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Human factors in patient safety: Comparative lessons from human and animal healthcare

On 7th May, I was proud to be involved in the very first comparative medicine conference of its kind; Human factors in patient safety: Comparative lessons from human and animal healthcare, organised by the Royal Society of Medicine in association with VetLed and MedLed. There was a great range of speakers discussing a broad array of topics which touched on non-technical skills, safety reporting, just culture, wellbeing as well as more in-depth reviews of how teams can reliably deliver their clinical skills.

The day started with John Pickles, Chair of the Clinical Human Factors Group who discussed the current climate of Human Factors in healthcare and whether or not the topic has reached a ‘tipping point’ whereby the principles have become so ingrained as to be self-sustaining. Liz Mossop followed John’s talk to offer a similar overview of the landscape of Human Factors in the Veterinary profession. Whilst it is evident that both professions are on an ever-evolving journey, it is a journey that has started somewhat more recently within animal healthcare. In many NHS trusts a great deal has changed over the past 15 years and there are signs that a similar shift is occurring within the Veterinary field, with Human Factors a well-established and ever-growing area of research and development.

Catherine Oxtoby spoke next about her fascinating research into human error, learning and reporting within Veterinary teams. Catherine discussed VetSafe, a profession-wide safety reporting system which she has developed, and the crucial aspect of gaining ‘buy-in’ across all levels of the team. She also covered the emotional considerations that are associated with a blame culture (or a perception there-of) and how anxiety associated with errors and safety reporting should never be underestimated with regards to their impact on learning and wellbeing.

Suzette Woodward’s response emphasised the importance of learning from adverse events and error and also elaborated to give a broader view to stimulate thought on how we can think differently about patient safety. She discussed incident reporting as a vital ingredient but not safety in itself. Addressing only events that go ‘wrong’ (this approach is known as ‘safety I’) can detract from the 100s, or likely 1000s of times that process has taken place when it hasn’t gone wrong. This ‘normal’ (sometimes exceptional) day-to-day performance is important to understand (known as ‘safety II’) so that we can help create systems and develop skills which enable teams to reliably deliver safe and compassionate care.

Professor Bryn Baxendale discussed how we can build Human Factors awareness and capability in daily practice by taking a ‘systems’ view and by appropriately applying solutions based on an understanding of the complexity of various processes. A few models of complexity were touched upon, one such model categorises tasks as simple, complicated and complex as originally described by Charles Vincent and René Amalberti.

This is relevant to both animal and human healthcare because they both involve processes which span the full range. From a Human Factors perspective, understanding such complexity will have significant implications on how teams and organisations can approach tasks in a way that applies an appropriate balance between compliance with procedures and supporting professional expertise and freedom.

Huw Stacey, Clinical Director at Vets4Pets, shared with us his experience of introducing Human Factors in Veterinary Practice. This provided an interesting contrast in terms of the management structure of his organisation versus something like the National Health Service. The level of autonomy afforded to each of the many hundred practices in the group is a significant part of his challenge and as such, Huw described the importance of focusing on buy-in across all levels of their teams. In the long term, what is currently a challenge could indeed turn out to be a great strength, if true buy-in is adopted rather than enforced compliance.

The final stream of the day was focussed on wellbeing. Dr Michael Farquhar, Consultant in Sleep Medicine at Guy's and St Thomas' NHS Foundation Trust delivered a highly emotive presentation on why we need to talk about fatigue. He openly shared his personal reasons for the HALT campaign that he has led at Guy’s and St Thomas’. HALT is an acronym for Hunger/Thirst, Anger/anxiety, Late/lonely and Tired - areas that are known to leave us vulnerable and less able to perform at our best. Dr Farquhar’s campaign was focussed around rest and sleep but his message was clear and is one that applies to all areas of wellbeing – that unless critically ill patients require your immediate attention, our patients are always better served by clinicians who have taken the time to first care for themselves. Much of his work in this area seeks primarily to address what he refers to as the Superhero mentality of many healthcare workers. Whilst he recognised that this approach comes with the best of intentions, in fact it can have negative impacts on their own health and wellbeing as well as their ability to offer their best for their patients and colleagues.

The talk also served as an opportunity to learn more about sleep and human performance. We all know that alcohol can negatively impact our ability to focus and make decisions and as such would ensure we are not under the influence when treating patients. However, being awake for 16 hours has the same impact on our cognitive performance as being at the legal drink-driving limit. As Dr Farquhar pointed out, many of us would not address fatigue with the same diligence.

I had the absolute privilege of speaking next, presenting the final talk of the day. 

I chose to tell the story behind VetLed's HALT campaign as it was something with which we were fortunate enough to have the support and collaboration of Dr Farquhar, following the campaign at Guy’s and St Thomas’. 

This provided me with an opportunity to not only summarise the key points from what we did and why this was so important to the Veterinary profession but also an opportunity to summarise an important principle from the whole day - that of collaboration and what I described as ‘translating not transplanting’.

There is so much that can be learnt from one profession to another and the development across the fields of Human Factors and Patient safety are no exception. Our Veterinary HALT campaign was inspired and based upon Dr Farquhar’s campaign at Guy’s and St Thomas’.However there was a great deal of work required so that is was appropriate for Veterinary teams.

I also had the opportunity to summarise another key point that came up several other times over the day - the crucial link between wellbeing and Patient Safety. I have so often heard these topics discussed in separate breaths, yet so many times over the day, the message has been reinforced that wellbeing is(and must be treated as) an integral element to patient safety. If we work in a system that does not support the basic physiological and emotion needs of the care-givers, their ability to look after their patients will be compromised.

There was a great energy and sense of enthusiasm throughout the whole day. Elizabeth Haxby’s introduction as President of Patient Safety Section at the Royal Society of Medicine created a sense of collaborative spirit as she described her Grandfathers pertinent role in the Veterinary profession. The day was closed with similarly warm concluding remarks by Gwen Covey-Crump (President of Comparative Medicine Network at the Royal Society of Medicine) which left everyone with a hunger for further discussions as both professions continue their respective journeys in Human Factors and patient safety.

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