Human Factors In a maternity service

Making it happen

Dr. Harriet NichollsConsultant Anaesthetist

Luton and Dunstable Hospital NHS Foundation Trust

How we’ve done it What we’ve gained

• Process– Raising awareness– Training – Introducing and spreading behaviours– Developing behaviours– Communications

• Achievements

Process – Raising awareness

• Senior management

• Heads of department

• Risk management• Staff groups• Walking down the

corridor

Process – Training

• Critical mass introduced to the concepts

• Monthly team training days

• Multi-disciplinary group on LIPS course

Process – Introducing behaviours

• One behaviour, one area

• One individual, one day

• Multi-disciplinary champions

• Monthly meetings

• Sharing good practice

• Learning from one another

• Asking of each other

Spread of BehavioursArea Briefing Debriefing Closing the

loopSBAR Critical

Language

Ward 32

Ward 33

ANC

Delivery suite

Elective Theatre

Emergency

Theatre

NICU

Community

MLBU

Developing Behaviours

• Realising potential

• Novice to expert

• Requires practice

• Coaching

• Reflection

Developing BehavioursBriefing

Red Amber

NOVICE

Green Silver Gold

EXPERT

Not being used

Done by minority of people

Every one takes part

Done using a structured checklist

Outstanding jobs are allocated to a named individual

Leader invites people to speak up if they perceive a problem with patient care

Developing BehavioursDebriefing

Red Amber

NOVICE

Green Silver Gold

EXPERTNot being used

Done by minority of people

Occurring at target frequency

What did we do well

What could we have done better

What can we learn

Teamwork

Equipment

System change required

Leadership

Task Management

Situation awareness

Communication

Patient’s feedback is fed into the debrief

OR

If a team member has spoken up they are thanked for having done so

Process – Communications

Evaluation

• Clinical Outcomes

• Cultural Survey

• Anecdotal

What have we gained?

• Day starts when it’s supposed to start

• We all know the game plan

• Handover time cut by 20 minutes, Ward 32

• ODPs want to come and work in maternity

• Communication has improved across and

within disciplines

• It feels safer in theatre

Success Factors

• Support at all levels

• Built in-house capability

• An appreciation that we are the culture…