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Human factors


proactive and preventative approach to surgical care. In addition to basic preventative health hygiene for the patient and their family, this should utilise health behaviour change approaches – for example, to reduce exposure to potential colds, flus, and COVID before the operation, ensuring the patient is washing his or her hands to be healthier, and ensuring that sleep and nutrition is optimised. Prevention really is essential to best practice. Preventing miscommunication and unnecessary ruptures in trust would be the psychological equivalent.


The patient’s mindset matters: The patient’s psychological state of mind will have an impact on their wound healing and surgical outcome. If they are thinking negative thoughts versus positively engaging in their care, this will affect all aspects of their well-being and outcome. Fears, stresses, life events and their own self-esteem and mindset can alter the surgical results. Steps toward responsible pre- preparation can have profound impacts on how the patient presents going into the operation, as well as how they engage with self-care, aftercare instructions on wound management, and adherence to medication, which will have synergistic effects for all involved in the surgical journey.


Emotional factors – not enacting risk taking: Understanding essential factors such as the ACS Surgical Risk Calculator should be matched with the surgical psychological tools outlined in this article, which change the emotional reactivity and decision making within human relationships, and the surgical team and patient working alliance.


Psychological contamination: Paisley and Yule5 provide clear examples of how non-technical skills, human factor decision making, and


human error can influence surgical safety profiles. Working to carefully integrate different disciplines of non-technical skills (the emotional understanding) of patients, with human factors, together with some of the psychoanalytic organisational insights into work-related behavioural change, provides a real opportunity to drive improvement. However, it requires looking at things differently. Understanding the more subtle points of


emotional experience has as much (if not potentially more) relevant impact on the wider profile of the system’s risk, as Reason6,7 articulates in his theoretical conceptualisation of why accidents occur. This was further refined, looking at: 1. Latent failures: (including organisational influences; unsafe supervision; and preconditions for unsafe acts.


2. Active failures. 3. How these interact with failed or absent defences (adapted from Shappell and Wigemann, 2000).8


In summary, complex feelings can infect and contaminate the thinking and capacity to effectively act, for staff and patients alike.


An entire systems approach: My recent work has focused on innovating new approaches in Psychological Human Factors in Surgery Assessments. While looking at the integration of these approaches within the entire system approach, I have focused on a more comprehensive set of Pre- and Post-Surgical Psychoeducational Tools. Additionally, I am actively developing other integrated support systems such as helpful Acronyms, traffic light systems and trigger awareness for surgeons and surgical teams in collaboration with the Confederation of British Surgery* (covered in my previous article, published in CSJ).9


It is imperative to provide comprehensive support systems that deliver compassionate care frameworks designed to alleviate unnecessary risk, improve the knowledge base, expertise, and result in collaborative cooperation among all stakeholders.


Improved frameworks and transparent (shared) goals and agreements: The psychological covenant and contract alone need to be addressed. Just like the patient’s legal agreement and identification of possible side effects and risks, these issues must be visualised, and actual agreed consent needs to be evolved. I would add that (like invisible pathogens or microbes that can cause infection) we need better visualisation of the behavioural and unconscious factors that can hijack and corrupt working alliances, in order to control for these variables – thus significantly affecting the optimum outcome.


Improving patient (as well as surgical team) care: Surgeons look at surveillance data and trends, but some essential personalised patient factors may be overlooked. Some key examples could include whether the surgical patient has a needle phobia, whether they feel listened to (and respected), how they feel their pain management is handled, and especially if they feel that they can trust their surgeon and their surgical team. All of these factors will fundamentally change whether or not they feel safe. Any, and all, of these factors can profoundly


change the patient’s experience of navigating through the task of the surgical procedure and, in turn, can deeply affect their innate stress response, and dynamically decrease the patient’s wound healing. Intense physiological responses can derail surgical process and outcomes – from the patient not adhering to discharge protocols, to engaging in unhelpful behaviours, which can affect their recovery. It is important to know that stress factors


go both ways. Surgical team members can feel impacted by anxiety, as well as patients or their families. There are also individualised, deeply held triggers (for both), which can influence the functional milieu affecting the socio-technical system.10


Here, the working environment for


the successful completion of the task needs to integrate with the technology and people involved, and we need to understand how conflict and anxiety may operate within the work environment to affect this functioning. The balance between the elements in this dynamic symmetry is crucial, as any compromise will have synergistic and a very real impact throughout the entire system –


September 2024 I www.clinicalservicesjournal.com 73


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