finding common ground: human factors, attitudes and behaviour in different nhs contexts

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


• 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


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)


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


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


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.


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)


“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…


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


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)


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


“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

finding common ground: human factors, attitudes and behaviour in different nhs contexts

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