Human factors
staff, as well as patient engagement. Strongly encouraging positive health-related behaviour and self-care – such as pre- surgical isolation, hand washing, ensuring good sleep and nutrition – all change the patient’s potential risk profile. These psychological factors frequently manifest in the patient’s pre-operative or post-operative risks, particularly if the patient escalates their risk taking to where it impacts their surgical preparation or recovery plan.
Neglecting the importance of these human factors can lead to avoidable complications and must be considered within a systems approach to care, well-being, and outcome.
‘Contamination’ is not just important for viruses or microbial processes: ‘Psychological contamination’ should be included as an essential part of the improved approaches to risk prevention in all aspects of surgical training and ongoing CPD. Mindset matters – especially to prevent risk. Making every possible effort to guarantee the best outcome for all should be the priority when it comes to addressing surgical site infections, tackling issues of hand washing, and minimising patient mortality or unnecessary periods of illness.
Regression and dependency: If this positive engagement is not supported, then the disaffected (antithetical) emotional responses are likely to passively emerge – whereby the patient might be expecting the surgeon and surgical team to take the entirety of the pressure of the risks and potential problems. This automatically establishes an adversarial dynamic where the patient then disengages with their own care and pushes this on to the responsibility of the surgeon and the surgical team. This is a major risk for derailment, stress, burnout, and serious risk of complication.
Immaturity creates unnecessary conflict and increases burnout: This is a kind of emotional contaminated process stemming from misalignment and other communication problems that can escalate to feelings of anger and betrayal. If these emotional triggers continue, these can contribute to enactments of rupture and emotional contagion. If such a precedent is opened, this is likely to sabotage much of the hard work and mutual cooperation that would otherwise support a positive and productive working alliance that is necessary for a long, fulfilling, and productive surgical career (as opposed to the increased risk of surgeon and surgical team mistakes and burnout). The stepwise escalation of risk forms a major
ingredient of ruptures of safety, negligence, and other negative directions of patient complication – where not only the patient is put at risk, but the surgeon and surgical team are just as vulnerable.
Psychological contamination: When considering human factors within the dynamic surgical environment, the psychological impact of human behaviour needs to be contextualised. What I hope to illustrate is that infection control can be influenced through preventative behavioural change with the guidance and principles outlined within this article. In order to properly influence preventative
behaviour, the psychological state of mind of the staff, as well as the surgical patient (or their family), needs to be addressed. We need to understand the social and emotional defences against the anxiety4
that can lead to a triggered
emotional response, which can create higher-risk behaviour. Surgery understandably elicits fear in all concerned. The maturity and compassion in how this is managed will make considerable differences in how reactions evolve and how these are understood and responded to. In my own experience, I have witnessed a significant divide between the physical/ medical and the psychological/mental health aspects, where the exploration of their interaction in a meaningful way is often overlooked. I have seen a consistent trend in teams with a phobic avoidance of looking at (or dealing with) these aspects – with the medical side looking solely at medical health aspects, and mental health teams focusing only on the psychological factors. In short, there is a reluctance to explore these components and how these human factors interconnect – especially in terms of how they mutually influence the patient’s journey.
Collaborative working preventatively addresses potential triggers: When collaborative working between staff and patient
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is neglected, key problems may be missed, thus increasing risk. An insight into human factors enables human behaviours to be more clearly understood. Defensive and reactive types of behaviour, if ignored, can undermine valuable feedback loops of data. This can lead to a negative culture of communication, where problematic organisational dynamics become enacted and are potentially played out. Just as the physical transfer of cross- infections can occur, which can pose serious risk, so too can organisational stresses and pressures leak out and affect the staff and patient interactions, which may ultimately result in unsafe patient care. These micro or macro ruptures can cause any number issues and lead toward cycles of derailments and more serious defacto accidents.
Mature autonomy: It is imperative to look at the entire patient journey and what can be done to assess, engage, and support the patient and their family to better understand issues that will affect their emotional and physical response. In addition, the patient’s active participation and proactive ownership of their own health – working collaboratively with the surgical team – is needed to ensure the best outcomes. This requires deeper, mature, and more responsible behaviour.
Developing the right tools: Surgically reducing risk and infection requires systemic understanding and solutions. What I am proposing, in addition to the robust and medical approach to manage hand-washing and surgical site infection, is an integration of a systemic human factors approach with health-related behaviour change and utilising psychoanalytic organisational approaches, so these work in conjunction. Infection prevention practical measures should not be treated as separate to the psychological prevention factors. Some of the most essential measures include the following:
Assessment: By encompassing a dynamic assessment, interventions for preventative care, and educational support for the patient and their family, the surgical team will better understand what they need to address. At its most basic, talk to your patients and find out what they are worried about and if there is anything that might be done to help them with their concern. This will help staff and patients feel much safer and re-establish a better working alliance.
Prevention: Together with the surgeon and hospital team, this would ensure a unified
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