Human Factors Awareness : The Foundations for compassionate safe
care
Professor Jane Reid
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Compassionate safe Care
Focus
• Explore compassionate care in context and the emotional labour of caring
• Examine compassion and care as a shared right of the ‘cared for’ and their ‘care givers’
• Discuss how human factors awareness/understanding (Board/frontline) can build emotional and organisational resilience, to support staff in their care giving role
• Outline the recent work of the NQB to establish ways of integrating human factors understanding and application at scale in the NHS
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“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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Care is our
business
Compassion
Co
mp
etence
Communication
Courage
Co
mm
itm
ent
CNO focus on 6Cs for Nursing.
…but can policy direct compassion and what of the rest of the workforce ?
Compassionate safe Care
Compassion, or caring is “nursing’s (healthcare’s) most precious asset
(Schantz, 2007)
a fundamental element of nursing/health care one of the strengths of the professions
(Dietze and Orb, 2000)
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Six essential elements of caring
confidence competencecompassionconsciencecommitment comportment (attitude)
Roach (2002)6
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Production science and systems engineering can enhance the way we organise care delivery
but misused, misunderstood or cherry picked ‘lean’ tools to contain cost vs driving continous quality patient experience can be catastrophic
People are not widgets
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What is compassion?
• Empathy, respect, a recognition of the uniqueness of another individual, and the willingness to enter into a relationship in which the knowledge, intuitions, strengths, and emotions of the patient and the physician can be fully engaged
Lowenstein (2008)
• A deep awareness of the suffering of another
coupled with the wish to relieve it Chochinov (2007)
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One of our challenges
is that everyone
will have their own personal, subjective definition
Personal definitions fit in with our own view of the world, but may have little in common with the views of others.
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Compassion & Quality
Compassion & Quality
Compassion & Quality
Compassion & Quality
Human Factors : shared mental models
The perception of, understanding of orknowledge of a situation or process, that is shared among the team through communication
Teams with shared mental models perform well
Rouse et al 1992Orsanu 1999Mathieu et al 2000Salas 2010
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Compassion involves
Generosity and kindness
Valuing otherness
Awareness and recognition (self and situation awareness)
Honesty
Dialogue
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Self & Situation Awareness
compassionate care is more than the competent execution of clinical skills
it involves a “doing role” and a “being role”.
it is vital to patients that they are “cared for” and “cared about”
(National Nursing Research Unit, 2008)14
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Expressive Caring=
Compassionate Caring
Emotional Labour of Caring
Compassion Fatigue
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Discussion Point
Identify the factors that contribute to compassion fatigue and the potential to avoidable harm
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Organisational Factors
• Conditions of work • Nature of the work• Poor Design • Lack of standardisation• Flawed systems and
processes• Inability to give of one’s
best
Staff Factors
• Experience• Training and preparation• Supervision• Morale• Mental and physical health• Tiredness• Distraction• Multi-tasking• Resilience
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Crucial Board Conversations
Factors that increase potential for error/harm/compassion fatigue
Discussion Point
If we were designing a quality service would we advocate 12 hour shift patterns ?
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Schwartz Center Rounds®
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The Point of Care Foundation Transforming the experience of healthcare for patients and staff
“The failings at Mid Staffordshire NHS Foundation trust were an extreme example of what can go wrong when there is a poor organisational culture.
But seeing the person in the patient, and supporting staff in the difficult work of care, even when it is delivered on an industrial scale with tight resources and competing demands is always going to be a challenge”.
Director Jocelyn Cornwell
Strengthening compassionate quality care-giving
• Communicating commitment
• Acknowledging the challenges and the costs to our care givers
• Active visible leadership for safety and compassionate care
• Strengthening patients’ and relatives’ voice in the system
• Actively developing managers’ relational skills
• Investing in Human Factors awareness and understanding for the workforce
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Compassionate Care Requires
1) Nurture an Essential Mindset
Not on my watch !
2) Create the conditions for Action ( Empowerment)
Choosing to act choosing to be counted !
3) Foster Leadership commitment
…………to the conditions/context and carer/care giver
to make it easier to do the right thing
Compassionate safe care
The synergies of Safety Science/Human Factors/ Nursing Theory
Nursing Theory
Being ‘present’
The art of ‘being’
‘therapeutic engagement’
Non-technical skills
Self awareness
Situation awareness
System awareness
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Category Element
Task Management Planning and preparation
Prioritisation
Providing and maintaining standards
Identifying and utilising resources
Team Working Co-ordinates activities with team members Information exchange Use of authority and assertiveness Assessment of capabilities of team and self Supporting others
Situation Awareness Gathering information Understanding and recognition Anticipation
Self Awareness Recognition of the impact of self
Decision Making Identifying Balancing risks and selecting options Re-evaluation
Recognise the contribution of non technical skills
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We engage with/respond to patients, relatives and our colleagues by
• serving• committing (individually and corporately)• advocating and challenging• ‘following through’• delivering
Being Present and therapeutic engagement is about social, emotional, ethical, professional conscience?
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• better performance under pressure (you're focused)
• improved listening and memory skills (you're "present-minded", not "absent-minded")
• better conflict resolution (you don't get emotionally 'triggered')
• awareness of system flaws and the organisational barriers to giving good care
Performance benefits of being present/therapeutic engagement
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• more persistence and ability to learn (you are more patient and tolerant of difficulties)
• wiser, clearer decisions (you don't react out of habit)
Performance benefits of being present/therapeutic engagement
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Maintain Identity:
‘See who I am’
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Creating Communities:
‘Connect with me’
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Share Decision Making:
‘Involve me’
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Care is our
business
Compassion
Co
mp
etence
Communication
Courage
Co
mm
itm
entExercise
What are you doing in your organisation to
1) integrate human factors awareness in all that you do ?
2) to build compassionate caring cultures ?
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HUMAN FACTORS
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There are two primary choices in life;
to accept conditions as they exist or
accept the responsibility for changing
them
Denis Waitley
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November 2013
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Concordat Signatories
Care Quality Commission Department of Health
Health Education England NHS England NHS Employers NHS Trust Development Authority
Monitor National Institute for Health and Care Excellence
General Medical Council HealthWatch England
Nursing and Midwifery Council Public Health England
Social Care Institute for Excellence NHS Leadership Academy
NHS Litigation Authority
The Parliamentary & Health Service Ombudsman for England
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Commitment
The NQB
believes that a wider understanding of Human Factors principles and practices will contribute significantly to improving the quality of care for patients.
will support the NHS to optimise leadership, systems and processes, design, education and training, regulation and quality assurance, to build a high preforming, resilient and efficient healthcare system
will provide leadership and oversight for embedding Human Factors principles and practices at all levels of the system
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What is happening
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Developing expertise in human factors science and root cause analysis to help providers learn from Complaints through better understanding of why mistakesHappen
Developing a safety and learning service and library ofresources including human factors so that organisationscan get to the heart of why claims occur and how they canbe prevented in future
Ensuring Human Factors approaches are embedded in all of its programmes and online materials and included in conversations with partners, participants and patients
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Acknowledgements
The Concordat is the starting point
For our ambitions to become a reality Human Factors principles and practices mustinform all aspects of the healthcare system
Not just about one thing, but multiple actions at multiple levels
Commitment of organisations to embed in ‘business as usual’ and when things gowrong/require investigation to maximise the potential of human factors
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It isn’t rocket science !! • Value and take care of staff• Equip the front line with human factors
awareness and understanding• Encourage and reward leadership for
safety/care/caring• Role model professional behaviours• Value communication at every level• Identify and correct flawed systems• Remember that little things make a big
difference!
Compassionate safe Care
Compassionate safe Care
Human Factors Awareness : The Foundations for compassionate safe
care
Professor Jane Reid
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Compassionate safe Care