Mick Horton FFGDP(UK), Immediate Past Dean of FGDP(UK), Trustee of the College of General Dentistry and the Faculty's representative on the National Advisory Board for Human Factors in Dentistry, discusses how individuals and teams can reduce the risk of mishaps occurring and recurring.
In those heady days last year, when a holiday was an option, I remember my partner Rach and I approached packing in completely different ways. Rach would make a list a week or two before the holiday of everything that was needed and fold it all neatly in piles in the spare bedroom ready to be put in the case. My approach was to finish work the day before, come home and see what was in the wardrobe, then just grab whatever took my fancy. Both approaches seemed to work well for several years, until last year I arrived at our destination and realised I had forgotten to pack any underwear. Thank goodness the local shops came to my rescue; embarrassment and disaster were averted.
It is not the fact that I forgot to pack everything that was the issue, it’s more the events that led up to this and how I could stop this happening in future. I had just finished a long day at work. I was tired, I was holiday-happy, I was thinking about the root treatment I had done that day and whether the new staff member would settle in to the practice instead of concentrating on packing. This series of events led to an undesirable effect; namely me without underwear! I do sometimes reflect and wonder if it is just me that can be seemingly intelligent, organised and carry out precise dextrous movements whilst at work, but then become some clumsy, blithering fool as soon as my holidays start.
How does this relate to dentistry? Well every informed decision we make, the precision with which we carry out our work, the hours of training we put in can all be upset when human factors come in to play. When we are tired or distracted or become complacent about procedures, mishaps will occur.
We are all living in an environment that has changed from that with which we are familiar, we have new processes which must be followed, but both team members and patients can and will make errors. The errors themselves are less important than what we do to reduce them occurring. Traditionally we work in a risk-averse environment, where much of our time is spent ensuring the safety of our team and patients as well as attempting to be compliant with the ever-growing levels of external scrutiny.
Like everyone else I am attempting to work in this peculiar environment we now practice in - far fewer patients with far less complex procedures being carried out on patients should theoretically mean we have more time to ensure we do not have mishaps. If only that were the case. Daily we must remind ourselves of the new standard operating procedures, and the things we took for granted and did every day now seem so much more involved and complicated. For the time being, gone is the smiling face of a team member popping their head round the door asking if anyone would like a cup of coffee when they get a break; in fact just seeing the face of a team member under all the PPE is unusual in these times.
Simple changes such as writing checklists for ourselves and team members, ensuring we all understand the protocols we now have in place, and doing dry runs before those dreaded aerosol procedures, will eventually make our working lives easier and safer. It just seems such a burden to do it all, but once in place life does become easier and a lot less stressful.
If nothing else, the current pandemic has made us re-evaluate our working environment; a shortage of both stock and finances has meant that we, by necessity must become more slick in our approach. We are resilient and resourceful and this has tested our skills to the limit; it is not a question of if we will adapt, more how we will adapt.
As a profession we must attempt to take control of our environments to show external bodies that there are mitigations to the risks posed, and as such less need for external scrutiny. Human factors are recognised throughout all areas of industry as playing a major part in mishaps, but as a profession we are often reticent to share these mishaps for a number of reasons. If we could more fully understand why these mishaps occur and inform our colleagues, then we will better understand what we need to do to mitigate against these.
Our team, and how we interact is vital to the reduction of mishaps. If we accept we are poor at sharing information with other colleagues, we are probably even worse at being open with each other as a team to allow us to speak out or challenge negative behaviour. It takes time to build trust within a team, but only minutes to lose it. These are stressful times for practice principals, but they are also uncertain and stressful times for our team members - we need to make time to listen to their concerns, whether personal or work-related, as they all have a bearing on how we interact. The mental wellbeing of ourselves, our families, our staff and our patients should not be underestimated during this pandemic, and often all we need to do is provide leadership and a listening ear.
We all think we are wonderful at communicating, but when we stop and really analyse if we can pass on instructions, it sometimes feels like we have just played a game of whispers, where the message becomes more muddled or diluted as it is passed on. Many hours could be spent writing protocols and SOPs, but if we fail to communicate these to our team, or leave the team to interpret these without guidance, then we are inviting human factors to play a major role in the outcomes. My two boys often remind me of how poorly I can communicate and how many different ways the same statement can be interpreted; the old adage “tell, show, do” becomes very relevant.
The National Advisory Board for Human Factors in Dentistry, which FGDP(UK) sits on along with several other bodies representing the whole professional team, recently published Human Factors and Patient Safety in Dentistry. The purpose of the document is to raise awareness of human factors and reporting of those mishaps within our environment. The document puts much more eloquently many of the themes around human factors and how they can apply in dentistry. I would urge readers to reference this document and look to improve the culture of understanding why mishaps occur.
Next time I manage to go on holiday I will remember to pack my underwear - I may even make a checklist!
Read more posts at www.fgdp.org.uk/deans-blog.