Human factors


they have worked so hard to be a part of and support. This scenario is unsustainable, fostering unhealthy working environments and practices, further burdening pressures, and, ultimately, leads to a broken system. These accrued stresses have resulted in an entire spectrum of defence mechanisms among surgeons and surgical staff, including withdrawal, numbing, emotional reactions (such as anger or irritability, or lack of enjoyment), and stress responses. None of these responses, although understandable, are helpful. Mindsets create processes that in turn give shape to realities. We need to bring in expertise to better understand what we might do to manage the severe impact, to alter this reality. As an example, if we can innovate within one of the most technical and stressful operational environments, such as surgery. Our underlying principles can also apply to other operationally demanding and stressful environments, such as other front-line working.


Making a healthier and easier experience for all My long-standing interest and expertise in developing healthier systems has led me to look at strengthening the ecosystem with hospital and surgical teams. I would also add that one of the more complicated and newer areas is in identifying how and why the patients’ (and their families’) mindsets also affect the surgeons and their surgical teams, and vice versa. This has been a critical, and thus far unanswered, component of the human factors and healthcare chemistry within our healthcare environments. How do we address the challenge of connecting with surgeons – who are typically perfectionists and hard-working – in the context of a multitude of, often unpredictable, patient responses and reactions? By nature of the traditional hierarchical


pyramid of leadership within surgery and medicine, in which at the top sits the surgeon,


we have placed and encouraged the patient to take a passive, non-engaged role in their own surgical journey. This creates a paradigm of potential blame, which is not good for anyone. We (and the patient) have placed them(selves) at the very bottom of the pyramid. It is crucial to recognise, across the board, that patients are not passive recipients of care, but active partners in their own surgical journey. The effective communication of the surgeon’s


role and the patient’s responsibilities can work towards building trust and confidence between the patient and the surgeon and the surgical team. This will lead to better health outcomes and a more positive experience for everyone involved. Additionally, it will contribute to an improved and more efficient healthcare system, in which patients are encouraged and empowered to take an active role in their own care, and in which healthcare providers work collaboratively with their patients, and their families, to achieve best outcomes for all. My collaboration with the Confederation of British Surgery (www.cbsgb.co.uk) focuses on looking at new approaches to improve upon all aspects of the care and well-being for the surgeons, the surgical teams, the patients, as well as the wider social good, within these very high- pressure settings. Operating theatres are literally life and death environments, with the ultimate and inordinate responsibility placed solely on the surgeon’s shoulders. I am developing key innovations related to systems processes, and organisational health and well-being.


Not shaming and blaming, but understanding The innovations I developed within aviation’s critical systems were in debriefing and relentlessly improving how things are done. These processes are relevant to improvements within our present medical model, in which patients are positioned as passive members of a process that is done to them (e.g. the surgery), rather than as an equally essential


38 www.clinicalservicesjournal.com I July 2023


team member who engages and takes care of themselves. Changing the patient’s mindset, pre- operative preparation and health behaviours, and post-operative care will maximise their well-being and recovery from surgery. These interventions range from


psychoeducational enfranchisement to practical steps they can take to protect their surgery. Positive thinking and understanding their role in following post-operative wound care and medication regimes are critical steps towards patients becoming fully cooperative members of a team that includes not only surgical and medical teams, but also the patient’s own family. This contrasts with the current role of a passive patient who only takes an active role when something goes wrong, and they are compelled to engage with medico-legal processes. The current ‘shame and blame’ model needs


to be replaced with an active collaborative health partnership, where everyone is working as a team for the patients’ health and well-being, as well as considering the impact on the surgical and surgical team. We are moving forward with an understanding of the stressful demands and resource limitations within this respectful reality.


True integrated health systems Much of my work, including my doctoral dissertation, was in developing integrated health and healing systems. This has led to looking at improving the process, diversity, and fundamental health ecosystem to improve on everyone’s health and work experience within the surgical journey. Within aviation, there are checklists that allow for preventatively addressing potential mental and emotional issues. These have been developed with medicine and surgery, but we need to implement them much earlier, proactively rather than reactively, before they reach a higher level of impact, ie. a preventable patient risk or career-ending mistake. We are developing a fully working ‘live’ system to improve on these fundamental elements, while


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