Human factors
Why civility must be part of the future of surgery
At NPAG 2024, human factors in operating theatres were high on the agenda. ‘Incivility can be contagious’ and ‘rudeness can prove deadly’ were among the take-home messages of the day. Louise Frampton reports.
The National Performance Advisory Group recently hosted the Theatres and Decontamination Conference at the Coventry Building Society Arena, covering a wide variety of issues affecting operating theatres – from the role of human factors in patient safety, sustainability and waste management, to the problem of biofilms and medical devices, and the competency framework for staff working in decontamination. Patient safety was high on the agenda, at
the event, and a key theme was the impact of incivility on the performance of surgical teams. Mark Bowers, Divisional Intervention Lead, Guys & St. Thomas NHS Foundation Trust, highlighted how hospitals have hit the headlines, in recent years, with some startling statistics following staff surveys. One organisation in particular received some high-profile negative publicity in the press, after it was revealed that ‘one fifth of employees had experienced harassment or bullying’.1 In his presentation, Mark highlighted the importance of teamworking. The definition of a team, he explained is “a group of people working towards a shared goal”. Human factors and the impact of incivility on teams in safety critical sectors need to be understood within the context of research developed by the aviation industry, he asserted. The latter turned its attention to developing safer teams following a number of high-profile aeroplane crashes, in the 1970s, in which incivility and team dynamics were found to be contributing human factors. In one incident, the pilot failed to notice that the aircraft was running out of fuel and the co-pilot tried to warn him in “a roundabout way,” Mark explained. The pilot failed to act and
there were significant fatalities as a result of the crash. Analysis of the incident revealed that incivility within the cockpit was a contributing factor, leading to a breakdown in effective communication. Following further incidents, in which incivility and human factors played an influential role, the aviation industry developed a strategy around ‘crew resource management’ (which focuses on team working) to improve safety. Over the years, NASA has studied teams
extensively and analysed what sets high performing teams apart from others that perform less well. They have identified 10 behavioural markers, but one stands out as being essential to ensure a high performing team: Interpersonal Relationships / Group Climate.
What happens when there is a steep authority gradient is people go down and stay down – they don’t speak up about anything safety critical. Mark Bowers
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www.clinicalservicesjournal.com I July 2024
“Sometimes you walk into the operating
theatre and look at the team around you and you think ‘Yes! Today is going to be great day!’ Other times, you turn up and think ‘Oh no, how am I going to get through the day?’” Mark continued.
He commented that to create high performing teams, NASA now recruits for “emotional intelligence”. The biggest barrier to high performance, however, is hierarchy and the authority gradient. This not only applies to aviation but other safety critical sectors, such as healthcare. Hierarchy is necessary on one level, as it is important to know who to report issues to. However, if the “authority gradient” is too steep, orders are simply issued from above and the communication is one way. This doesn’t encourage others to provide important input or speak up when there is a potential safety issue, Mark explained. Team leaders need to be able to ask: ‘what is going on and what am I missing here?’ This facilitates a ‘multi-brained approach’, he pointed out.
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