Improving safety through collaboration, connection and behaviour change
Helping Our Teams Transform (HOTT) is a programme developed at the Trust that uses behaviour nudges, human factors and team building to improve safety, effectiveness and efficiency within teams. The programme’s human factors skills course helps individuals and teams understand their skills, abilities and limitations and how they can best use their capabilities. The programme also offers in-situ observation and coaching, simulation training and facilitated conversations. Here, facilitators Dr Dimitri Amiras, consultant radiologist, and Miss Clare Rees, consultant paediatric surgeon, explain why they became facilitators for the HOTT programme and how they think it can help staff from all areas improve they way they work together.
How did you get involved with the HOTT programme?
Clare: I’ve always been interested in human factors – how we interact with our environment and how that affects patient safety. I really enjoyed the programme so I signed up to become a facilitator.
Dimitri: I signed up to the human factors training sessions during lockdown. It reinforced a lot of things I was thinking about the way we practice medicine, and I thought it had a novel approach to patient safety. I signed up to become a facilitator.
How does the programme work?
Clare: Today, most of the sessions are conversations or simulations that are facilitated online via video calls. We run half day online courses in human factors and team coaching using the technique of Conversation Cafés, as well as team simulation training. We explore the ‘dirty dozen’ human factors – the 12 most common factors (including fatigue, stress, and lack of teamwork) that result in errors across safety-critical industries, including healthcare. Facilitated conversations form a big part of the training – a facilitator will help the participants explore challenging scenarios, how their behaviours affect others, and how we can challenge norms that might hold us back.
What did you find most striking about the programme?
Dimitri: As doctors, we’re trained to compete and be the best, so some of us can struggle to admit our faults or discuss difficult issues. This approach challenges that instinct to compete. It flattens the hierarchy, so everyone on the course, no matter their role or level, has the same opportunity to speak openly and freely about their experiences. Hearing and understanding the experiences of nurses, AHPs and together understanding shared goals with our patients was inspirational and enlightening. Working in a pressured environment we often forget we share the same goal. The programme improves communication, psychological safety, and team members’ understanding of each other’s roles. As a result, it makes a real difference to patient safety.
Clare: This is one of the only cross-professional training opportunities there is, and I think that’s one of its massive strengths. Part of the training is about understanding what is and is not in our control. In anybody’s job, you can only control about 15 per cent of your time of what is going on around you-;the remaining 85 per cent is beyond your circle of control . So we ask, “What will you do to make a difference with that 15 per cent?” It’s incredible to see how people respond – they feel empowered to make changes. They immediately start thinking about what they can do the next day to help their team work better. One of nurses who attended HOTT conversations said it helped people to open up and really speak up for safety and felt it would bring their team together. ‘I don’t feel so alone in this anymore’; it feels good to be part of something that positively impacts culture and people’s feeling of empowerment.
How does the programme facilitate collaborative working?
Dimitri: We talk a lot about unkindness and incivility, and the consequences of those behaviours. Former medical students might remember being the butt of jokes and feeling like they are under so much pressure to always have the right answer. But if you are afraid of being ridiculed, you won’t learn.
In the media, when you see serious incidents reported, often you’ll see that people knew something was going wrong but were afraid to speak up. This programme is about empowering people to speak up and creating safe spaces for people to be honest.
Clare: One of the things we talk about is that you bring your stressors to work – you cannot pretend that a difficult commute or a disagreement with your spouse won’t have an impact on your day. But if you acknowledge it with your colleagues and put it to one side, you can get on with your day. When everyone on your team feels empowered to be honest in this way, you can work better together.
How has the programme changed the way you work?
Dimitri: The biggest thing I’ve learned is to remember to enjoy and love my job and be present in every moment of doing it. That’s what I went to medical school for. It’s easy to forget that when you’re busy or overworked. But the project has allowed me to remember why I love doing it.
Clare: I’m the surgeon leading my team, so I’m aware my leadership matters. Me voicing my vulnerabilities enables other people to do the same. It changes the way people interact. When my team did this programme, there were people who were sceptical of it. But afterwards, everyone behaved differently. Everyone brought a better game.
Because this is all about situational awareness and behaviours, it doesn’t fizzle out. It’s a non-punitive, non-judgmental training approach that enables staff to be more open about their challenges and how they can improve. And it really works.
To learn more about the HOTT programme, contact imperial.hott@nhs.net
