 Hi everybody. This is Donna Prosser, Chief Clinical Officer with the Patient Safety Movement Foundation and we're excited to bring you another COVID-19 update today. We're excited to be joined by Martin Bromley who is with the Clinical Human Factors Group and he's going to share with us today how we can apply the science of human factors to what's happening right now on the front line. Welcome Martin. Good afternoon. It is afternoon in our time. Yes and it's morning here. So thank you so much for joining us from all the way across the Atlantic Ocean. No problem. Martin I wonder if you could tell us just a little bit about your background and how you got involved in the work of human factors. So my background is as an airline pilot. I'm still an airline pilot but 15 years ago my then wife Elaine went into hospital for a routine operation. Problems occurred. She remained unconscious and in fact died 13 days after the attempted procedure. Now as the review of her care took place the issues that occurred it would appear were all around human factors related problems. So the team were under immense pressure. I can't intubate, can't ventilate scenario had occurred. There had been no briefing of possibilities, no kind of surgery checklist or anything like that when she got into the procedure and in essence the team became fixated on a particular problem. The nurses were well aware of what the problem was and were trying to intervene but were unable to do so and in essence she was starved of oxygen completely for over 20 minutes. So as we reviewed the report it was obvious that many of the things that in my industry we train for and we simulate and we understand very well were not really well understood in healthcare and I suppose for me although I had two young children to bring up and wanted to get back to my flying job out to the side of my mind was the thought that maybe I should do something healthy and useful for healthcare. So what I did is I founded a charity. It brought in clinicians and academics and policymakers and we've expanded over the last 15 years or so to really just promote an understanding of human factors and the science of human factors in healthcare. So I'm very lucky the chair of the group now is a surgeon. We have a whole range of people in our group from pharmacists, from anaesthetists, ICU specialists etc and very proud of what we've managed to do. Great. Well as you mentioned research has shown that if we apply those human factors to healthcare we can reduce medical errors and and we can also help clinicians to deliver better care to their patients. But for those who are out there who maybe don't understand what the term human factors means could you perhaps just define it a bit for us? Yeah sure. So when you work in a in any form of system so you're in a hospital or any form of business it doesn't matter and you have equipment to use, you have a building to work in to move around, you have various tools, you have protocols, processes and it's about designing those so that it's easy to get it right and hard to get it wrong. In the simplest example using pumps that are of different designs but on the same ward where the keypad is in a different direction for example or an indicator light works in a different way it takes up just a little bit of your mind just a little bit of cognitive process to try and work it out. Humans are quite adaptable but we can create easily create error prone situations with the equipment around us and the design of drugs packaging and things like that. It's not just about the design though it's also about how people behave with each other to make it easy to do the right things. So the style of leadership, the style of your communication really sends a strong non-verbal message to the recipient about how you want to interact with them so how can we behave in a way that makes it easy to do the right things and really it's just trying to apply that science to day-to-day working. Some organisations outside of healthcare are really really good at this we know in aviation this is a science we've been using for most of our life really since the second world war in the design of the equipment used in the way we train people and what it does is it saves lives and it makes our day easy and essentially the science of human factors is really helpful for anybody who works under any form of pressure which in reality we all do in today's world and particularly at the moment healthcare is under exceptional pressure and stress and anxiety because of COVID-19. Yes absolutely well I mean that leads me into my next question there is a great deal of stress and anxiety but our hospitalised patients right now are at even greater risk of medical harm than they were before the COVID crisis but with all of the stress that the front line is under is this now the time to talk about continuous improvement and the science of human factors or should we maybe put that discussion aside until after the coronavirus crisis? So the irony is if you just forget the term about continuous improvement and just think about the fact that people who have been going into work in a healthcare environment are all of a sudden facing enormous change anyway. They are using having to work in ways they weren't familiar with donning PPE for example and having to think about how teams work together what equipment you can use and the organisation of buildings just simply on that level and often staff unfamiliar with that sort of intensive care environment or high-risk environment are having to work in there to back up the staff that are there so there's enormous amount of change going on and the problem is that creates complexity so for me bringing the science of human factors in is not about trying to do a whole load of new stuff it's trying to do what people are doing but just doing it better finding easy ways to do it and the reality is from the front line is that right now people aren't making changes to processes they are doing continuous improvement all the time as a way of just trying to help themselves but what I'm suggesting is that we can actually bring a little bit of science in there to help people do that and indeed just in the last few days in the UK we've published guidance on the design of new ventilators because we have different manufacturers designing them now about how you make it easy for the staff to do the right things there's research going on about how we make PPE easier to don and off so that reduces the chance of infection increases the speed at which it can be done and we are also at my own charity has been involved in in developing some guidelines around behaviors that make it easy for new teams and existing teams to work well because you're working under pressure and an element of anxiety which is which is really unfamiliar to most people in healthcare and when I say that what I mean is is healthcare has always worked under pressure they're used to that and perhaps in some cases they shouldn't have had to be used to that but that's the reality but the problem now is that in as times were you could come into work as a healthcare practitioner you could have a good day or a bad day but you still got to go home at the end of the day the difference now is that your life sadly is is potentially at stake and really making it easy for you to do your job properly and well and making it hard to get it wrong is so critical at the moment and we are seeing a massive interest in human factor science and as a way of people trying to just make things better for themselves yes absolutely um and so so then another question I'm sorry I lost my question for a second we're going to edit this part out um Martin what specific tips can you give to healthcare organizations to help healthcare workers and patients be safer in this pandemic using the science of human factors so the first thing obviously is something that's probably out of most organizations ability but it would be to get equipment that is easy to use well and some organizations have already done that but that cannot that's obviously a longer term process so in the short term it's something about helping teams to um first of all if possible the equipment they're using should be standard so they're not using different pieces of equipment different pieces of PPE unless it's required uh because of the nature of what they're doing but I think the second thing should be first of all giving them some some structure when there's an enormous amount of uncertainty and anxiety structure is really really important so that's protocols that are not only evidence based but have been designed by those doing the work and have been simulated the role of simulation is really incredibly important simulation is quite good because you can learn some of the technical skills but in reality the success or failure of a unit and just quoted by a head of an ICU unit here in the UK recently this is all about communication now that was a fairly generic term but we know that the the non-technical skills the behaviors are absolutely critical uh in terms of who does what who says what so let's have some protocols developed and simulator tested and run through multiple times so all the unintended consequences of behavior can be drawn out but not only that these protocols need to work when you're under uh when you're you're donned your PPE and and we need to have very simple processes and actually that you mentioned the phrase continuous improvement that's what the reality is going to have to be because you're going to be learning all the time so organizations supporting that in terms of more directly what can you as an individual clinician do or what can be done to help you we published some guidelines these are based on what we call these non-technical skills these behaviors so there is obviously no evidence base around what non-technical skills are particularly pertinent with COVID because it's not been around long enough but what we do have is a lot of evidence base around non-technical skills in other industries who have to cope with these sorts of rapidly developing dynamic situations where there is a lot of personal threat so for example teaching pilots how to handle in-flight emergencies helping nuclear plant operatives deal with issues in a nuclear plant that could get out of control or all rig workers on a on a rig and we can we can learn from those and apply those in other situations because the the real thing here is the human is the same it doesn't matter whether it's you me or somebody else we still tend to react we still have the same sorts of emotions and and really these guidelines are which we published on our website are things around briefing skills it's around skills about coping with high anxiety situations it's about how you how you pace yourself it's about how you slow things down and there's a whole series of things that we've identified that can be useful but certainly having a in terms of a hospital helping your staff with simple structures to use simple mnemonics simple processes which are not complicated which are designed to be used with PPE which are designed to be used under stress is really really important as I say we've got a whole sheet here which I know you're going to share of ideas on a couple of pages we've also got different translations and that's been contributed to by clinicians both in the UK and in Italy as well well those are excellent tips for hospitals and we really appreciate your time today do you have any final thoughts for organizations and clinicians out there before we conclude I think the big thing is to be kind to each other and that's kind of an obvious thing to say but you know you have to remember that for all of us when we're under personal threat anxiety we will act in different ways and it's just to be tolerant of that to recognize that and and really if you can stick to simple structures it helps everybody to have a sense of knowing what they're about to go into there is nothing worse than going into a situation where you don't understand what you and your colleagues are about to do the more you can clarify that before you go into a hot zone the more certainty or give to your staff the better performance but still remembering that the end of the day we're all human and and you know those those people will come out and need some help and support and an arm around the shoulder yes well our clinicians certainly need that today lots of arms around their shoulders so I appreciate your time and thank you so much for joining us today no problem thank you very much son excellent okay