Today’s session (25 September 2017)

Hi everyone

Today we had a visit from Phil Hawes from the Whitireia School of Health.

Even though I missed most of Phil’s presentation, I do have my notes from last year (below) which may help to jog some memories from today presentation:

Phil Hawes, from Whitireia’s Faculty of Health, came in to speak to us about PSDM in a health sector setting. In particular, Phil was interested in telling us what the Health Faculty does to improve students’ PSDM skills, why it is important and how they achieve it.

Phil started by asking us how we felt about the prospect of self-driving vehicles on the roads. He noted that, with most road accidents being due to human error, we could improve road safety by using vehicles which reduced the incidence of human error.

Phil then talked about how the Health Faculty prepares students for work in an inherently stressful environment, requiring correct decisions to be made within (sometimes) critical timeframes. To do this effectively, the Faculty creates a managed stress environment in which conditions are made to resemble actual industry conditions, as closely as possible.

The Faculty has a training suite, where staff can manipulate variables in a simulated hospital ward (which includes a dummy patient which can speak, provide the students with vital signs and even sweat!)

Phil talked about similarities between the airline industry and the health sector, noting that both settings dealt with life-and-death issues, tight timeframes, specialist knowledge and hierarchical relationships. The stress created in each of these environments has a major effect on how well people can perform and the outcomes that they can achieve.

In 1999, research showed that on average 231 people were dying each day in US hospitals due to medical misadventure. In New Zealand, 12% of people in New Zealand hospitals will have a negative event while in hospital. As most of the negative outcomes are due to errors by people, we should be able to reduce negative events through better management of PSDM in stressful situations.

Phil noted that the 231 deaths per day is the equivalent of an airplane crash every 24 hours. The aviation industry analogy doesn’t stop there, as Phil went on to discuss a well-known air disaster from 1972, Eastern Air Lines Flight 401. This flight crashed in a Florida swamp, after initially developing a problem with a light switch in the cockpit.

The light was supposed to indicate whether the landing gear had been deployed and was locked in place. However, the light bulb had blown and it took the crew some time to check the problem. During this time, the plane (which was supposed to be on autopilot) gradually descended until it crashed into the swamp, killing many of the passengers and nearly all of the people in the cockpit. If you are interested, then you can watch the full documentary at https://www.youtube.com/watch?v=C-HmU4-hYio.

Phil discussed several human factors which contributed to this tragic situation. He noted fixation (which meant that, in this case, the flight crew were focused on a task of limited value, viz. changing the light bulb on the instrument panel), distraction, poor leadership, communication difficulties and issues around hierarchy. These things can make us vulnerable to making errors. (Phil also noted that ‘production pressures’ and financial penalties could also contribute to similar situations). These factors could create decision making traps which everyone can be vulnerable to.

Phil noted that similar things happen in hospital settings. When a crisis occurs we tend to shed loads, fixate on immediate issues (which can be good or bad), lose our situational awareness, become confused and make errors of judgement.

There are some things that we can do to reduce the problems that arise in hospital crisis situations. For instance, when a crisis occurs, we can manage the situation and minimise the likelihood of mistakes through simple strategies.

One way to do this is to centralise communication through a leader who does not take part in specific tasks. The leader observes and instructs by devolving responsibility to others in the team. This allows the leader to retain awareness of the whole situation, at a global level.

Another tactic is to speak out loud every four minutes. This allows others to check on the leader’s appreciation of the situation, check for understanding, maintain time awareness, etc.

Helpers can assist by taking responsibility for their actions (for instance, saying if they can’t do a task).

Other useful communication tactics include:

* Addressing people directly (including introducing yourself)

* Being willing to declare an emergency (conveying urgency, not panic)

* Using non-judgemental forms (be respectful and be respected; ask for help when possible)

* Closing-the-loop (if a question is asked then reply to it; keep talking until there is a response, make it clearer, etc.)

Phil also mentioned the ISBAR model used in hospitals.

Identify

Situation

Background

Assessment

Response

This model helps us to establish clear communications by imparting information in a clear and logical manner. To gain a better idea of how ISBAR is used, have a look at the following links:

http://www.westcoastdhb.org.nz/publications/policies_n_procedures/policies_n_procedures_docs/clinical/ISBARCommunicationToolForHealthProfessionals.pdf

https://www.hse.ie/eng/about/Who/qualityandpatientsafety/resourcesintelligence/Tool-box_Talks/ISBAR.pdf

https://www.safetyandquality.gov.au/implementation-toolkit-resource-portal/resources/organisational-leadership/ISBAR%20revisited%20Identifying%20and%20solving%20barriers%20to%20effective%20handover%20in%20inter-hospital%20transfer%20-%20Project%20Toolkit.pdf

Phil then took us on a tour of the Faculty of Health’s simulation suite and he explained how the facility works. The use of a realistic hospital setting (even including the smell of faeces, when required!) helps to create a realistic setting. The tutor can observe the students from behind a mirrored wall while manipulating variables (such as the dummy patient and the patient’s vital signs on the equipment). The sessions are recorded and played back to the students so that they can learn from their experiences.

Today was a very good example of how problem solving and decision making can operate in high-stakes, high-pressure environments. We learnt about ways in which human beings can contribute to errors and what we can do about preventing them from happening.

Returning to 2017, it is unbelievable that we have only four more scheduled classes for this year!

* Monday 16 October – Industry Guest

* Monday 23 October – Labour Day (holiday)

* Monday 30 October – Class session

* Monday 6 November – Assignment 2 presentations

* Monday 13 November – Assignment 2 presentations

However, there are still a number of assignments which need to be completed before the end of the semester:

* Assignment 2, Task 1 was originally due by 4:00pm Friday 29 September 2017. However, as there are a number of student commitments in that week, we agreed to move this assignment date to 4:00pm on Friday 6 October 2017.

* Assignment 3 can be submitted any time up to and including 4:00pm on Friday 20 October 2017.

* Assignment 2, Task 2 is an in-class presentation scheduled for Monday 6 November 2017 and Monday 13 November 2017.

* Assignment 4 (Review) can be submitted any time up to and including 4:00pm on Friday 10 November 2017.

Have a look at the Course Outline so that you are familiar with the things that you need to do for the above assignments. Assignment 4 (Review) has been posted on Moodle since the beginning of the semester and you should be working on this after each class to record any part of the session which is relevant to this assignment.

Students who have not yet seen me to collect their Assignment 1 results need to do so as soon as possible. I will be on campus on Monday 25 September for a morning meeting and I should be available from around 11:30. If you would like to meet me on that day, then please text me on 027 331 9658 to confirm a time.

Cheers

Phil