certain behaviours and find out why certain things aren’t working as well as they should be,” Fazeela continues. “We found that a lot of staff were getting checklist fatigue but HOTT’s approach allows staff to learn in a practical and enjoyable way.”


Paediatric surgeon Miss Clare Rees took part in HOTT in 2019 and has since become a HOTT coach because of the benefits she has seen in theatres. “Our theatres now operate in a different way to anywhere I’ve ever worked before,” Clare says. “We have been able to see a positive culture change really quickly and the surgical and nursing team work together, with everyone having the confidence to speak up. “We now have one of the more junior roles in the theatre read out the safety checklist and ensure everyone is listening, reinforcing that everyone’s voice counts.”

Fazeela Chharawala

Simulation re-creates the surgical environment but without patients. This gives the team a chance to focus in on ‘human factors’ behaviour – how they speak to each other, how instructions are given and who takes them on board while reiterating where policy and the WHO surgical safety checklist fit into day- to-day work.

Theatres unite a mix of surgical and theatre staff who don’t usually train together so simulation offers a great educational opportunity for the multi- speciality team, as well as a chance to understand the task at hand from different perspectives.

The second stream, human factors, looks at the ‘dirty dozen’ – the 12 most common factors which result in errors

Spring 2020

across a range of safety-critical industries. This part of the programme improves understanding of how individuals perform under different circumstances and why errors happen, while teaching the team tools for better communication in high- stress and complex situations. It focuses on how human factors play a role in understanding safety or doing safety differently.

Finally, the coaching stream involves a ‘HOTT coach’ attending a live operation to watch the team in practice – a fresh eyes approach on the ways of working. The coach offers feedback directly to the team on how the team interact. This is followed by a debrief where the team reflect on their experience and performance. “The programme allows us to look at

Marc Castillo, theatre charge nurse, says: “The HOTT programme has also bred a culture of fairness, openness and equality amongst our team in the paediatric theatres. I think one of the reasons it’s been so successful is because change is being led by the consultants. This atmosphere in theatre is giving everyone confidence to speak up. From nurses to anaesthetists to operating department practitioners, we are not hesitant to speak our minds if we think something important needs to be addressed.”

The programme has reached all theatres at the Trust and will be continuing to roll out to the wider invasive procedures teams. Anyone can take part, whether it’s getting your team involved in human factors learning or joining the coaching team.


Contact one of the HOTT leads: Shehan Hettiaratchy (shehan.hettiaratchy@nhs. net), Fazeela Chharawala (, Sadie Syed (, Mark Tempest (, Sabrina Das (

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