Preparing to Teach Human Factors

As trainers in maternity we all know how to teach technical skills but much less so the non-technical skills that are so important to deliver safe care. Teaching human factors involves
observing the behaviour of others, assessing its appropriateness for a
given situation and then encouraging reflection and change. All of us are unique and in order to assist others to understand where their behaviours could be improved, we first need to understand our own preferences, predispositions and biases. Which lets face it, is difficult for all of us. An important concept to understand is
the difference between personality and behaviour. Personality is who you are. Behaviour is what you do. But certain personalities prefer certain behaviours. One way of understanding personality is to take the Myers-Briggs Personality Instrument which is influenced by Carl Jung’s study of personality types. This instrument helps us to understand our personality and appreciate the differences between people. There is no best type, there’s just your type. We’re all prone to subconscious biases which form part of our individual cultural and personal makeup. When teaching human factors you’ll need to be aware of your own cultural values and how some behaviours that others exhibit don’t fit the cultural context of the NHS. You’ll then need to decide how best to deal with that. When examining behaviours you have to ask why people are behaving in certain ways rather than just telling them to change. It’s important not to stereotype or treat
people like cultural caricatures and it’s also worth remembering that the
term cultural could refer to a family environment that sets certain standards, the norms for a town or village you come from or the normal behaviours from previous workplaces. You cannot make the assumption that an external feature such as being from a specific ethnic group reflects certain characteristics but you can ask people to reflect on why they feel a certain behaviour is the correct one in a certain situation. You should only use open questions to this effect and also carefully consider how this might be received as well as the correct timing and manner in which to start this conversation. Let’s look at an example. Mandy is an ST3 Registrar in a District General Hospital. She’s managing a PPH and the ST1 doctor can’t get a cannula into the arm of a patient. Mandy’s visibly annoyed and makes negative comments audibly. These negative comments are overheard by the ST1 doctor who then complains that he felt belittled during their encounter. This is going to be a challenging debrief for all concerned but it’s essential as obviously Mandy’s approach needs to change. Here are a few starting points for her trainer to prepare a debrief. As a trainer write down what your preconceptions are and why you think this situation has happened. Do not share these but be aware that during the debrief you’ll be much more open to ideas which seem to prove your own theories about what has happened. Choose a safe, non-threatening environment where
you will not be disturbed. Make it clear that the focus of the discussion is for development and not a judgement of the behaviours exhibited. Ask an open question and listen. Avoid reacting in an emotional manner. Remember to address behaviours and not attack the personality. Close down unhelpful lines of thinking instead encouraging deeper reflection on areas which are really relevant. Avoid drawing your own conclusions but it’s ok to offer reflections on what a trainee has said. At the end, summarise the understanding or the lack of it. Signpost trainees to resources that might help with their development and arrange a follow-up. Don’t imagine that complex problems like this can be solved in one sitting. In this scenario it turns out that Mandy trained in a trust that had been in special measures for the last two years. She had little or no training in leadership and was shocked to learn that the ST1 doctor was upset. She recognised that there might be a better way to do things and showed insight. She took this learning to her educational
supervisor who was able to support this going forward. Understanding our personalities and preferred behaviours is important in becoming self-aware about how we’re implementing human factors in our own everyday practice. All personality types are valuable and having a variety of personalities within
a group helps contribute to an effective team. Damaging behaviours however are
undesirable and need to be dealt with. The key to being an effective human factors teacher is to be able to understand your own
behaviors and improve them and then to help others to do the same.

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