-system, but

there will be clear mapping of the relationship of the micro-system with the larger systems

To think about design

• HF is relevant to all stages of the life-cycle from early

stages of planning and design, right through to implementation and evaluation

Simple framework to start problem solving/discussion

WHO WHAT WHEN WHERE HOW WHY

Scope of issue/challenge/problem Define stakeholders Participatory Ergonomics, Inclusive Design Physical factors Anthropometry, Biomechanics, Postural Analysis, Vision, Hearing, Thermal comfort Cognitive factors Mental models, Individual decision making, Variability, Human-Computer Interaction , Navigation (unfamiliar environments) Organisational factors Hierarchies (professional, employer and staff-patient relationships) , Team stability, Decision making (authority, accountability, responsibility, delegation) Investigate/explore HFE methods

Component Size Mismatch in Total Hip Arthroplasty: Surgical Never Event

HSIB report 2018

Work-as-Done: Hierarchical Task Analysis

Observing practice

Evaluation of the packaging for implants from 4 manufacturers

• Inconsistencies in the sizes of the text for the component sizes

• https://bit.ly/2KbW1wm

Pharmaceutical Ergonomics & Human Factors Group

Promoting a more explicit use of HF to support:

• Product design
• Systems design and performance (case studies)
• Enhanced research and innovation methods

Based on building a diverse and better informed multidisciplinary community

Multiple pharmaceutical stakeholders in UK How do we work together? Who is the regulator?

Patient

Regulators

Professional:. GPC, GMC, GDC, HCPC, NMC Industrial: MHRA, ABPI, (FDA), ISO, CIOMS

Buyers

OTC*/Trial NHS/NICE Insurance Trial (funders)

Dispensing

Industry

(Pharmaceutical & Biotech) Manufacturing (industry and hospital-level) Safety Information Promotion R&D

Establishing the value for Human Factors in Health and Social Care

McNeish/Newell (Dstl, 2016)

Understanding the wider value of HF for healthcare

People’s Value

• Service user

experience

• Care
• utcomes
• Wellbeing

and positive experiences at work

• Culture and

perception about care delivery Allocative value

• Increased

performance and efficiency (productivity)

• Reducing

waste in the system

• Eliminate

fragmentation and duplication Technical value

• Clinical
• utcomes/

targets

• Safety of care
• Quality of

care

• Reducing

inappropriate care Economic value

• Upfront costs
• Long term

costs (sustainable finances)

• Allocative,

technical and people’s value directly impact economic value

Case studies

‘Performing Well, Feeling Well’ Taking forward Human Factors & Ergonomics (HFE) Integration in NHS Scotland Building CAPACITY and CAPABILITY

Dr Paul Bowie Programme Director (Safety & Improvement) NHS Education for Scotland Paul.Bowie@nes.scot.nhs.uk Twitter @Pbnes

National HFE Development Work in Scotland

• 150+ clinicians; leaders; managers; educators; risk, safety and

improvement advisers; academics; Human Factors specialists/advisers, safety researchers etc

• NHS Boards, Royal Colleges and

Professional Bodies, Higher Education Institutions etc.

• Represent simulation, NTS,

team training, clinical skills, patient safety, risk, QI, governance, occupational health, clinical, management, medical device, policy communities

• Four Workshops (2017-18)

Progress – Agreed Priority Areas for HFE Integration

1. Creation of a National HFE Advisory Board 2. Building Workforce Capability and Capacity 3. Learning from Events 4. Integration of HFE Principles in National Procurement and in Design of Workplaces and Care Buildings 5. Integration of HFE Design Principles with National Programmes and Initiatives – Integrated R&D/Evaluation agenda

Vision for Building Capacity & Capability

• Integration of HFE principles and methods:

– undergraduate teaching and postgraduate training – appraisal and CPD – simulation / NTS / clinical skills / team training – national safety and improvement programmes (e.g. SPSP) – organisational induction processes – CPD arrangements for NHS Board Members/Strategic Decision-makers – bespoke workforce education inc. managers, leaders & executives

• Minimum 1 Qualified HFE Practitioner at NHS Board level
• Explore CIEHF Technical/Associate Membership for key target NHS

staff groups (e.g. Risk/Safety/Improvement)

Example – How HFE Could be Integrated in Postgraduate Curricula

Progress in Building C & C

HFE Integration in Learning from Events

1. National / Organisational Policies on Learning from Events 2. Significant Event Analysis in Primary Care 3. Hospital Safety Reviews (Mortality & Morbidity Meetings) 4. Human Factors in Barrier Management 5. Systems Thinking for Everyday Work (STEW)

New Chair of NHS Education for Scotland

‘Slow down and take you time to get it right’

• HFE awareness, very supportive and ‘on board’ – will take to all national

leadership networks and Scottish Government (SG)

• Going straight to SG – tricky at moment
• Prepare the ground - short Briefing Paper (‘essential facts’), slick

presentations, informal chats with key stakeholders

• Align with all major Government strategies – health AND care; stress

multi-professional approach

• Continue with multi incremental approach e.g. NES funding for each

Board to get HFE qualified individual / building consensus with educators

• Advisory Body – good idea but caveats/governance issues
• Strategic plan – why, how, who, cost benefits, outcomes: take time to get

this right, may take further resource

Building Capacity & Competency Hard Truths and Next Steps

HARD TRUTHS

• Scratched the surface but good progress
• Regrouping and rethinking our approach
• QI is King
• Significant misunderstandings and confusion prevails
• Taking a ‘hard line’ can ‘work’
• HFE initial strategy is to ‘add value’

1 2 3 4 5 6

SIMULATION BASED EDUCATION Challenges

UNMEASURED

Minimal studies measuring clinical

• utcomes

1

MYTH / REAL

Lack of understanding of “how “ and why

2

POOR CAPTURE

Limited data on

• perational / cost

effectiveness

3

UNEXPLORED

Lack of an overarching approach to patient safety

6

NON STANDARD

Failure to adopt best practice in SBE design /delivery

5

UNPROVEN

Minimal studies linking SBE and clinical outcomes

4

Bergh A-M, Baloyi S, Pattinson RC. Best Pract Res Clin Obstet Gynaecol 2015. Mcgaghie, W.C. Issenberg, SB Petrusa, E R Scalese, RJ. Medical Education,2016

Accreditation Benefits

People

• focuses on needs
• identifies areas for improvement
• builds stronger trainers and

workforce Performance

• assess performance
• reward achievement
• drive improvement

Profile

• raises awareness
• builds confidence
• promotes credibility with governing

bodies and public. Partnerships

• joined up thinking
• joint working

Planning

• forward planning
• formalising procedures and policies
• projecting for future growth and

direction. Patient

• safer care
• effective processes

Accreditation standards provide a common quality language and common set of expectations to point the way forward.

Joint Commission International

We cannot continue to educate 21st century doctors using 19th century technologies

McGaghie et al ,2014

Our mission is to promote, and support simulation-based education in the pursuit of best practice for our patient, learners and members.

Developing resilience in a complex, resource constrained workplace

4th – 6th November 2019

10th Anniversary