I’m delighted to have accepted an invitation to join Clinical Human Factors Group (CHFG) as a Patron. What, you may ask, does a Patron do? Well, as I see it, my job is to lend my support to CHFG, to raise the profile even more, to be an ambassador where it matters both here and abroad, and to offer challenges to make sure that what CHFG does and what it stands for reach an ever-widening audience and, critically, influence behaviour.
I recognised the importance of research into human factors and their role in affecting and promoting the safe care of patients when I chaired the Public Inquiry into paediatric cardiac surgery at Bristol Royal Infirmary over 20 years ago. I remember being particularly struck by the evidence of Marc de Laval, a surgeon at Great Ormond Street. His humility, his preparedness to interrogate his own practice, his insistence on data, were immensely impressive – all as part of his relentless pursuit safety for his patients. He was prepared and courageous enough to look beyond what he was presented with and look inwards to his and his team’s behaviour. How did they affect the outcomes of surgery? Could what they did and how they behaved and interacted be broken down and analysed and thereby lead to better, safer care?
Similarly, I was struck by Martin Bromiley’s willingness to ask questions not previously asked of the NHS. He assumed that, as a matter of course, there would be an inquiry into the circumstances which led to the death of his wife. The assumption was born of his experience as a professional pilot. He was told that the NHS didn’t do that. In short, “these things happened – that’s healthcare”. He refused to accept this approach. It set him off on a road of almost heroic dedication, always pursued with only one aim – that things should get better. Something had to be done about the safe care of patients. In particular, what he had learned from the world of aviation and from the insights of human factors research must inform the thinking and actions of those working in and running the NHS and, never to be forgotten, a further audience – patients.
Hence CHFG. It has not been an easy path. Convincing people of what is self-evidently obvious is often very hard, particularly if it challenges accepted ways of working and might upset established apple carts. But Martin and those around him have persevered and deserve our gratitude. My hope is that I can add my shoulder to the wheel.
If one of my roles as Patron is to challenge CHFG, let me use this first note to throw out a couple of challenges. There are, of course, so many that it’s hard to know where to start, but the two I mention here have been of concern to me for some long time. The first is bullying. Here is not the place to explore why, amongst people whose role explicitly is to care for others, there are so many examples of staff bullying those they work with. Poor training, poor leadership, insufficient numbers of staff (often dangerously so), preoccupation with hierarchy and status – these are just a few of the complex mix of reasons. But the important point for me here is not the cause but the effect. There can be little doubt that a culture of bullying, whether in a team, on a ward, in a practice, or in an organisation puts at risk the safe care of patients. Staff are intimidated, fearful of doing what’s right by the toxic environment of their workplace. Patients are unwilling witnesses, their experience of healthcare, often fraught, made more so, with consequences for the safety and outcome of their care.
A first challenge I invite CHFG to address is the culture of bullying in healthcare and its effect on the safe care of patients. What can CHFG do to demonstrate the link and help to deal with it?
My second challenge builds on the painstaking efforts of CHFG to get the safe care of patients into the minds and actions of those caring for them. Yes, healthcare professionals are exposed to the concept of human factors and its relevance to what they do. Regulators such as the GMC are signed up to it. But the time has come to take a further step. I have spent a long time involved with and in regulation. I know the truth in the old adage of what gets measured gets done, if consequences follow. So, simple. Identify how human factors affects healthcare in all its various sectors, set relevant standards, measure compliance, and publish the results. This is what regulation is about – a very sophisticated method of risk management if done properly.
The challenge is to persuade the principal regulator of healthcare, the CQC, to incorporate the measurement of compliance with human factors best practice in its assessment of the performance of organisations providing healthcare. It would be for the organisation to cascade down the mechanisms which would ensure compliance. For its part, CHFG can play a leading role in helping to devise the standards and in ensuring compliance with them. It would be an exciting challenge, applying the latest research and practice to achieve real practical effects and helping to identify and collect and make public the relevant data. In this way, CHFG would make another step in its journey to make patients as safe as possible.
There will be more challenges to come, but the two I’ve suggested are enough to get on with! One further challenge which I might mention more in hope than in expectation is one I’ve been banging on about for years – with a complete lack of success. I leave you with it. Can we spare a thought for calling what we are concerned with “the safe care/safety of patients” and not “patient safety”. It’s not the brutalist English I object to. It’s the reduction of a key concept in the care of patients to a managerial abstraction; something to be ticked off on a checklist or left to “the patient safety team”. The safe care of patients is the responsibility of all those who come into contact with patients. It’s everybody’s business. It must be in the front of everybody’s mind at all times. It isn’t an abstraction. Using the term “patient safety” makes it possible to treat it as such. So, can we watch our language and reintroduce patients into the equation!
Professor Sir Ian Kennedy