Thread by @MartinBromiley

For #WorldPatientSafetyDay myself & @PatrickWaterso1 have some thoughts about human factors & maternity. @PatrickWaterso1 is one of the @ClinicalHF Trustees & expert, he’ll be tweeting about systems, here I’ll share reflections about non-technical skills 1/

It’s #WorldPatientSafetyDay In maternity tragedies we hear “teamwork” is the issue. But what is teamwork? I’ve experienced excellent teamwork, learnt about it, trained it, examined others in it & been examined in it myself. But……. 2/

My late wife’s death was when teamwork went badly wrong. I’ve got it wrong myself in the past, every team & situation presents new challenges - but getting it right is priceless 3/

In my own profession we train teamwork by developing individual behaviours that allow you to work with any similarly trained colleagues. In healthcare the patient must be part of the team, they are critical to your SA 4/

My colleague @PatrickWaterso1 will be tweeting about systems & maternity, but one system you need for effective teamwork is SOP’s. SOP’s reduce variability of performance and cognitive workload, and……5/

SOP’s create more certainty and the triggers for intervention. They create a shared “mental model” for the team but they don’t cover everything. We need a set of behaviours that recognise, detect & manage or avoid threats and errors but….6/

You can’t expect to suddenly develop these behaviours overnight or during an unexpected emergency. They have to become habitual through daily use, the same behaviours that bring success in easier moments also do so in tough moments 7/

Following a landmark investigation in 1978 the NTSB coined the phrase “participative management”. The leader uses an inclusive, inquiring approach. It creates & maintains safety far better than depending on one expert ntsb.gov/investigations… 8/

Just because you’re an expert doesn’t mean you are right. Your perception and thinking isn’t perfect. A friend asked a Doctor how someone could raise something that the Doctor had got wrong. He replied “I can’t possibly imagine a situation where that would be relevant” 9/

Good teamwork uses the observations, perspectives and experience of the whole team to manage situations, but the starting point is the leader’s behaviour, they set the standard. Our guide to this is publicapps.caa.co.uk/docs/33/CAP%20… 10/

Early on @RhonaFlin @NOTSS_lab @ggyrach @spbsurgery @nikkimaran @KenCatchpole et al led work on these behaviours in healthcare, here’s an example of one great book on the topic…..11/

…..here’s a few more….12/

So what behaviours work? Start by setting the standard: “I need you to tell me if I’m doing something wrong”/“please shout if you’re unhappy or uncertain about what I’m doing”. If someone does speak up, thank them, even if in retrospect they were wrong (but are you sure?) 13/

Things can still be missed and people perhaps not speak, as leader your role is to use every brain, set of eyes and ears in the room. So use open questions from the start 14/

Eg “how would you approach this?”/“what just happened?”/“how should we deal with this?”/“what are you thinking?” 15/

As a leader you’ve probably already got a good plan. Wait, listen to others. When I use open Q’s it really helps, sometimes I end up with a different solution to my own, often it adds to my solution and makes the outcome better 16/

Just remember to shut up and listen. “What’s right not who” counts. Using Q’s is especially useful in a time critical situation, it gives you time to control your inner chimp to make sense of what’s happening 17/

If one of the Doctors in my late wife’s case had asked the team “what are we missing?” or “any ideas?” and looked at the most junior person in the room I suspect the outcome would’ve been different 18/

We can all fixate, it can be useful, but in a complex situation it can be deadly. Your team are the best counter to it if you let them. To quote a Doctor who experienced (by his own admission) fixation: “it never occurred to me that I could have made such a grave error” 19/

Confirmation bias is very dangerous, the right question is important, perhaps ask “why shouldn’t we do this?”/“what would be a better idea”/“what are the risks with what I’ve suggested”? 20/

As a team member, take a moment to consider such a question before answering. What would you do? Do you feel any discomfort? Share what’s in your mind. That “stupid doubt” has been the difference between life and death 21/

The behaviours mentioned in this thread are used in my profession to create safety. Context is important, but the context and evidence here is around human behaviour under pressure, which sadly, is often predictable. 22/

Use of these behaviours doesn’t guarantee success (or not using them failure). But they do increase the chance of success. The problem in healthcare safety isn’t speaking up, it’s people who think they have all the answers. Humility is never out of fashion 23/END