The road to a national strategy for human factors: Part 1 - openness and transparency

In March this year Helen Hughes, Chief Operating Officer of the Parliamentary and Health Service Ombudsman, was seconded to NHS England to review the progress being made in embedding human factors, especially in the light of the National Quality Board Concordat.

Helen has made incredible progress already, building on the work of Professor Jane Reid over the last three years with the National Quality Board and Department of Health Human Factors Reference Group. Helen’s first task was to establish what’s going on around health care regarding human factors, a task which Clinical Human Factors Group (CHFG) members and others in the system helped with.

In the last few months, using ideas from the many passionate clinicians, academics, policy makers and managers that make up the CHFG, Helen has made great strides in outlining a plan to help the NHS grasp human factors.

The problem, as Helen sees it, is that whilst other industries such as rail, nuclear and construction have made great strides in safety, health care has barely moved forward. Initiatives seem to lack sustainability. The following quotes are from a draft paper Helen and colleagues (including myself) produced:

‘There is little appetite or evidence for thorough investigations that identify all the “causal” factors, with “tokenism”, “defensiveness” and “cover-up” rife across the NHS.’

‘There is no organisation that has the expertise or capacity to identify or share good practice across the NHS...wheels are continually being reinvented across the system.’

‘Progress in safety performance is despite the system, not because of it.’

What followed was a lovely example of ‘openness and transparency’. Instead of writing a paper and keeping it confidential, Helen chose to share it widely, both within and outside the service. And Helen asked an open question:

‘What do you think?’

Helen had included a proposal about establishing a nationally led body, and it’ll come as no surprise to learn that the idea provoked some considerable dissent. To quote one clinician: ‘I think a national centre is a mistake. I think we need a distributive model of education. I would welcome initiatives of regulation with regards to equipment and standardisation but please, please do not stifle what is happening.’

So what did Helen do? She stopped and listened. The challenge is that a big system often benefits from doing things on a large, centralised scale; but the expertise, passion and the ‘how’ is often better applied locally and thoughtfully. So how can the NHS (and I mean covering the whole of the UK, not just England) support the front line, provide resources and capacity, yet avoid the old centralist habits that achieve little?

Ideas have since morphed into developing a national knowledge network, with resources signposted and some expertise funded centrally to support the frontline users, with most expertise drawn from around the UK. As I speak, Helen is discussing these ideas with people around the NHS, and I will be sharing details in parts 2 and 3 of this blog.

I myself have been following Helen’s example. Earlier this year the CHFG (which I chair) decided to introduce a membership subscription – the group up until then had been free to belong to. The trustees and myself had debated it, taken some well qualified advice, and finally emailed a few close friends for their thoughts. I thought it might help to refine our ideas, so I asked an open question:

‘What do you think?’

What I got back was an unexpected and emphatic ‘Don’t’, ‘You’re mad if you do this’ sort of response.

It only took a few more emails from colleagues to realise that I’d made a serious strategic mis-judgement. So for the foreseeable future I’ve stopped the process (and if you want to join while it doesn’t cost anything just sign up at www.chfg.org!)

All this collaborative decision making is great, you might ask, but what happens when you don’t have the time to ask an open question?

In my experience, taking the time to ask a genuine open question and to listen to the answer is always valuable. No matter how sure we are, it gives a chance for colleagues to share mental models, concerns, threats and worries that at worst will give you confidence in the decision, at best may save you from making big mistakes, whether you’re a top medic, manager, policy maker, or even leader of a health care charity!

Martin is a pilot and the founder and current Chair of the Clinical Human Factors Group, www.twitter.com/MartinBromiley.