Opening his keynote address – ‘Patient Safety and Human Factors’, Rob Galloway, A&E and ITU Consultant, told delegates that NHS staff could “learn a lot from Wetherspoons and Chinese take-aways!”.
Rob, who works at Brighton and Sussex University NHS Hospitals Trust explained: “Standardisation is the key to Wetherspoons’ products and they use prompt cards for everything – every step in making a Sex on the Beach cocktail is covered, from taking the jug off the shelf to finally charging the customer, so that each drink tastes exactly the same at every Wetherspoons venue.
“And, if you order a Chinese take-away by phone, then the person taking the order repeats it back to you to make sure he has heard you correctly. Wetherspoons and take-aways use these systems to avoid mistakes, so why don’t we in the NHS do the same thing when the stakes are so much higher than a drinking a bad cocktail or getting the wrong rice?
“If it’s good enough for pubs and Chinese restaurants, it’s good enough for us!”
Citing some cases from the past where mistakes were made by hospital staff – not always fatal for the patient but causing death in one particular case, Rob told delegates that poor communication and traditional hierarchical protocols have a direct physical and mental impact on patients, their families and on the medical and healthcare professionals themselves.
“Coping mentally with something like this is very difficult when you know you could have done things differently. We have been doing wrong things for more than 100 years – it’s time for a change.”
The current structure of the hospital hierarchy is flawed, Rob says, so that junior staff are reluctant to speak out if they believe their superiors or even their peers are making a mistake; healthcare staff are afraid to speak up if medical professionals are making an error and generally everyone is worried that if they speak up they sound idiotic – it’s a real problem.
“Hospitals have too many different systems and protocols – why don’t we have standardised behaviours? We can reduce harm but we have got to get over the traditional ways of doing things
“In diagnostic medicine, 15% of patients are misdiagnosed – mistakes don’t always lead to problems, but sometimes they do and these will impact both the patient and the healthcare or medical professional. We have to understand why medical errors occur – plug the gaps that are in the system and do something about it.”
Checklists are a waste of time unless you change the culture and Rob believes that flat hierarchies and multidisciplinary working, where everyone feels comfortable enough to voice their opinion is the way forward.
“We are not perfect and this is why we need to double check everything; we are fallible and human and so we have to embrace human factors. We have to understand and accept our own cognitive limitations and do things systematically, rather than thinking ‘we are professionals, we don’t need systems’. And remember, learn from your successes as well as your failures.”
Not speaking up is a natural tendency, Rob told delegates and the norm is to go along with the group – you need to be given that permission to speak. So if you are a team leader, he said, then give everyone permission to challenge – better for staff, better for the patient.
“Checklists don’t save lives – changing the culture does.”