Human factors
contributing to changes in the decision making, situational awareness, and communications (with all concerned). Factors of anxiety, conflict, and defences also affect the leadership of the surgical team and can alter the communication for everyone involved. Stress can compound these reactions. Factors such as feeling safe and understood can profoundly alter interactions and can reduce the stress reactions. Unseen influences, such as neurodiversity, are critical in that stress can profoundly make clarity and shared goals and collaborative communication so much harder if undermined. Better understanding of stress and how these factors negatively affects clear and optimised communication is critical. Neurodiversity can negatively activate wider social defence factors (and even group dynamics such as bullying) that can also significantly change the human side of the socio-technical system. It is important to conceptualise that
neurodiversity is not a problem but has stress sensitive vulnerability components and cognitive processing styles that need to be supported and understood. If this factor is met with compassion and understanding, this can provide for a much safer and smoother system for all concerned. Neurodiversity needs to be understood as being a human factor for patients, as well as surgeons and surgical teams. Attention deficit hyperactivity disorder (ADHD), Asperger’s Spectrum Condition (ASC), Dyslexia, Dyspraxia and many other kinds of neurodiversity all contribute to the necessity to attend to different learning styles and felt experiences.
Feeling heard and respected Seeing the physical body and viscera is only one aspect of understanding the patient. We need to also understand their psyche and the broader social and environmental context, to ensure the provision of holistic surgical care. Ultimately, this can enfranchise and transform multiple key areas of health and well-being. When patients, as well as staff, feel heard and respected, this will lower more (immature) defensive and stress related responses replacing these with more optimal (and mature) flow responses. Neglecting to consider this more integrated human factors psycho-social approach may eventually be viewed as a negligence of high-quality patient and medical care. What I am proposing in this paper is for the ‘invisible’ psychological factors to be recognised as important as Semmelweis’ medical necessity of hand washing and prevention of cross contamination for good patient surgical care. I appeal to you to see and comprehend
both patients and the whole surgical team as complete human beings who must navigate immense stress, and that the decision making of both have considerable and profound impacts on each other and the overall team environments. Changing the technologies, ethical legal values, and approaches to guarantee increased control and consistent quality of safety critical environments will be a significant influence. This crucial behavioural adaptation also needs to contribute to creating an environment where patients feel truly heard and understood, allowing us to seamlessly address the fears and anxieties around the surgical process in a compassionate manner, so triggers and defences are not predominating their engagement with their surgical pathway. Understanding the deeper psychological
factors – and even being able to effectively map and identify what might lead to a significant emotional trigger or derailment (for both the patient and staff) – can drastically increase the feeling of psychological containment for all concerned. This will ultimately lead to improvements in the physiological management of stress reactivity, wound healing and transition toward complete recovery.
Valuing each person and the greater ecosystems of care As identified, there are unseen factors that could greatly influence neglecting preventative measures such as hand washing, or further consequences of developing surgical site infections. All of these play a critical part in determining patient mortality (which is currently around 3%). In his fascinating book, Deep Survival,10
Gonzalez looks at who lives
and who dies – where the core experience of fighting through adversity, versus simply giving up, has roots within the person’s belief system. However, the environment and support available, versus stress triggers, can completely change what belief system is activated and expressed. We need to look at building new, more mature
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ways to ensure professional psychological approaches are harnessed within surgical systems of healthcare, which could potentially change the expression and outcomes. One key point in updating Human Factors
in Surgical Care is the importance and value of genuine empathy and care, as a significant preventative system to reduce complications and infection. Emotional insights are part of a connected relationship and getting these parts right reduces conflict and negative emotions - including anger and rage - which can be played out within the patient care journey. These negative emotions can break down trust, which forms the baseline of most medico-legal lawsuits.
Systems of decision making My objective is to put forward a case to understand and incorporate how the psychological perspective of the surgical patient and their family context can have a powerful bio-psycho-social impact, which has previously been a rather invisible field and largely overlooked. Furthermore, we need to understand that, as long as human beings are involved (this includes the surgeons and surgical teams), everyone needs to be understood and supported. When experiences are not understood and supported, a negative cycle of distress, lack of trust, and a greater likelihood of conflict can materialise, which will affect both the patient journey and safety. The present model of team work significantly neglects that the patient and their family are a critical part of the surgical team and their active participation is part of responsible team working practice. Ignoring this engagement is to everyone’s detriment. Addressing negative patterns of communication and harnessing a deeper psychological human factors approach can result in a truly meaningful adjustment – supporting positive engagement. This enhances satisfaction for patients, surgeons, and surgical teams, leading to improved outcomes, as well as risk reduction. Overall, understanding emotions,
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