Returning to the AfPP’s annual Congress as a popular keynote speaker, Martin Bromiley, chair of the Clinical Human Factors Group, gave a compelling presentation on the issue of patient safety and provided an insight into the reasons why people fail to speak up, or act, to prevent disaster – even when the dangers are obvious.
A well-known figure in patient safety circles, Martin Bromiley has first-hand knowledge of the impact of human factors as a result of the death of his late wife during routine surgery. A subsequent investigation and inquest found that the clinical team struggled with their non-technical skills – such as communication, teamwork, leadership and decision-making under stress. Since then, he has sought to promote an understanding of human factors in healthcare – a strategy already employed in his own profession as an airline pilot.
Using examples of high-profile incidents within a variety of non-healthcare environments, he examined some of the difficulties associated with speaking up and made some comparisons within the healthcare setting.
Highlighting the findings from a recent documentary, he explained that one of the key issues associated with speaking up arises from the need to conform. This was identified as one of the main reasons why so many people, who could have evacuated, died in the attack on the Twin Towers in New York. A number of people believed they would be safe by staying where they were in the building, which had a profound influence on others who felt more comfortable conforming to the general view.
Martin Bromiley also highlighted an investigation of a Kenyan plane crash which found that one of the reasons why the first officer had not intervened, when he saw a serious mistake being made, was that he had been “subdued by the strong personality of the captain”. The captain was described as having “a strong character and a heightened ego, and was known to be authoritative and domineering with subordinates”.
“In aviation, we recognise that this is a very dangerous situation,” he commented. “I would suggest that in some parts of the NHS, this would be considered normal, however.”
He highlighted the importance of understanding the human factors that influence safe working, including:
• The environment.
• Time of day.
• Organisational culture.
• Position with the team and people around you.
• Procedures and systems followed.
• Complexity of the task.
• Personal confidence.
• Technical ability.
• Inter-personal skills.
He reminded delegates that, during their career, they may also be on the receiving end of a “difficult conversation”, where they are challenged over unsafe behaviour.
“There will be times when people find they have to speak up to you – even if they are more senior to you they may find this extremely difficult,” he warned delegates. “You need to ensure that you listen to what they are saying and answer their concerns. Above all, when someone raises an issue, you must ensure you thank them – after all, they could be saving your behind.”
