Designing Healthcare Around the 'Human Factor'

Paris In the the spring

The Magic Number! 7 + or -2

Our

o!ing "trategies

#eneralisation
Deletion Distortion

The Iceberg of Ignorance

Problems visible to senior managers

Problems visible to front line staff

Di$$erent Tribes!!!!

Corporate Services

Childrens Services

Clinical Governance

Social Care

Secondary Care

Acute Hospitals

Add to that%&the Hierarch'!

An Industrial

odel in a !no"ledge #or$er% &elationship Age $no"n as the tree of blame

All this 2riving 3ariation4 #aste and Potential for 5rror66

'( ) *(+ of "or$ doesnt add value for patient up to ,(+ of process steps involve a -handoff./ leading to error/ duplication or delay no one is accountable for the service user -end to end. e0perience 1ob roles tend to be narro" and fragmented #ho listens to the voice of service users and carers

organisational/departmental boundaries
A B C D

Asthma

Diabetes

Mental Health

ancer care

(ach bus holds 7) !assengers

Designing Healthcare Around the Human Factor

om!le* s'stems are not basicall' sa$e& +eo!le ha,e to create sa$et' -hile negotiating multi!le s'stem goals&
"'dne' De..er

Designing Healthcare Around the Human Factor

The !oint o$ an in,estigation is not to $ind -here !eo!le -ent -rong 2 it is to understand -h' their assessments and actions made sense at the time
"'dne' De..er

Designing Healthcare Around the Human Factor

3&+reoccu!ation -ith $ailure 9 all potential problems or errors identified%analysed

/arl 0eic.1s five $ey organisational operating principles re7uired to create an organisational infrastructure for reliability8

Designing Healthcare Around the Human Factor

2&4eluctance to "im!li$' 5nter!retationsnothing ta$en for granted8 Chec$s happen in ultiple "ays

/arl 0eic.1s five $ey organisational operating principles re7uired to create an organisational infrastructure for reliability8

Designing Healthcare Around the Human Factor

)& "ensiti,it' to o!erations 9 all observe ops/ have continuous communication

/arl 0eic.1s five $ey organisational operating principles re7uired to create an organisational infrastructure for reliability8

Designing Healthcare Around the Human Factor

6& ommitment to resilience ) the ability%agility to respond to the une0pected8

/arl 0eic.1s five $ey organisational operating principles re7uired to create an organisational infrastructure for reliability8

Designing Healthcare Around the Human Factor

7& De$erence to e*!ertise 9 decisions are made a"ay from formal authority to"ard e0pertise and e0perience

/arl 0eic.1s five $ey organisational operating principles re7uired to create an organisational infrastructure for reliability8

0hat management model do 'ou ha,e in 'our mind8

That of Command and Control

3ision :;<(

=r that of Coordinate and Cultivate

3ision <(((

oordination focuses on activities that need to be done ulti,ation focuses on the people doing these activities

Designing Healthcare Around the Human Factor

&esults Pyramid) &oger Connors> Tom Smith

9sing Data to 9nderstand :ariation and its 5m!act on "er,ice Deli,er'

Angies trips to Leicester

120 100 80 Min. 60 40 20 0 Consecutive trips

Upper process limit

Mean
Lower process limit

4eliabilit' Failure 2 Free O!eration O,er Time

Manage the "'stem +eo!le

And %%% ;ead the

<=6> o$ !roblems are s'stem ?!rocess@ !roblems A> o$ !roblems are to do -ith the indi,idual1 0&(& Deming

Designing Healthcare Around the Human Factor ;eaders need createB Consistency Clarity of purpose Sho" 5mpathy Give Support ?e Authentic Coach ?e Persistent and Communicate4 communicate4 communicate66 anage relationships anage Transition