Finding common ground:
Human factors, attitudes and
behaviour in different NHS contexts
Dr Vivien Swanson
Programme Director, Psychology Specialist Practice,
Deirdre Holly, Michelle Clark, Lisa Sutherland
NHS Education for Scotland
Human Factors for Quality Healthcare:The Way Ahead for Scotland
March 19 2014
Quality Education for a Healthier Scotland
AIMS
• Extend previous Human Factors (Non-technical skills) work
(mainly surgical, hospital-based) to other NHS Scotland contexts
• Using psychology, behaviour change theory to develop and
evaluate interventions
• Understand differences in Human Factors related to context
• Develop a basis for future curricula for patient safety training
Quality Education for a Healthier Scotland
HUMAN FACTORS…
Enhancing clinical performance through
an understanding of the effects of
teamwork, tasks, equipment, workspace,
culture and organisation on human
behaviour and abilities and application of
that knowledge in clinical settings”
(Catchpole 2010)
Quality Education for a Healthier Scotland
Five studies : Five contexts:
Five sets of HF behaviours?
• BASICS – remote and rural resuscitation
training
• SHINE – eSEA reporting in primary care
• MUS – reducing GPs secondary care
referrals to improve patient care
• MHPSP – human factors in restraint
mental health in-patients
• TRAINEE hospital doctors and hand
hygiene
Quality Education for a Healthier Scotland
Commonalities – human factors
individual/team-based
• Common Human
factors
Including……….
Personal : Cognitive,
mental load, stress and
fatigue
Team : Communication,
decision making,
teamwork
Context: Situational
awareness, information
gathering
Quality Education for a Healthier Scotland
Commonalities: Using
behavioural theory,(TPB)
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•
•
•
•
•
•
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Attitudes
Norms
Self-efficacy
Intentions
The intentionbehaviour gap?
Patey, Flin et al. WHO Patient Safety Curriculum
Guide for Medical Schools: Implementation Study
(2010)
Wakefield et al, 2010 Health professionals patient
safety behaviour ;
Jenner et al. 2002. Explaining hand hygiene
practice. Psychol health and med.
Quality Education for a Healthier Scotland
TPB: Positive attitudes, norms and
confidence predict intentions
(BASICS, MUS, HH)
ATTITUDES
Perceived importance of communication during resuscitation
(BASICS)
SOCIAL NORMS
Other doctors encourage me to refer (patient) for investigations
(MEDICALLY UNEXPLAINED SYMPTOMS)
CONFIDENCE
Its easy for me to wash my hands before and after patient contact
(HAND HYGIENE)
Quality Education for a Healthier Scotland
Intention-behaviour gap…
“And I was trying to do several things at
once. And I did not do that very well. And
certainly that is one thing when I thought
about hand hygiene at the end of it that
just went out the window. It basically
never entered my head even though I
had spent so long before that point
washing my hands every time I went into
a room, every time I left a room” (HH)
Quality Education for a Healthier Scotland
And differences…
• Health professionals :
– Level of experience, seniority
• Control (responsibility):
– Individual, group, system
• Task : demands
– Frequency, (Routine, habit, one-off),
implications, cognitive complexity
• Context:
– Time, resources
Quality Education for a Healthier Scotland
Quality Education for a Healthier Scotland
BASICS : Mapping human factors onto BCTs
(Motivation, Action, Prompts)
Elements
Human
factors
Behaviour change
technique
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Planning, preparing
Prioritizing
Coping with pressure
Goal setting (A1)
Time management (A19)
Coping strategies (M14)
Team working
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Co-ordinating activities
Exchanging information
Supporting others
Social support (M12)
Social skills training (A27)
Situation
awareness

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Gathering information
Recognizing, understanding
Projecting, anticipating
Self-monitoring of behaviour (A3)
Antecedents and consequences (A4)
Coping strategies (M14)
Decision-making
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Identifying/considering options
Balancing risks, options
Implementing & reviewing
Goal review (A10)
General problem solving (A22)
Assertion training (M18)
Leadership

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Setting, maintaining standards
Supporting others
Coping with pressure
Goal setting (A1)
Feedback (A5)
Assertion training (M18)
Communication

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Exchanging information
Shared understanding
Acting assertively
Information about behaviour (M10)
Graded tasks (A11)
Behavioural rehearsal (P11)
Task
management
Quality Education for a Healthier Scotland
Recommendations :
Generic and specific behaviour
change techniques
• Further work to develop and evaluate training in
Human Factors
– Use taxonomy to MAP BCTs onto generic and
specific human factors
– Test in different groups of health professionals
– For both novice and experienced groups
• Develop a curriculum for the service with standards
(levels of competence) which could be assessed with
both generic and specific elements
Quality Education for a Healthier Scotland
“Without this, human factors will be
considered as a generic
competence and fail to receive the
attention that it rightly deserves or indeed be appreciated for what
it is - a way to secure high
standards of care, performance
improvement as well as minimise
risk and harm to patients.”
Professor George Youngson
Quality Education for a Healthier Scotland