Human Factors Training Research Articles

WP8.2 - Human Factors Analysis of CORESS cases using the NOTSS Framework

Abstract Aims Determine human factors implicated in cases submitted to the Confidential Reporting System in Surgery (CORESS), using the non-technical skills for surgeons (NOTSS) framework. Methods Consecutive cases submitted to CORESS, between 2005 and 2011 were evaluated as an interim analysis. The type of case, whether patient harm occurred, Clavien-Dindo (CD) classification, and the location of the incident were collected. Demographic data was not collected because they are often changed to protect patient identification. Each case was reviewed according to the non-technical skills for surgeons (NOTSS) taxonomy. Results There were 100 cases included in this interim analysis. The most common types of cases were delayed diagnosis (n=19), known complications (n=10), near misses (n=10), poor surgical technique (n=9), misuse of equipment/device (n=8), and wrong site surgery (n=5). Two-thirds of patients were harmed, with complications ranging from minor to life-threatening (9 CD I, 10 CD II, 32 CD III, 12 CD IV), and 4 resulting in death (CD V). Incidents occurred most frequently in the operating theatre (n=54), the ward (n=16), or the emergency department (n=9). There were 71 incidents that endangered patient safety related to deficiencies in situational awareness, 59 to poor communication and teamwork, 48 to poor decision-making, and 48 related to leadership failures. Conclusions The main human factors implicated in surgical patient safety incidents related to errors in situational awareness, communication and teamwork, and to a lesser extent, decision-making, and leadership. Efforts to prevent medical errors should be focused on clinician human factors training.

EVALUATING THE SUCCESS FACTORS FOR KNOWLEDGE MANAGEMENT IN THE FINANCIAL SECTOR: AN AHP- DEMATEL APPROACH

The objective of this article is to identify and understand the success factors of knowledge management within the financial sector. In the ever-evolving business environment, effective knowledge management (KM) is imperative to maintain a competitive advantage. Effective KM within financial institutions can build standardized processes, ensure speedy delivery, and foster better customer relationship management. An integrated approach of the Analytical Hierarchy Process (AHP) and the Decision-Making Trial and Evaluation Laboratory (DEMATEL) methods was used to rank these critical success factors and understand their interrelationships. The findings identify organizational factors (cultural aspects, organizational structure, top management support), technological factors (technological adoption, infrastructure support, collaborative systems), and human resources factors (training & learning, agile workforce, knowledge sharing) as the critical success factors. Technological factors were identified as the most important factors. The article further complements the findings of the AHP by exploring the interrelationships between the identified factors to understand and prioritize possible intervention areas. This research has significant theoretical and practical implications. The findings can help financial institutions implement and manage knowledge management initiatives within the organization. This study also adds to the extant literature and addresses gaps in the research in the context of KM within the financial sector.

Veterinary High-Stakes Immersive Simulation Training With Repeat Practice Following Structured Debriefing Improves Students' Ability to Cope With High-Pressure Situations.

Immersive simulation is used increasingly in medical education, and there is increasing awareness of the impact of simulation scenarios on emotional state and cognitive load and how these impact learning. 1 There is growing awareness of the requirement to equip veterinarians with skills for managing high-pressure environments and provide training on human factors. Veterinary students participated in a high-fidelity immersive simulation of a road traffic collision involving multiple casualties. The students took part in the same simulation twice, the second time after a debrief. Each participant's emotional state and cognitive load were assessed after participating in each simulation. Each participant was asked to score the effect of pressure on their performance. One hundred twenty-five students participated and demonstrated a higher cognitive load with more positive emotional states during the second scenario after the completion of a structured debrief and discussion focusing on pressure relief techniques (cognitive load - ¯ μ Scenario run 1 = 4.44 ± 1.85 [SD], ¯ μ Scenario2 = 5.69 ± 1.74 [SD]). Most (63%) participants described being in a low-performance state of frazzle during the first scenario compared with most (61%) who described being in a high-performance state of flow during the second. Immersive simulation scenarios, with structured debriefing, may allow the measurement of emotional state and cognitive load in participants. Furthermore, this study suggests that curriculum training in human factors and pressure relief techniques, coupled with immersive simulation and debrief, may improve future performance in high-stakes and high-pressure scenarios.

Experiences with Postdoctoral Training in Human Factors: Mentor and Trainee Perspectives

Postdoctoral training positions are becoming more common in the human factors and ergonomics (HFE) discipline. However, conversations related to training in the HFE discipline have largely focused on undergraduate and graduate education. This panel assembles both postdoctoral mentors and former trainees who collectively have a diverse set of HFE-related postdoctoral experiences. By panelists discussing their experiences, observations, and recommendations related to postdoctoral training with the audience, the panel session will support HFE faculty and students in making more informed decisions about if and how a postdoctoral experience (either as a mentor or trainee) could be a part of their career development in HFE.

An Assessment of the Current State of Human Factors Training Related to Aging and Gerontology

Human factors is an interdisciplinary field that seeks to understand interactions between humans and other elements of a system. As such, human factors practitioners, researchers, and students should be informed of age-related changes in sensory processing, memory, and attention across the lifespan and their relevance to design. Advancements in healthcare and an aging generation from the mid-20th century baby boom have led to increasingly older populations worldwide. To continue functioning independently, older adults will need to be able to use technology both now and in the future. Product designs must appropriately accommodate and be accepted by the growing aging population. Thus, it is particularly pertinent to understand how the new generations of human factors students are being educated about agingrelated changes that can inform the design of technology. Therefore, the current project seeks to document the prevalence of coursework and courses dedicated to aging and gerontology within human factors programs.

Patient Safety Education in the Undergraduate Dental Curriculum: Evidence Base and Current Practice in UK Dental Schools.

International consensus advises patient safety education (PSE) for dental undergraduates. A previous systematic review found no articles describing PSE in dentistry. This article aimed to review the evidence base for, and the current practice of, PSE in UK dental schools. Literature search and surveys were sent via email to all 16 UK dental schools. Six articles describing PSE interventions were found: 2 small-scale studies for dental students and 4 interprofessional studies. Patient safety education is effective for undergraduate dental students with significant improvement in knowledge and interest. Interprofessional studies reported improved teamwork skills and more positive attitudes toward interprofessional working.The 2018 and 2021 surveys had response rates of 56% and 100%, respectively. An increase in integrated formal PSE and assessment in UK dental schools is demonstrated. No barriers to implementation were reported. Forty-six percent of schools deliver interprofessional PSE, 38% deliver human factors, 81% teach communication, 94% teach professionalism, and 31% of schools have a patient safety (PS) champion. Limited published literature on PSE in dentistry is available. However, the lack of published articles does not mean that PS is not being taught, as many UK dental schools were found to have formal PSE integrated and assessed within their curriculum. Further development is needed in terms of appointing PS champions for leadership and human factors training. Patient safety must form a part of an undergraduate student's core values.

MP25-01 AN ETHICAL ROBOTIC SURGICAL TRAINING CURRICULUM USING SIMULATION AND 3D PRINTED SYNTHETIC ORGANS

You have accessJournal of UrologyCME1 Apr 2023MP25-01 AN ETHICAL ROBOTIC SURGICAL TRAINING CURRICULUM USING SIMULATION AND 3D PRINTED SYNTHETIC ORGANS Daniel Costello, Dean Driscoll, Ahmed Ghazi, and Anthony Costello Daniel CostelloDaniel Costello More articles by this author , Dean DriscollDean Driscoll More articles by this author , Ahmed GhaziAhmed Ghazi More articles by this author , and Anthony CostelloAnthony Costello More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is no longer necessary to rely on live animals or cadavers for surgical training. We used 3D printing technology and injection moulding to produce realistic hydrogel synthetic organs for robotic surgery training. These synthetic organ models were a key pillar in a novel multistep robotic surgery curriculum. Phase 1 included an online learning program the first robotic surgery course accredited by the Royal Australasian College of Surgeons. This course included access to a catalogue of live 3D video accessible through VR headsets. Participants then proceeded to VR simulation training, dry lab exercises and human factors training in preparation for procedural training on hydrogel organs. When proficiency was achieved finally live human surgery. Following are results from the synthetic organ robotic procedures. METHODS: Three different synthetic organ models were fabricated for this study; an anatomically correct insufflatable anterior abdominal wall for port placement, a robot assisted partial nephrectomy model and a robot assisted radical prostatectomy model. These models were fabricated using 3D digital models segmented from patient CT images using computer aided-design software. These models were uploaded to 3D printers to generate negative moulds, which were injected with polyvinyl alcohol, a low-cost hydrogel. These positive casts went through freeze thaw cycles achieving different tissue consistencies. These casts were layered in anatomically correct positions creating multi-step procedural models with clinically relevant objective surgical performance metrics. Metrics include blood loss, nerve injury measured by digital strain gauges, cancer margins using fluorescence, anastomosis leak tests, operative time and video based skill assessment. RESULTS: Twenty surgeons performed robotic surgery on 5 synthetic abdomens, 10 hydrogel partial nephrectomies and 30 radical prostatectomies. Participants ranged in experience from novice to experts. Clinically relevant performance metrics were recorded and GEARS video tool was used to assess proficiency. Preliminary validity assessments demonstrate face, content, construct, concurrent and predictive validity. CONCLUSIONS: We demonstrated feasibility and preliminary educational validity of realistic synthetic human organ models for urological robotic surgery. These models offer a viable alternative to live animal and cadaver surgery training, without associated cost, ethical and accessibility drawbacks. Source of Funding: An equipment grant was provided by Intuitive Surgical for simulation surgeries © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e342 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Costello More articles by this author Dean Driscoll More articles by this author Ahmed Ghazi More articles by this author Anthony Costello More articles by this author Expand All Advertisement PDF downloadLoading ...

Implementation of Human Systems Integration technical and management process for the lunar Gateway Program

NASA recognizes Human Systems Integration (HSI) as part of the overall systems engineering and acquisition strategy for space systems. The Lunar Gateway Program is implementing HSI technical and management process across the lifecycle of the mission, as required by NPR 7123.1C NASA Systems Engineering Processes and Requirements, and led by the Gateway HSI team as required by NPR 8705.2C Human-Rating Requirements for Space Systems, now HEOMD-003 Crewed Deep Space Systems Human Rating Certification Requirements and Standards for NASA Missions. NASA has been using HSI principles for many years and has applied them to many of its previous human spaceflight Programs. As NASA returns to the Moon in a more sustainable manner, the Gateway Program is maturing the application of HSI by implementing it more visibly as part of Artemis, with guidance from the NASA/SP-20210010952 NASA HSI Handbook. This paper discusses how HSI is being implemented in the Gateway Program, challenges faced with its implementation during the development phase, and strategies/approaches used to overcome those. The paper also covers HSI implementation for flight systems, vehicle processing, and interfaces across the six identified NASA HSI domains: human factors engineering, operations, safety, training, maintainability and supportability, habitability and environment. The goal is to provide an overview of the implementation process of HSI in the Gateway Program as an example for other Programs/Projects/Missions that are looking to implement HSI.

Fatal Air Medical Accidents in the United States (2000-2020).

Currently, many airplanes and helicopters are used as air ambulances to transport high-acuity patients. Unfortunately, civilian air medical transport in the United States has experienced a significant number of serious and fatal accidents. At the moment, additional research is needed to identify what factors affect air medical safety. Accident reports from the National Transportation Safety Board (NTSB) were queried. Accident reports were analyzed if the accident occurred from 2000 through 2020, involved a helicopter or airplane on an air medical flight (as identified by the NTSB), and had at least one fatality. The date of the accident, the model of aircraft involved, and NTSB-determined probable causes of the accident were examined. Eighty-seven (87) accidents and 239 fatalities took place from January 2000 through December 2020. Nearly three-fourths (72.4%) of fatalities occurred on helicopters, while just 27.6% occurred on airplanes. Interpreting the NTSB findings, various human factors probably contributed to 87.4% of fatalities. These include pilot disorientation, pilot errors, maintenance errors, impairment, fatigue, or weather misestimation. Nighttime-related factors probably contributed to 38.9% of fatalities, followed by weather-related factors (35.6%), and various mechanical failures (17.2%). These data show that the probable causes of fatal air medical accidents are primarily human factors and are, therefore, likely preventable. Developing a safety-first culture with a focus on human factors training has been shown to improve outcomes across a wide range of medical specialties (eg, anesthesia, surgery, and resuscitation). While there have been fewer fatal accidents in recent years, a continued emphasis on various training modalities seems warranted.

The Influence of Human Factors Training in Air Rescue Service on Patient Safety in Hospitals: Results of an Online Survey

Background: Air rescue crew members work equally in aviation and medicine, and thus occupy an important interface between the two work environments of aviation and medicine. The aim of this study was to obtain responses from participants to a validated online-based questionnaire regarding whether hospitals may benefit from the commitment of a medical hospital staff which is also professionally involved in the aviation system as emergency physicians and Helicopter Emergency Medical Services Technical Crew Members (HEMS TC). Furthermore, it focused on the question of whether the skills acquired through Crew Resource Management (CRM) training in the air rescue service might also be used in the ground-based rescue service and, if so, whether they may have a positive effect. Methods: Medical air rescue staff of 37 German air rescue stations was included. Between 27 November 2020 and 03 March 2021, 253 out of 621 employees (response rate: 40.7%) participated voluntarily in a validated anonymized online survey. A quantitative test procedure was performed using the modified questionnaire on teamwork and patient safety (German version). Results: The examination and interpretation of the internal consistency (Cronbach's alpha) resulted in the following reliabilities: Factor I (Cooperation): α = 0.707 (good); Factor II (Human factors): α = 0.853 (very good); Factor III (Communication): α = 0.657 (acceptable); and Factor IV (Safety): α = 0.620 (acceptable). Factor analysis explained 53.1% of the variance. Conclusions: The medical clinicians participating in this online survey believed that the skills they learned in human factors training such as CRM are helpful in their daily routine work in hospitals or other medical facilities, as well as in their ground-based rescue service activities. These findings may result in the recommendation to make CRM available on a regular to the medical staff in all medical facilities and also to ground-based rescue service staff aiming to increase patient safety and employee satisfaction.

Use of high-fidelity simulation to ensure inclusivity and equality of international medical graduates

The UK medical profession is becoming increasingly diverse as the number of international medical graduates (IMGs) joining the UK medical workforce increases every year. However, IMGs face a number of significant sociocultural and educational challenges. Recent studies show that IMGs lack insight into the system and lack clarity in relation to the role of a supervisor, career pathways, and medico-legal and ethical issues [1,2]. They exhibit differences in clinical practices and team dynamics. Recent studies suggest the introduction of dedicated induction programs in the form of formal teaching sessions, or tailored online induction for IMGs prior to their first job [1–3]. Most IMGs have minimal exposure to simulation and human factors training with international medical schools favouring more didactic methods of education. We have designed a high-fidelity simulation course with frequently encountered clinical scenarios to improve inclusion and a harmonious transition for the IMGs. This provides an opportunity to familiarise themselves with the healthcare system and team dynamics within the NHS and instils confidence to perform to the best of their ability in their respective roles. The course has been designed specifically tailored to the needs of IMGs who may find it daunting at first to make their place in a completely new system. We employ high-fidelity simulation encompassing multiple frequently encountered clinical scenarios. The scenarios are followed by a debriefing, with a special focus on human factors, interpersonal and communication skills, and understanding of authority gradients. The attendees are also encouraged to reflect on their performance and to participate in the discussion, share their professional opinions, experiences, and cultural influences. The attendees are asked to fill a pre-course and post-course questionnaire. Two pilot courses were conducted with a total of 22 attendees. Pre- and post-course feedback with reflective questions about various aspects of the course was obtained. The scenarios assessed 5 categories, which the IMGs graded on a Likert scale. Pairwise comparison was performed between pre- and post-course feedback, showing a statistically significant increase in confidence levels related to all assessed categories; basic management skills (p <0.001), clinical skills (p=0.006), communication skills (p<0.001), teamwork (p<0.001), and leadership (p<0.001). Based on the positive feedback from attendees we believe that this induction simulation course can greatly help IMGs have a smooth transition into the NHS, and ensure inclusivity by equipping them with confidence, a knowledge of the system, and human factors. 1. Rasquinha M. Difficulties and educational challenges faced by international medical graduates in trust grade roles in the UK. British Journal of Hospital Medicine. 2022;83(4):1–7. 2. Hashim A. Educational challenges faced by international medical graduates in the UK. Advances in Medical Education and Practice. 2017;8:441–445. 3. Emery L, Jackson B, Oliver P, Mitchell C. International graduates’ experiences of reflection in postgraduate training: a cross-sectional survey. BJGP open. 2022.

Implementation of a high-fidelity simulation programme for year 3 internal medicine trainees (IMT3)

Year 3 Internal Medicine Trainee (IMT3) is a new (in 2021) grade of medical trainee intended to bridge the chasm between the supported environment of being a senior house officer and the more independent role of a medical registrar. We identified an unmet need for simulation experience to develop skills in emergency management, team leadership, and medicolegal/ethical judgement needed by the medical registrar [1]. Medical simulation and human factors training are essential for the development of IMT3s [2]. We created a novel high-fidelity simulation programme to address this training requirement and support this new grade of junior registrars. We designed five scenarios according to current curriculum guidance and Trust human factors framework. These scenarios were: (i) managing a Jehovah’s witness with an upper gastrointestinal tract bleed but lacking capacity, (ii) tricyclic antidepressant overdose, (iii) cardiac arrest in pregnancy, (iv) duty of candour after a fatal medical error, and (v) a hypoxic COVID-19 patient refusing treatment. The scenarios were piloted to a focus group with iterative improvements made. Participants responded to a Likert-type scale on both pre- and post-course questionnaires regarding their perceived confidence in managing difficult clinical and ethical conundrums, and their ability to share decision-making and communicate effectively during these situations. 23 out of 30 (77%) of the Trust’s IMT3s attended the programme which ran from January to May 2022, 22 (96%) of whom have completed both pre- and post-course questionnaires across the six sessions held. Mean course satisfaction and subjective knowledge gained ratings amongst participants following attendance at the course was 4.9/5. There was a 34.9% increase in mean confidence rating towards the management of challenging ethico-legal dilemmas (pre- versus post-course: 6.6/10 versus 8.9/10). Similarly, the average confidence towards the delivery of effective resuscitation in acutely deteriorating patients rose from 7.3 to 8.8/10 (20.5%), while average confidence in sharing decision-making and effective communication increased from 7 to 9/10 (28.6%) amongst the participants. Unclear audio system and lack of handouts were reported as limitations. Pauses in study leave access due to COVID-19 surges posed a challenge to the delivery of sessions and additional sessions were instituted to limit this impact. This is a novel programme for a new grade of doctors. The pilot data suggested that the implementation of a high-fidelity simulation programme appeared to be an effective modality to support the progression of this junior medical registrar cohort. 1. Joint Royal Colleges of Physicians Training Board (JRCPTB). Internal Medicine Training (IMT) Stage 1 ARCP Decision Aid. 2019 (last updated 2022). [Accessed on 4/06/2022]. 2. Joint Royal Colleges of Physicians Training Board (JRCPTB). Rough Guide to Internal Medicine Training: Guidance for training programme directors, supervisors and trainees. 2019 (last updated June 2019) guide to IMT June 2019.docx %282%29.pdf [Accessed on 17/05/2022].

Reflections on our experiences of delivering a simulation-based education programme for medical support workers

International Medical graduates (IMGs) contribute significantly to the NHS medical workforce, but often face unique challenges which are not always catered for within medical education [1]. The Medical Support Worker (MSW) role was created in response to the COVID-19 pandemic, providing an opportunity for doctors seeking GMC registration to gain clinical experience within a supervised NHS placement [2]. Our Trust’s Postgraduate Medical Education department was asked to deliver a teaching programme to the Trust’s first cohort of 29 MSW’s, 28 of whom are from Myanmar. The aims of this programme were to provide support for the MSW role and preparation for working as an NHS doctor. Based on a scoping questionnaire of the MSWs’ perceived learning needs and our prior experiences of working clinically with IMGs, we developed an innovative tailored programme, consisting of three days covering frequently-encountered clinical scenarios, non-technical, procedural and communication skills. Throughout the teaching programme, several themes unique to MSWs became apparent. These learners’ previous experiences of medical education were predominantly behaviourist, consisting of didactic teaching in which learner contribution was not encouraged. Their only prior experience of simulation was for assessment. It was therefore vital that we ensured a psychologically safe environment in which they felt confident and were encouraged to participate in near-peer learning. We achieved this by explicit conversations about different styles of medical education and modelling these behaviours consistently. A particular challenge we encountered was introducing the learners to the hidden curriculum of the NHS [3]. This refers to the behaviours and values that form an acceptable professional identity and may differ between international healthcare systems. It became apparent during simulation that dedicated human factors training would be valuable. This was integrated via two half-day sessions focussing on non-technical skills and communication-based simulation. Cultural differences, especially in communication styles, became apparent. This included: a doctor-centred versus patient-centred agenda; challenges inherent to communicating in a second language; and different cultural values and legal frameworks. We endeavoured to expose our learners to scenarios that provoked discussions around these issues, for example communicating with a teenager requesting contraception. IMGs face unique challenges when entering the NHS workforce and it is inherent upon medical educationalists to consider and meet these needs. We have identified three major themes (different educational models; the hidden curriculum of the NHS; and cultural differences) that must be addressed to ensure high quality care and patient safety. 1. Slowther A, Lewando Hundt GA, Purkis J, Taylor R. Experiences of non-UK-qualified doctors working within the UK regulatory framework: a qualitative study. J R Soc Med 2012: 105:157 –165 2. Temporary Medical Support Worker (MSW) Secondary Care – Job description and person specification. NHS England and NHS Improvement. 3. Hafferty FW, O’Donnell JF. The Hidden Curriculum in Health Professional Education. 2014.Hanover, NH: Dartmouth College Press

What you see may not be what you get! Simulate towards effective planning of pediatric intensive care unit.

Aims and objectivesThis study aimed to describe the application of low-cost inter-professional simulation over 4 phases in identifying structural and design issues, latent safety threats as well as test systems, processes, including facilitated team training during the design of a new pediatric intensive care unit (PICU).Materials and methodsThe four-phase inter-professional simulation sessions involving clinical and non-clinical teams were conducted over a 3-month period in a corporate hospital during the designing of a new PICU. Low-cost resources, such as floor tapes, low-tech manikins, reused sterilized consumables, and actual patient beds and equipment, were used for the in situ simulation sessions. A plus-delta method of debriefing was done, and changes agreed on consensus were implemented after each simulated session.ResultsThere were 10 simulation sessions conducted over 4 phases during the 3-month period of designing the PICU. The participants included 10 doctors from PICU and adult critical care, 25 critical care nurses, 12 members from the project team, and 2 hospital administrators in various combinations. The first phase led to the re-design of workspace and clinical areas for better space utilization. The second phase required further revision to facilitate better mobility and facilities. In the third phase, the number of beds was reduced to 6 beds following the simulated drills involving the actual placement of patient cots and equipment. The fourth phase had thematic 5 simulated exercises involving the newly recruited clinical teams that enabled the identification of systems and process issues. Cognitive aids and video orientation of the setup, team training, and human factors training were addressed, and the unit was open for patient care in a week.ConclusionA phased inter-professional simulation exercise with low-cost resources can enable the identification of structural challenges, design issues, latent safety threats, test systems, processes, patient flow, and facilitated team training during the design of a new PICU. Further studies are needed to understand the generalization of the study findings into designing PICU.

Patient safety problems in community-based mental health services: A qualitative exploration

Introduction Existing research has seldom examined patient safety problems experienced by service users accessing community mental healthcare, with the growing evidence base focusing largely on safety in psychiatric inpatient settings. Accordingly, there is poor understanding of safety issues in community-based mental health services as perceived by service users, carers, and healthcare professionals.ObjectivesThis study aims to explore safety problems in adult community-based mental health services, their causation, and priority areas for improving the safety of care provided in these services.MethodsIn-depth, semi-structured interviews and focus groups were conducted with users of community-based mental health services, carers, and healthcare professionals employed within these settings. Interview topic guides were designed jointly with stakeholders from these groups (N=7) and piloted (N=3). Interviews and focus groups will be transcribed, coded, and analysed using an inductive thematic analysis approach. Illustrative quotes will be extracted and used to describe the key themes that emerge from the analysis and their inter-relationships.ResultsThis presentation will provide an outline of patient safety as understood and experienced by key stakeholder groups. Study findings will explicate safety issues, healthcare system factors underpinning their causation, as well as practices which could improve safety in this context.ConclusionsThis research will help to advance understanding of the nature of patient safety problems in community-based mental healthcare services for adults, based on the experiences of service users, carers, and healthcare professionals within these services. The research will address key evidence gaps and represents an important step towards identifying areas which warrant intervention to improve patient safety.DisclosureNS is the director of London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors have no competing interests.

Characterising the nature of the beast: Challenges associated with understanding patient safety within community-based mental health services

IntroductionPatient safety problems stemming from healthcare represent a significant cause of morbidity and mortality globally. The evidence base on safety in mental healthcare, particularly regarding community-based mental health services, has long fallen behind that of physical healthcare, with fewer research publications, developed primarily in isolation from the wider improvement science discipline. This disconnect both yields, and stems from, conceptual and practical challenges which must be surmounted in order to advance the science and improvement of safety in mental healthcare.ObjectivesThe objectives of this research were to conduct a narrative review to provide an overview of conceptual issues in this area, their origins, and implications for patient safety science and clinical care. We also sought to identify approaches to overcoming these issues.MethodsWe examined theoretical and empirical evidence from the fields of patient safety, mental health, and improvement science to address this knowledge gap.ResultsWe identified challenges with defining safety in the context of community mental healthcare, ascertaining what constitutes a ‘preventable’ safety problem requiring intervention, and in finding relevant research evidence. The research indicated that risk management has taken precedence over proactive safety promotion in mental healthcare. This positions service users as the origin of safety risks, with iatrogenic harm and latent system hazards associated with mental healthcare widely overlooked.ConclusionsWe propose a broader conceptualisation of safety to advance the field and outline potential next steps for the integration and uptake of different sources of ‘safety intelligence’ within community mental health services.DisclosureNS is the director of London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors have no competing interests.

Patient safety in community-based mental healthcare: A systematic scoping review

IntroductionThere is limited existing research about patient safety issues in mental healthcare. A lack of evidence is particularly pronounced in relation to safety in community-based mental health services, where the majority of care is provided. To date, reviews of mental health patient safety literature have focused primarily on inpatient care settings.ObjectivesThis systematic scoping review will aim to identify and synthesise literature about the types of patient safety problems in adult community-based mental health settings, the causes of these problems, and evaluated safety interventions in this care context.MethodsA systematic search was conducted on 19th June 2020 and refreshed on 23rd October 2021, across five databases: Medline, Embase, PsycINFO, Health Management Information Consortium, and Cumulative Index to Nursing and Allied Health Literature. The search strategy focused on three key elements: ‘mental health’, ‘patient safety’ and ‘community-based mental health services’. Retrieved articles were screened at title, abstract and subject heading level, followed by full-text screen of longlisted articles.ResultsIn this presentation, the findings of this systematic scoping review will be described, based on synthesised literature about safety incidents, broader care delivery problems, their causes, and evaluated patient safety interventions to address these issues.ConclusionsThis study will offer learning opportunities about the safety problems, contributory factors, and safety interventions in adult community-based mental health services, as described in the evidence base. Review findings will also help to ascertain gaps in existing research, which should be addressed in future studies.Disclosure NS is the director of London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors have no competing interests.

Patient, Procedure, People (PPP): recognising and responding to intraoperative critical events.

Intraoperative critical events are rarely experienced by individual surgeons but are commonly experienced at a workforce level. Finding unfamiliar or unexpected pathology, anatomy, haemorrhage or an iatrogenic organ or structure injury cannot be completely eliminated in the complex surgical environment. It is vital that an appropriate, safe response to these infrequent events takes place to prevent possible further harm to patients. This paper introduces 'Patient, Procedure, People', a tool adapted from aviation threat and error management (TEM) training. It allows surgical teams to improve situational awareness (SA), communicate effectively, flatten team hierarchy gradients and improve decision-making before responding to critical events. We review factors contributing to poor decision-making, with resulting errors. These include loss of SA (tunnel vision), acute stress reactions (fight-flight or freeze-hide) and limbic hijacking (surprise and startle events). Events may cause workload to increase beyond cognitive capacity, further exacerbating the situation. After completing initial actions to achieve a temporary 'place of safety', surgical teams may use the tool to effectively manage threat or mitigate error. Aviation is a high-reliability organisation that has pioneered human factors research and training. Airline pilots undergo regular simulated emergencies assessment, including mandatory human factors assessment. Although the complexities of the operating theatre do not currently lend themselves to high-fidelity simulation as in aviation, valuable transferrable lessons can be learnt from aviation's approach to TEM.

The effectiveness of improving healthcare teams’ human factor skills using simulation-based training: a systematic review

BackgroundSimulation-based training used to train healthcare teams’ skills and improve clinical practice has evolved in recent decades. While it is evident that technical skills training is beneficial, the potential of human factor training has not been described to the same extent. Research on human factor training has been limited to marginal and acute care scenarios and often to validate instruments. This systematic review aimed to investigate the effectiveness of simulation-based training in improving in-hospital qualified healthcare teams’ human factor skills.MethodA review protocol outlining the study was registered in PROSPERO. Using the PRISMA guidelines, the systematic search was conducted on September 28th, 2021, in eight major scientific databases. Three independent reviewers assessed title and abstract screening; full texts were evaluated by one reviewer. Content analysis was used to evaluate the evidence from the included studies.ResultsThe search yielded 19,767 studies, of which 72 were included. The included studies were published between 2004 and 2021 and covered research from seven different in-hospital medical specialisms. Studies applied a wide range of assessment tools, which made it challenging to compare the effectiveness of human factor skills training across studies. The content analysis identified evidence for the effectiveness. Four recurring themes were identified: (1) Training human factor skills in qualified healthcare teams; (2) assessment of human factor skills; (3) combined teaching methods, and (4) retention and transfer of human factor skills. Unfortunately, the human factor skills assessments are variable in the literature, affecting the power of the result.ConclusionSimulation-based training is a successful learning tool to improve qualified healthcare teams’ human factor skills. Human factor skills are not innate and appear to be trainable similar to technical skills, based on the findings of this review. Moreover, research on retention and transfer is insufficient. Further, research on the retention and transfer of human factor skills from simulation-based training to clinical practice is essential to gain knowledge of the effect on patient safety.

Impact of human factors in aircraft accident mitigation and aircraft maintenance training needs in post COVID-19 aviation

PurposeThe purpose of this study is to analyze the effect of human factor training in aircraft maintenance accident mitigation and aircraft safety in post COVID-19 aviation scenarios. The cause of aircraft accidents and details of three decades of selective aircraft maintenance accidents are analyzed to arrive to the significant aviation safety factor. The effect of COVID-19 pandemic and related technological applications to maintain high standards of safety and their applications in aircraft maintenance with respect to the view of human factors are discussed in details.Design/methodology/approachThis paper details the overview of the human errors, error mitigation and need of human factor applications in aircraft maintenance industry for safe air travel. The criticality of aircraft maintenance in keeping aircraft in airworthy condition to provide safe air transportation without delay and to support airline economy is discussed in this study.FindingsThe cause of aircraft accidents and details of three decades of selective aircraft maintenance accidents are analyzed to arrive to the significant aviation safety factor. The effect of COVID-19 pandemic and related technological applications to maintain high standards of safety and their applications in aircraft maintenance with respect to the view of human factors are discussed in details. The route of error mitigation and need of high standard technological training with human factor knowledge, to aircraft maintenance students are analyzed in detail with the opportunity of percentages of error reduction.Originality/valueThis study bridges, gained knowledge for aircraft maintenance error mitigation, current accident rates and future training needs for safest air travel through high standard quality maintenance in aircraft and its systems.