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,...
In many respects the NHS can be proud of what it’s done around human factors. No other national health care system has yet tried to do what we’re doing, so it’s no surprise that it’s hard. It’s been made even harder for those ‘in charge’ by the seismic shifts in how the NHS is organised. A shifting landscape, followed by the enormity of scandals such as Mid Staffs, has left people like rabbits in headlights, in an extended process of what human factors refers to as ‘sense making’. Things are happening that don’t fit the standard mental models anymore.
For many, just getting their head around human factors has been a struggle. If you’re not at the front line of it, I’ll fully acknowledge that human factors can at first be hard to grasp. It’s a scientific coming together of a number of disciplines (such as psychology, physiology, etc) that together aim to develop a focused approach to ‘making it easy to do the right things’. It is a science in its own right, with an extensive evidence base.
What we can't afford to do, however, is ignore human factors just because it's a little challenging. The price of ignoring it is continued failure to improve, continuing inefficiencies, continuing staff frustrations, and the same loss of life that hurts thousands each year. Campaigns come and go – they're usually not sustainable because they're not founded on the philosophy of ‘making it easy to do the right things’.
There are now quite a few human factors practitioners (many also clinicians) who work in the NHS, but they're spread across the UK working for individual trusts or research establishments, often on individual improvement projects. They can't be accessed by people right across the system, their resources are limited and their time is precious.
The good news then is that there's expertise out in the field, just not being shared. We need to harness this passion, enthusiasm and expertise, but we have to do so thoughtfully. A couple of weeks ago I joined Professor Lord Ara Darzi on a judging panel looking for safety improvement projects to fund in one particular NHS trust. Lord Darzi got frustrated at one point, querying why people seem to want to reinvent the wheel, didn't they know that a trust down the road was working on a similar project?
The simple answer is that, in most cases, people don't know what's going on elsewhere.
More than ever the NHS must encourage people to connect and create the conditions that encourage sharing, learning and joined-up thinking. By all means allow local variation where it's genuinely appropriate, but for too long health care has been a disjointed mess.
One fundamental idea of the Lansley reforms seemed to be that local people could organise health care to meet their local needs. But what about the massive benefits of economies of scale? If you run a national supermarket chain you'll adapt product lines for certain parts of the country, but the fundamental ways that people shop, like to be treated, make choices about what to buy etc, are predictable, are (human factors) evidenced based.
Perhaps one big difference though between other industries and health care is that while human behaviour is often sadly predictable, application of this knowledge in the world of health care is still on a steep learning curve. Experts don't have all the answers. So we need a national strategy that both shares the known science and allows connectivity between frontline clinicians – innovating and learning as they go – and the wider system, to ensure the whole system learns more efficiently.
But don't be fooled into thinking this is about years of research, this is about informing hard fundamental decisions that need taking now if we're to improve the way we do business. Much of that research is already being practically applied elsewhere. Don't believe me?
The Health and Safety Laboratory pulled together a simple chart based on their own (admittedly subjective) view of how industries compare in embedding human factors. But however subjective it is, you should remember that the chart was produced by an organisation that's worked with all the industries concerned in its 100 year history, and in my view is a pretty accurate summation of the situation now.
The NHS really needs a national resource for human factors, not to control knowledge and policy, but to encourage, learn and inform. And by national that shouldn't just be about one county, but the whole United Kingdom. Why shouldn't patients in Bournemouth benefit from learning in Belfast or vice versa? Why shouldn't national bodies developing policy be properly informed instead of doing what's always been done and hoping for the best?
We can't afford not too, financially or morally.
Martin is a pilot and the founder and current Chair of the Clinical Human Factors Group, www.twitter.com/MartinBromiley.