Quality Education for a Healthier Scotland
Finding common ground: Human factors, attitudes and
behaviour in different NHS contextsDr 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
• 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
AIMSAIMS
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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)
Quality Education for a Healthier Scotland
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
Including……….Personal : Cognitive, mental load, stress and fatigueTeam : Communication, decision making, teamworkContext: Situational awareness, information gathering
• Common Human factors
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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.
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TPB: Positive attitudes, norms and confidence predict intentions
(BASICS, MUS, HH)
ATTITUDESPerceived importance of communication during resuscitation
(BASICS)
ATTITUDESPerceived importance of communication during resuscitation
(BASICS)
SOCIAL NORMSOther doctors encourage me to refer (patient) for investigations
(MEDICALLY UNEXPLAINED SYMPTOMS)
SOCIAL NORMSOther doctors encourage me to refer (patient) for investigations
(MEDICALLY UNEXPLAINED SYMPTOMS)
CONFIDENCEIts easy for me to wash my hands before and after patient contact
(HAND HYGIENE)
CONFIDENCEIts easy for me to wash my hands before and after patient contact
(HAND HYGIENE)
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“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)
Intention-behaviour gap…
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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
Quality Education for a Healthier Scotland
Human
factors
Elements
Behaviour change technique
Task
management
Planning, preparing Prioritizing Coping with pressure
Goal setting (A1)Time management (A19)Coping strategies (M14)
Team working Co-ordinating activities Exchanging information Supporting others
Social support (M12) Social skills training (A27)
Situation awareness
Gathering information Recognizing, understanding Projecting, anticipating
Self-monitoring of behaviour (A3)Antecedents and consequences (A4)Coping strategies (M14)
Decision-
making
Identifying/considering options Balancing risks, options Implementing & reviewing
Goal review (A10)General problem solving (A22)Assertion training (M18)
Leadership Setting, maintaining standards Supporting others Coping with pressure
Goal setting (A1)Feedback (A5)Assertion training (M18)
Communicatio
n
Exchanging information Shared understanding Acting assertively
Information about behaviour (M10)Graded tasks (A11)Behavioural rehearsal (P11)
BASICS : Mapping human factors onto BCTs (Motivation, Action, Prompts)
BASICS : Mapping human factors onto BCTs (Motivation, Action, Prompts)
Quality Education for a Healthier Scotland
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
Quality Education for a Healthier Scotland
“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