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Human factors


each person’s experience and how positive engagement can be supported is an important part of leadership and patient safety.


Flow states: One aspect of immense value is the passion that surgeons usually have for operating. By enabling them to get into a deep flow state, outcomes can be significantly improved, leading to noticeably enhanced satisfaction and health benefits for all involved. This is a critical and viable way of reducing medical burnout and stress-related reactions and illness, helping to improve the quality of care delivered. Patients also have their own version of this and, if we can get both staff and patient flow states to work together, to optimise this engagement, this would be the gold standard of optimised, collaborative team performance.


Infection control From my analysis, there is an essential missing piece in infection prevention. In a nutshell, this is the human factors or psychological component. Reducing infections is about changing the understanding, the experience, and the cooperation and care that goes into the surgical and patient teamwork. It requires an understanding of human behaviour and emotions9


and where this can be in peak


performance versus just preventing patient error. To use an analogy, Thomas Eddison’s innovation of the lightbulb was part of a deeply planned and carefully integrated system of generators, civic and domestic electrical wiring, and other related first-tier development engineering firsts that were able to bring a more mature and technologically workable system to bring light and functionality to what had not been previously available. The psychological engagement was the crucial factor that allowed the uptake and utilisation to begin. The invention of the lightbulb would have been useless unless the other inventions had been put in place to support these new ways of working. In addition, a psychological understanding of how people would feel safe enough to make use of the technology was required for its dissemination. In much the same way, ensuring critical


behaviour and system change to reduce infections, human behaviour and improved care are a fundamental point of innovation for proper change to occur. Therefore, there needs to be a shift away from viewing emotions as distractions or problems – to these being understood as part of feedback, in a dynamic system of directional culture and ecosystem, which ultimately improves communication and ensures connected, meaningful care.


Summary Historical paradigm shifts – with Semmelweis’ understanding of the invisible pathogens, hand washing with carbolic acid and close attention to cross infection – changed the entire profile for medical and surgical risk and mortality, thereby increasing patient safety. What I have proposed in this paper is the need to better understand the invisible world of emotional psychological processes – to be better equipped to assess, account for, and understand how these might be more effectively addressed and controlled. There is an opportunity for better patient and surgical team engagement, which understands the need for containment of emotional contagion, and the tools and processes to proactively remedy these human factors. This approach leads to a holistic improvement in the collaborative surgical health journey of patients, families, and surgical teams alike.


CSJ


* For further information, visit: https:// www.cbsgb.co.uk/


References 1. Sfantou, D. F., Laliotis, A., Patelarou, A., Sifaki- Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of Leadership Style towards Quality-of-Care Measures in Healthcare Settings: A Systematic Review. Healthcare, 5(4), 73. https://doi.org/10.3390/healthcare5040073


2. Tyagi, U., and Barwal, K.C., Ignac Semmelweis— Father of Hand Hygiene, Indian J Surg. 2020 Jun; 82(3): 276–277. Published online 2020 May 21. doi: 10.1007/s12262-020-02386-6 PMCID: PMC7240806. PMID: 32837058


3. Totty, J., Moss, J., Barker, E., Mealing, S., Posnett, J., Chetter, I., & Smith, G. E. (2020). The impact of surgical site infection on hospitalisation, treatment costs, and health‐related quality of life after vascular surgery. International Wound Journal, 18(3), 261–268. https://doi.org/10.1111/ iwj.13526


4. Jacques, E., (1955) Social Systems as a Defence against Persecutory and Depressive Anxiety. In M. Klein, P Heimann, and R. Money-Kyrle (eds.) New Directions in Psychoanalysis. London. Tavistock Publications.


5. Paisley, A., and Yule, S, (2023) Patient safety and clinical human Factors, in Garden, O.J., and Parks, R.W., and Wigmore, S.J., (2023) Principles and Practice of Surgery, Chapter 2., Elsevier: London. pp. 7-17.


6. Reason, J., (1990) Human Error, New York, NY: Cambridge University Press.


7. Reason, J., (1997) Managing the Risk of Organisational Accidents. Aldershot, UK,: Ashgate.


8. Shappell, S.A., and Wiegmann, D.A., (2000) The Human Factors Analysis and Classification


About the author


Dr. Richard Sherry is a Consultant Chartered Clinical Psychologist, HCPC Reg., and Fellow of the BPS CPsychol, CSci, FBPsS. He is a BPC and UKCP Reg. Psychoanalytic Psychotherapist. He is a Specialist Aerospace and Aviation Clinical Psychologist. Dr Sherry is on the BPS Board for Aviation and Aerospace Psychology where he has been working to innovate the new field of aerospace psychology. He is a Clinical Neuropsychologist (SRCN Register) and Full DoN BPS Member). Is a Full Member of the BPS Division of Occupational Psychology (DOP). Dr. Sherry has a specialist training and


interest in military psychology, the psychology of surgery, plastic, and aesthetic surgery. He is currently the Clinical Psychologist in Residence and Fellow with the Confederation for British Surgery (CBS) where he is looking in innovating human factor and psychological interventions to improve safety and positive surgical outcomes. He is a lecturer at Regent’s University in the Psychotherapy and Psychoanalysis Department. He is deeply interested in complex safety critical and stressful environments.


September 2024 I www.clinicalservicesjournal.com 75


System – HFACS. Technical Report. DOT/FAA/ AM-00/7. Washington, DC: Federal Aviation Administration.


9. Sherry, R. A human factors approach in surgery, The Clinical Services Journal, The Operating Theatres Supplement, p37, July 2023, (Accessed at: https://content.yudu.com/ web/1u0jl/0A1up6l/CSJ-OTS-2023/html/index. html?origin=reader). (7)


10. Trist, E.L., and Bamford, K.W., (1951) Some Social and Psychological Consequences of the Longwall Method of Coal-cutting. Human Relations, 4(1): pp. 3-38.


11. Gonzales, L., (2003) Deep Survival: Who Lives, Who Dies, and Why. Norton Pub: London.


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