Finding common ground: Human factors, attitudes and behaviour in different NHS contexts

Dr Vivien Swanson Programme Director, Psychology Specialist Practice, Deirdre Holly, Michelle Clark, Lisa Sutherland NHS Education for Scotland

Human Factors for Quality Healthcare:The Way Ahead for Scotland March 19 2014

Quality Education for a Healthier Scotland

AIMS

•

Extend previous Human Factors (Non-technical skills) work (mainly surgical, hospital-based) to other NHS Scotland contexts

•

Using psychology, behaviour change theory to develop and evaluate interventions

•

Understand differences in Human Factors related to context

•

Develop a basis for future curricula for patient safety training

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HUMAN FACTORS… 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)

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Five studies : Five contexts: Five sets of HF behaviours?

• • • • • BASICS – remote and rural

resuscitation

training

SHINE – eSEA reporting

in primary care MUS – reducing GPs secondary care

referrals

to improve patient care MHPSP – human factors in

restraint

mental health in-patients TRAINEE hospital doctors and

hand hygiene

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Commonalities – human factors individual/team-based

• Common Human factors

Including……….

Personal : fatigue Cognitive, mental load, stress and Team : Communication, decision making, teamwork Context: gathering Situational awareness, information Quality Education for a Healthier Scotland

Commonalities: Using behavioural theory,(TPB)

• • • • • Attitudes Norms Self-efficacy Intentions The intention behaviour gap?

• • • Patey, Flin et al. WHO Patient Safety Curriculum Guide for Medical Schools: Implementation Study (2010) Wakefield et al, 2010 Health professionals patient safety behaviour ; Jenner et al. 2002. Explaining hand hygiene practice. Psychol health and med. Quality Education for a Healthier Scotland

TPB: Positive attitudes, norms and confidence predict intentions (BASICS, MUS, HH) ATTITUDES Perceived importance of communication during resuscitation (BASICS) SOCIAL NORMS Other doctors encourage me to refer (patient) for investigations (MEDICALLY UNEXPLAINED SYMPTOMS) CONFIDENCE Its easy for me to wash my hands before and after patient contact (HAND HYGIENE)

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Intention-behaviour gap…

“And I was trying to do several things at

once. And I did not do that very well. And certainly that is one thing when I thought about hand hygiene at the end of it that just went out the window. It basically never entered my head even though I had spent so long before that point washing my hands every time I went into a room, every time I left a room” (HH)

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And differences…

• • • •

Health professionals :

– Level of experience, seniority

Control (responsibility):

– Individual, group, system

Task : demands

– Frequency, (Routine, habit, one-off), implications, cognitive complexity

Context:

– Time, resources Quality Education for a Healthier Scotland

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BASICS : Mapping human factors onto BCTs (Motivation, Action, Prompts)

Human factors Elements Behaviour change technique Task management Team working Situation awareness Decision-making

  

Leadership Communication

              

Planning, preparing Prioritizing Coping with pressure Co-ordinating activities Exchanging information Supporting others Gathering information Recognizing, understanding Projecting, anticipating Identifying/considering options Balancing risks, options Implementing & reviewing Setting, maintaining standards Supporting others Coping with pressure Exchanging information Shared understanding Acting assertively Goal setting (A1) Time management (A19) Coping strategies (M14) Social support (M12) Social skills training (A27) Self-monitoring of behaviour (A3) Antecedents and consequences (A4) Coping strategies (M14) Goal review (A10) General problem solving (A22) Assertion training (M18) Goal setting (A1) Feedback (A5) Assertion training (M18) Information about behaviour (M10) Graded tasks (A11) Behavioural rehearsal (P11)

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Recommendations :

Generic and specific behaviour change techniques

• •

Further work to develop and evaluate training in Human Factors

–

Use taxonomy to MAP BCTs onto generic and specific human factors

– –

Test in different groups of health professionals For both novice and experienced groups Develop a curriculum for the service with standards (levels of competence) which could be assessed with both generic and specific elements

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“

Without this, human factors will be considered as a generic competence and fail to receive the attention that it rightly deserves or indeed be appreciated for what it is - a way to secure high standards of care, performance improvement as well as minimise risk and harm to patients.” Professor George Youngson

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