About our guest
Ben is a former international athlete, competing in several World Championship events with the Great Britain rowing team, whilst completing his degree in Leadership & Sports Psychology at Reading University. The combination of these experienced laid the foundation for Ben’s interest in optimising individual, team and organisational performance and when forced to retire from competing through injury, Ben turned to coaching and within 4 years had produced National Champion crews and international selections in roles in both the UK and South Africa – culminating in taking the South African Women’s Team in 2010 to their most successful ever World Championships. Ben describes a key realisation in his coaching experience;
“Very often the differentiators between the good crews and the best crews, the good athletes and the best athletes, had nothing to do with rowing. They were almost always the non-technical skills, for example how people managed pressure or how well they worked together as a team”.
This realisation led to a desire to apply the principles of high performing teams to other areas, and after several years working with corporate and individual clients, became drawn to working with teams in healthcare. Ben has been developing and delivering training and support in Human Factors and Performance Improvement to healthcare organisations since 2013, and founded MedLed in 2017 with the desire to broaden the scope of practice and bring together a diverse team with complementary skills. He still actively delivers training, support and coaching, as well as growing and developing the MedLed team.
Outside of work, Ben’s passions include fishing, rugby, travelling and anything that involves being outside in nature.
Overview
Listen to Ben talk about human factors – what that means, and what impact its consideration could have in not just healthcare, but all industries.
Ultimately, human factors breaks down into people and then processes. Human factors is the study of designing for people: designing systems, processes, rules, guidelines, ways of working, and in particular precedent that has implications in high-risk environments like healthcare and the aviation industry.
Of course, to a lot of people, human factors has a more behavioural focus: that might mean looking at how teams operate, how teams communicate, how people manage pressure, and looking at individual resilience.
What actually is human error? Are there certain realities of the way that we process the world around us, which means that although, with the benefit of hindsight, a mistake might seem ‘obvious’, could it have made sense at the time?
A lot of what L&D tends to measure is whether people have understood what the rules are, what the processes should be, but not actually how well they apply them, and how they apply them in stressful situations.
Top quotes
- If you were to think about an A&E department, you can’t standardise everything out. You can’t design everything out. You’re very reliant on naturalistic decision-making, and experts making judgements on the move, in dynamic situations, so yes, we can design systems to help them in that, but equally, there will probably be more of an emphasis on how teams work together, in environments such as these.
- Human error just means we haven’t figured out what happened yet, and why. What nature of error was it, and was it simply that people working within the system, where it was almost impossible for them to get it right, or it certainly made it easy for them to get it wrong, to set them up to fail?
- Very often, processes and rules are put upon people, often by others who don’t understand the day-to-day work as well as the frontline operators. So, it doesn’t mean it’s done deliberately to make people’s lives difficult, but it’s applied to the work they imagine is being done.
- People have to make judgements. It’s amazing how often people get it right. We love to focus on when they get it wrong, but it’s amazing how frequently they get it right in challenging situations.
- You know, I think the pursuit of perfection is a destructive goal, but function optimally, and minimise and optimise performance, I think are constructive goals.
Transcription
Owen Ashby:
Welcome, Ben Tipney, Ben is from MedLed, a really interesting organisation that looks at human factors, and I think the clue is probably in the title about your main focus. Why don’t you tell us a little bit about your background, Ben, because I think that’s really a key component of what you do, and why you are where you are, and why you’re very successful at it, and why we’re working together, I guess, and what, as an organisation, you’re focused on?
Ben Tipney:
Okay. Well, firstly, thanks for having me, Owen. Yes, so my background’s quite varied. I studied leadership and sports psychology at university, some time ago, about fifteen years ago, and I was part of the GB Rowing Team at the time, so I had the experience in human performance from that perspective, as an athlete.
I actually got injured fairly early in my career, so I was about 23, and I was involved in coaching and running itself, and one of the things that fascinated me was that obviously, as anyone who’s involved in sport will know, that technical skill is only part-, like, one component of performance. How people deal with pressure, how teams work together, and the systems that are set up around those people, whether the systems set them up to succeed or fail, is equally if not more important.
I suppose the short version of it is, I’ve spent the last twelve, thirteen, fourteen years involved in looking at the nature of performance across a number of different spheres. I spent a lot of time working in education, I’ve done various bits of work in corporate environment, and sports teams, obviously, and for the last four or five years, specifically working in healthcare, looking at what affects performance. Interestingly, specifically looking at the field of human factors, and around that field, there’s a fair amount of debate going on at the moment about what it really is, and what it really isn’t.
Owen Ashby:
I’m going to ask you to clarify, define that for everybody. I think maybe it means different things to different people, and I guess that’s the point. So, what do you mean by human factors?
Ben Tipney:
So, there are two angles to look at human factors. From a purist, certainly from an academic perspective, human factors is the study of designing for people, so designing systems and ways of working that, you know, might often be-, they could be anything from how you design a workstation, a chair, you know. The layout of a car, something like that, for ease of usability to improve performance and to improve wellbeing, but that can obviously also be systems, processes, rules, guidelines, ways of working, and particular precedent has implications in high-risk environments like healthcare, aviation industry, things like that. Of course, to a lot of people, and this is particular what’s happened in healthcare, human factors has a more behavioural focus.
So, human factors might be looking at how teams operate, how teams communicate, how people manage pressure, and looking at individual resilience. Looking at it from that angle, and I think that provides a real challenge, because a lot of the interventions in healthcare, because they’ve largely been based on aviation CRM training, and we can revisit that in a bit if you like-,
Owen Ashby:
That’s crew resource management?
Ben Tipney:
Crew resource management, that’s absolutely right. The emphasis has been very much on changing behaviour, and I think quite rightly, some people have said, ‘Well, that shouldn’t be the only focus. We should be looking at systems, so if people fail, how you can change the system.’ So, I come at it, because I’m not an ergonomist, that’s not my background, equally, I think it’s absolutely right to look at systems.
I think looking at it from a, sort of, outside perspective, I think the nature of variation in healthcare means that how you balance those two focuses needs to change, depending on the demands of the environment. So, for example, in some highly controlled environments, like doing a blood transfusion, and of course, the similarity there is with something like commercial aviation or a nuclear power plant, where it’s low levels of variation, high levels of reliability generally, sort of, procedural compliance. Very much, base system safety, or what people might call Safety-I, is very much the best way. You’re trying to minimise, really, the amount of variation in behaviour. Right down to the other end of the spectrum, which is something, you know, if you were to think about an A&E department, you can’t standardise everything out. You can’t design everything out. You’re very reliant on naturalistic decision-making, and experts making judgements on the move, in dynamic situations, so yes, we can design systems to help them in that, but equally, there will probably be more of an emphasis on how teams work together, for example, in environments like that. Of course, that’s a sliding scale. There’s everything in between.
So, I think one of my focuses is I see myself, and MedLed, as trying to fill that gap, I guess. So, we have ergonomists working with us, we have people from either high-risk backgrounds, high-performance backgrounds, working with us. So, we provide various, sort of, consultancy training, and service and input.
Owen Ashby:
Great. That’s a really good explanation of what human factors is. So, it breaks down into people and then processes, ultimately.
Ben Tipney:
Yes. It’s breaking down-, a lot of the time, when things go wrong, you’ll get an explanation, almost a bullet point, that says ‘human error’. It’s a common thing, you know, to open a paper often, there are various disasters, and they’ll say, you know, ‘Human error is cited as the root cause.’ Of course, that doesn’t mean anything. Human error just means we haven’t figured out what happened yet, and why. What nature of error was it, and was it simply that people working within the system, where it was almost impossible for them to get it right, or it certainly made it easy for them to get it wrong, to set them up to fail? Or, was it simply, you know, looking at the nature of human limitations, there are certain realities of the way that we process the world around us, which means that although, with the benefit of hindsight, a mistake might seem, in inverted commas, ‘obvious’, a lot of what we’re trying to do is help people think about, you know, why does it make sense at the time? If you work out why it made sense at the time, you have a fighting chance of understanding why it happened.
Owen Ashby:
Of course, it’s sort of multifaceted, I guess, and much more complex when you have a team of individuals, rather than just that individual that you’re working with. So, we look at how people touch processes, if you like. A lot of what L&D tends to measure is whether people have understood what the rules are, what the processes should be, but not actually how well they apply them, and how they apply them in stressful situations. That’s the reality, isn’t it? So, it’s different if you’re trying to pass a maths exam, as opposed to running an operating theatre. Then, I guess you’ve got a further component, where you have a level of hierarchy in an organisation, potentially a level of, sort of, built-in expectation around who the decision maker is, who the leader is in your team. How does that, kind of, manifest in the work that you do?
Ben Tipney:
Yes, there are kind of two things there, I guess, and your first point there, one of the things I allude to is the difference between ‘work as imagined’ and ‘work as done’, so very often, processes, rules, for example, are put upon people, and often by others who don’t understand the day-to-day work as well as the frontline operators. So, it doesn’t mean it’s done deliberately to make people’s lives difficult, but it’s done with work as they would imagine work is being done. Particularly in the NHS, with the stretched resources, understaffing, increased demands, you know, one of the real challenging things in healthcare today is that the last couple of decades, with improvements in healthcare, we’re now dealing with people with multiple co-morbidities, and very complicated conditions, which simply wouldn’t have survived a few decades ago.
So, it’s almost impossible to have a set of protocols that provide for every patient. So, people have to make judgements. It’s amazing how often people get it right, despite those difficulties. We love to focus on when they get it wrong. It’s amazing how frequently they get it right in challenging situations. So, I think that’s one of the issues, and part of it, if you take a human factors lens to an organisation, it’s trying to get-, one of the key things is getting more involvement from frontline operators in how work is designed. Particularly around the processes, the rules, the guidelines that they’re working within.
That second piece, as well as really-, it can be a huge factor in whether teams and departments function optimally. You know, I think the pursuit of perfection is a destructive goal, but function optimally, and minimise and optimise performance, I think are constructive goals.
Yes, natural hierarchies can be a huge issue. I think in almost every single incident that I’ve ever looked at, there was someone, at some point, who noticed something unusual or something wrong, or something uncomfortable with, that very often, if they were a more junior member of the team, it either was not said, or it’s said in a very deferential way, with a hint and hope.
Owen Ashby:
Yes, hint and hope.
Ben Tipney:
You know, people drop gentle hints, you know, ‘I wonder if you’ve noticed-,’ rather than, Have you seen all that blood on the floor?’
Owen Ashby:
Yes.
Ben Tipney:
Getting past that can be complex, and there’s a lot of really interesting research at the moment by a lady called Christine Porath on civility, and her research has found that rude behaviour is significantly correlated with poor patient outcomes, increased staff turnover, and all sorts of other metrics. Actually, if you think about it, you stop for a moment, you think, you know, if someone senior to you in the organisation was rude to you in the morning, does that make it more or less likely that you share a concern with them, later in the day?
Owen Ashby:
Exactly, yes.
Ben Tipney:
When you’re not happy. That behaviour might not even be on that day, and they might be quite subtle things. It might be quite subtle, passive aggressive behaviour, and over a period of weeks, months, years, and so the sort of working culture is hugely important. That what people might think are quite simple things about how people behave towards each other, day to day, can have huge impact on outcomes for staff and patients. So yes, that’s obviously a key focus.
Owen Ashby:
So, there are two sides to that coin, of course, aren’t there? There’s the individual who might have a concern that they need to raise, and they need to have the confidence to be able to raise that in a way that is effective, and on the other side of the coin is that the recipient needs to have a level of emotional intelligence and self-awareness, not just of themselves but of the situation and the pressure of the situation, to be able to accept that challenge. It might be, the challenge might be well-intended but inaccurate, and they need to know how to handle that too.
Ben Tipney:
Absolutely.
Owen Ashby:
So, I think I’ve been really interested in people like Anders Ericsson. So, his work in Peak, where he was looking at how surgeons ultimately become, I say become, more confident in their abilities. They’ve been doing it for longer, they get into automaticity, and so they actually, technically, become less competent, but they’re much more confident. People are less likely to challenge them, and I think this is where-, so, Matthew Syed, and his Black Box Thinking, starts with Martin Bromiley’s wife, and that unfortunate story. Exactly that scenario, where everyone became suddenly tunnel visioned and myopic. The challenge didn’t get heard, or didn’t even get raised as a result, you know, and ended up in tragedy.
Ben Tipney:
The interesting thing, and you mentioned Matthew Syed, and Black Box Thinking. You know, that sort of cognitive dissonance that comes with, you know-, and ironically, the more intelligent someone is, the better their brain is at convincing themselves-, convincing, at a subconscious level, that what they’re doing is the right thing.
Owen Ashby:
Okay.
Ben Tipney:
It’s amazing, when we have a mental model of what’s going on, what we expect. Even if you really understand human limitation, so for example, you alluded to tunnel vision, and you alluded to automaticity.
Owen Ashby:
Automaticity, it’s a dreadful word, isn’t it?
Ben Tipney:
It is a terrible word, but I think hopefully, everyone knows what you mean by that. You know, sometimes, it might be stating the obvious, but just getting people to think about the fact of their own nature, the fact that you know, when you’re new at stuff, it’s hard. You have to do it consciously, you have to think about it, it’s hard work, it takes a long time. It can be frustrating to work with. The flip side of that, of course, is that when you’re highly skilled, you can do things quickly, and you actually, you’re really good, most of the time, at making quick, accurate judgements in difficult situations. Of course, because every now and again, something seems to fit the picture, but you’ve missed a piece of information, or you’ve misinterpreted a piece of information, that affects your mental picture, which therefore means you start automatically going down a path that might not be the right path. So, you know, we obviously spend a lot of time in our training, sort of, working on that, getting that through to people, and I think the assumption is sometimes that, ‘Well, now I get that, I’ll recognise it when I’m heading off down the wrong road.’ The reality is, no one does. So, I teach this stuff for a living, have done for some time, I was on holiday a few weeks ago in Cornwall, doing a walk, and the directions of the walk had been given to us by the B&B where we were staying, and I remember looking at it, going, ‘I think there’s some scope for ambiguity in these directions.’ I raised the concern with my wife, but perhaps I should learn from my own teaching here, I allowed myself to be persuaded to going anyway. Sure enough, about an hour into the walk, we suddenly think,
‘Something doesn’t feel right here, but that tree though, that must be that thing on this direction,’ so what you start seeing, of course, you start making sense of what’s in front of you, based on what you’re expecting. ‘Since there’s a ridge, that must be that bit over there.’
Owen Ashby:
Yes, yes. You try and make it fit for you.
Ben Tipney:
Exactly. Then, of course, we slip into the destructive goal pursuit, as the path starts to narrow, and we’re starting to go into denser and denser bush. My wife says, ‘Maybe we should turn back,’ I say, ‘No, it’s fine, we’ll keep-,’ you know, entrapped commitment of heading off. We’ve committed to this path now. Then, eventually having to-, when the path actually ended in a great big rose bush, having to admit defeat and backtrack in a very grumpy manner.
It was a great, kind of, reminder, that actually, no matter how well you know this stuff, we’re all susceptible to these biases, you know, our mental models, formulas, subconscious thoughts, without realising it. That’s why we have to be willing to listen to those around us, and actually, ironically, it’s very often the less experienced people around us who spot the glaring-, what might in hindsight, seem the obvious error, the obvious submission, the obvious thing, because they’re not in that automaticity. They haven’t got the bank of mental models. They’re having to consciously process what’s going on around them. They’re much more likely to go, ‘Are you sure that’s the right-,’ and, however, they’ll only do that if you’ve created the right emotional climate, and so sometimes, very simple things, the way people interact at the start of a shift, whether they even have some form of briefing or team meeting before you start what might be a busy shift, open the channels of communication. How people introduce each other. Their body language when they interact with their colleagues at the beginning of the working day. These sound like such little things, but they can massively impact performance. Not just that day, but on future days.
Owen Ashby:
Yes.
Ben Tipney:
These things are very rarely a quick fix. It’s usually an ongoing challenge, which is partly what makes it fascinating.
Owen Ashby:
It’s definitely fascinating. Humans are endlessly fascinating, and then putting humans in different situations and positions, and effectively adding stress points, and hierarchies, and all sort of things, it’s just as well we don’t rely on them to save our lives and things. It’s those kinds of environments.
Ben Tipney:
Equally, so humans, we are inherently limited, but also, we have amazing capacities as well. So, one of the big developments is learning, you know, and for those who are interested in, sort of, safety science, will know that moving from Safety-I to Safety-II, and Safety-II is not just learning. Well, among other things, it means not just learning from things that go wrong, but learning from day-to-day work.
Owen Ashby:
Right.
Ben Tipney:
So, instead of looking at the nought-point-something percent of times that things go catastrophically wrong, or the still low percentage of times where things nearly go wrong, obviously there’s the top. You can look at the top 5% of outcomes. So, look at our best practice. So why, on challenging days, do you get it right, when actually, you didn’t even think you’d get it right, you know? What’s your top? Also, just the day-to-day practice. How, in complicated situations, do people manage to get the job done? I think that’s-, so, sometimes people simplify it as learning from success, rather than learning from failure. It’s a bit more than that. It’s actually learning from, how is it that certain teams, in certain situations, manage to just get work done? It sounds like a very simple thing, but for anyone who’s spent any time in a hospital, or (inaudible 00:18:47) community healthcare is even more complicated. How, and actually, I don’t think we often analyse that enough.
Owen Ashby:
So, how do you take that from a really interesting, sort of, psychological self-reflection and analysis for a team, into something that’s codified and tangible, that an organisation can deploy or measure, or get some kind of, you know, you said incremental benefit, from-, how do we turn that into something that has some substance, rather than-,
Ben Tipney:
Just, yes. It’s always, they’re all nice ideas, aren’t they?
Owen Ashby:
They’re all absolutely accurate, aren’t they, but how do you deploy something? What is it you deploy to provide that framework, or is it simply about raising consciousness among people to say, ‘Actually-,’. I think your point is absolutely bang-on about creating a culture that allows for people to raise these things, or at least consciously doesn’t provide blockers, if you like.
Ben Tipney:
Yes.
Owen Ashby:
How do you start to-,
Ben Tipney:
Well, that’s one key thing. Obviously, at my pro level, that might be the, sort of, simple day-to-day thing of, (TC: 00:20:00) at the sharp end, making sure that we create the right emotional environment for people to be able to openly communicate and share concerns with each other. Maybe there’s seniority, but that goes all the way up to the top level as well. You know, how do people in the organisation, at the sharp end, feel about sharing ideas?
It’s one of the things that’s interesting when you look at the NHS staff surveys, over the last few years. There have been improvements in certain areas, and certainly, obviously there’s variation from trust to trust, but one of the areas where there still seems to be a sticking point is frontline staff feeling that if they share an idea or concern with senior management in an organisation, that something will change. So, quite commonly, people feel that someone will let them share it, that they might be listened to, but that people are much less confident that something will change. Again, I genuinely believe that, you know, pretty much everybody working in our NHS, that those people are doing their best, and you know, that’s everything from your Band 1 and 2 staff, all the way up to senior executives, and that they have huge demands on time, but I think being able to somehow bridge that gap. So, that culture, and I think one of the big issues there is there’s a gap between perception and intent. So, very often, staff in an organisation will feel that their fear is that if they report a problem, that they’ll be blamed for it. If they report a mistake, you know. So, for example, if they’ve reported a near miss, or, ‘We nearly did the wrong thing today, but nothing really happened, the patient was fine,’ if they report that, they’ll be blamed for it.
It might well be that actually, the people that work in risk in governments, and at a senior executive level, would have no intent to do that. They advocate a learning culture, what we’d call a just culture, where people aren’t unfairly blamed for mistakes, as long as it wasn’t reckless.
Owen Ashby:
In reporting-,
Ben Tipney:
In reporting, they want people to report, so we can learn, but somehow, that message isn’t getting through, and I think it’s easy, at quite a senior level, to forget about the stages of separation, and just because if I’m a chief exec or a medical director, just because I understand, and I don’t want to blame anybody for their mistakes, doesn’t mean they know that. I think it’s easy to put posters up, and to put banners up, and put stuff on your intranet, and you know. I’ve seen loads of good stuff being shared, like that, around hospitals and trusts around the country, but actually, having a strategic plan, a communications plan, much in the same way that any company would have a marketing plan for getting their message out there to reach their customers, in a trust, it’s exactly the same. In a trust of 5,000, 10,000 people, you’ve got to have a strategic plan for getting that message through, and I think that’s often a sticking point. So, just linking that, as you said, culture, but ultimately, how you approach making change, it varies organisation to organisation. I think one of the challenges you mentioned, how do you find tangible outcomes? One of the challenges is that the primary outcomes that we’re looking for, so things like morbidity, mortality data, reduction in serious incidents for example, A, you need a long time to measure that, and B, there are so many variables contributing to the number of those. Proving that any intervention was the cause of a reduction in incidence, rather than simply a correlation, is almost impossible. However, what you can do, is look at things that we know can be linked to that. So, for example, a recent meta analysis looking at safety culture. So, for example, it found that on several measures, one of which was psychological safety, was shown to be correlated significantly with patient outcomes.
So, it’s a meta analysis for safety culture data across the healthcare industry. You know, so we know that psychological safety in an organisation has significant correlations for patient outcomes. So, you might not be able to measure the result of your intervention against patient outcomes, but you can measure your intervention against a measure of psychological safety, for example. Or, of course, you can be looking at things like the staff surveys, you can be looking at things like safety attitudes. So, safety attitude questionnaires. We can be looking at things like other forms of staff experience and morale, like staff turnover. So, there are various qualitative and quantitative measures you can take, and I guess it varies in each organisation, depending what they think their particular issues are.
Owen Ashby:
Yes. It’s certainly a hugely complex, hugely complex subject, and it sometimes seems to me that where things get complex, people look for a simpler deliverable, or a simpler solution which says, ‘Well, we’ve trained everybody,’ and you know. A lot of what-, you know, to bring it to something almost too simplistic, is kind of like ‘(inaudible 00:25:12), we have a training course for that. Yes, but the tick-box man that you’re training is not the same as people having to work in a team, having to work under pressure. So, I think the healthcare environment is such a significantly challenging and pressurised environment. How do you see that being-, you know, how do you see other safety-critical environments, either it being like, or what are the lessons we can learn that maybe the airline crew resource team, resource management, into healthcare, and how does what we’re potentially learning in healthcare contribute to some of those other safety-critical areas, do you think?
Ben Tipney:
Yes, it’s a really good question.
Owen Ashby:
It’s quite a hot topic. I may have embellished it a little.
Ben Tipney:
That’s an interesting point, and it’s quite a hot topic in healthcare at the moment, in that I think there’s a kind of growing frustration of single industry comparison, and the most common one is with commercial aviation. In fairness, there’s some logic in that to start with, because you know, 20-30 years ago, safety wasn’t as good as it is now in commercial aviation. It is true that the integration of human factors into the industry had a massive impact on safety. You’re talking hundreds of percent worth of improvements in safety. Of course, what I think often happens is a lack of recognition that that input was at many levels. So, of course it was in engineering, it was in aircraft design, and it was in how people work. So, crew resource management, we’re looking at training operational crews in (mw 00:27:04) flight decision making, situational awareness, and leadership, and communication, and some of that’s classroom-based, and some of it is then obviously linked to what people do at the simulator. Of course-, and I think it did have a big impact, and you know, for example the crash in 1989 at Kegworth, you know, just low down next to the M1. You know, that loss of situational awareness and (mw 00:27:30) actually heavily linked to a steep hierarchy gradient, people at the top of the chain not necessarily hearing information from people further down, was a factor, and I think most people would agree that introduction of CRM into the aviation industry created a more open culture. A culture where having more open conversations across levels of hierarchy and operational level was now a way we do things. I’m sure that had an impact on safety, and I think crucially, it created a culture, and I think this is easier when you have a single regulatory rather than fragmented regulation. You know, privatised industry. It’s much simpler.
So, now it is true. That introduction created a culture where now, it’s a norm to report mistakes, and it’s norm to accept that we make mistakes. Those are reported, and of course at an engineering level, if you hear about mistakes, you can tweak design, you know. So, for example, instead of designing switches that all look the same, you design switches that look different, that do different things, so that it’s more intuitive to use safely. You only get information if the frontline operators tell you about it, and you have to create the right culture. So, I think that had a big impact, and again, from my perception, and most of my family are either pilots or ex-pilots, so I get this, yes. Both my dad and stepdad were trained (mw 00:28:58) British Airways. Actually, my brother, who works for that company, flies for TUI. You know, I get a lot of information from them about the realities of working in that industry, and I think it’s true to say that that had a big impact quite early on. You’re talking early 90s. I think a lot of the people that receive CRM now, because it’s just part of the working culture, when they receive their CRM training, will say the quality is very variable, and they’re not convinced that it actually makes any difference now.
Owen Ashby:
Oh, really?
Ben Tipney:
Again, I’m talking to people who have a background in education, but work in the aviation industry, who will say it’s not a fault of the concepts, it’s a fault of the quality of delivery.
Owen Ashby:
Okay.
Ben Tipney:
So, from a pedagogical perspective, it’s not high-quality education. Well, it’s variable in its quality, therefore its variable in its efficacy.
Owen Ashby:
Is that because it’s been in place for a while, and there’s a level of complacency around it? (TC: 00:30:00) Are they adding any new stuff to it?
Ben Tipney:
Well, I think there are updates. I think there are two things with it. One is that to be an instructor, a CRM instructor, you do a five day course, and you have no obligation to do further CPD. When you think to be a teacher, you have to do a year’s worth of postgraduate study, and you have to do ongoing CPD, and teaching is still challenging, which you do that, so I think that’s an issue, from an efficacy. Again, talking to people who I know in the industry, it’s the lack of efficacy and training will never get exposed, because the systems are now so safe. The chances of something going wrong on a commercial airliner are about one in 17 million, today, as we are.
Owen Ashby:
That’s a reassuring fact for my mother-in-law.
Ben Tipney:
It’s incredibly safe, which-, one of the most, in inverted commas, ‘common’ emergencies is an engine fire. I don’t know any pilots who have ever had an engine fire, touch wood, because my brother’s still flying, but I don’t know any pilots who have ever actually had one. So, the systems are incredibly safe. So, breakdowns and it will fail, or poor training is unlikely to be exposed. So, what’s happened, the relevance of this is that I think over the last ten or fifteen years, what’s happened, and I think this is where the frustration comes from the ergonomics community, is that then, healthcare looks at that. The people who are in healthcare said, ‘Well, if we do CRM training, we’ve done human factors.’ Which A, is obviously not true, because if you haven’t considered systems, rather than simply the training, making the point in inverted commas, ‘human factors training’, you haven’t done it, and also because even if you are looking at the behavioural side, it isn’t just a quick fix. Healthcare is massively more challenging and varied than commercial aviation. So, I think it is absolutely right that we should look at both the systems, and we should look also at act behaviour and interventions, because of the varied nature of it, but I would say when you’re looking at human performance, team performance, and any form of behavioural intervention, most of the expertise and evidence from that is from fields like education and elite sport, and other high-risk environments. It doesn’t mean that, actually, all the concepts originally developed in the aviation industry don’t have value. They do, usually, but they’re one of many bits that you can take learning from, and I think that’s-, so, my interest is looking at lots of different avenues, and trying to pick out common strands.
You know, there is some really interesting work going on with the fire service at the moment, for example, that you know, down in the southwest, and where they’re developing all the interesting ways of what they call ‘tactical decision-making exercises’, and using virtual reality. As you know, there’s some really good work going on in Nottingham with a simulation team.
Owen Ashby:
I used to be a part of that.
Ben Tipney:
Yes. So, there’s a lot of really, really high-quality work going on, in terms of where healthcare’s looking to develop what we call non-technical skills, that you might argue, has almost gone beyond a lot of what happens in aviation. So, it’s an interesting time, I think, at the moment. There’s scope for cross learning in multiple directions, between multiple industries and areas and domains.
Owen Ashby:
Brilliant.
Ben Tipney:
So, I try as much as I can to connect those.
Owen Ashby:
Yes. What an interesting thing you do. Just bring to life a bit, for me, specifically how the sporting background and experience is brought to bear in the work that you do. I mean, I think it’s probably obvious, and a bit implicit, but specifically when it comes to team working, it would be interesting if you’ve got some thoughts around how that manifests.
Ben Tipney:
Yes, and I think it’s another one where there’s a lot to be gained, but you have to exercise caution. One of the reasons I say you have to exercise caution is because sport has several advantages. There are several advantages in sport over business, in general, and particularly in high-risk industries. One of the benefits sport has over most other areas of work is that in sport, you spend 90-95% of your time preparing for 5-7% of your time performing. You know, even if you pair match, or have a race every weekend, you’re still probably talking about 85-90% of your time preparing to performing. Some sports, it’s even more than that. Whereas in business, and of course, in most high-risk industries, you’re probably spending over 95% of your time performing, if you like.
Owen Ashby:
Yes, of course.
Ben Tipney:
Actually, very little time preparing, i.e. getting to go and do CPD, and things like that. So, a lot of the learning has to come from your performances. You don’t get the same amount of time and preparation and training, so you have to do more of that. That’s where your systems and culture around the learning have to be robust. You can’t afford to just keep sticking people on training, and we’ll come back to that, especially if training isn’t targeted. I know we’ll come to that. The other advantage is, in sport, when you are training, you can push people to failure and get it wrong, and you’re not going to kill anybody. So, you can learn from failure. It’s easy. It’s a no-brainer. You don’t have to convince anybody to learn from failure, but in high-risk industries, the concept of learning from failure is a difficult one. Learning from failure doesn’t mean that in any way we’re saying you should just go out and try and kill people, so that we can learn from it, but it’s accepting that we will fail. Human beings will have lots of millions of tiny little failures in life, and then there will be some bigger failures, and it’s always the combination of little ones. As I say, particularly because it’s 90-95% of your time performing, you have to learn to create an environment where that’s okay, and it’s okay to discuss it, and learn to be able to fail safely. If you can fail safely, and discuss and learn from it, you have a lot less of the big failures.
Owen Ashby:
Sure.
Ben Tipney:
So, that’s one of the big advantages of sport, but that said, yes, there is certainly a lot I’ve learned, particularly about how teams work together. What does a team actually mean? It’s one of the things I often say to people in organisations, you know, ‘Do you have teams here?’ A lot of people say, ‘Of course we have teams,’ you know. (toeo 00:36:31). ‘Well, we have teams, and we have this team in this department, we’re here to work on teams of our own, of course we have teams.’ I say, ‘No. Do you have teams, or do you have collections of highly skilled individuals?’
Owen Ashby:
Yes.
Ben Tipney:
That is not the same thing. That was really interesting, looking at the-, if you look at the last World Cup for example, you know, why have England done so much better under Gareth Southgate? I’m not a big football fan, but you couldn’t help but get caught up in the last one. Why have England done so much better under Gareth Southgate than they have previously, at previous World Cups? Is it because we have more talent? Is it because they’ve got more resources? I don’t think many people would suggest that either of those are true. Or, is it that they now are a team that’s more than the sum of their parts? That know they’re less of a collection of individuals? That doesn’t mean that I’m suggesting that any of the previous England teams that turned up to World Cups turned up with the intent to play as individuals. I’m sure they turned up with the intent to play as a team, but there’s a difference between having the intent to be a team, and putting in the work that’s necessary to actually be a team. So, you look back to the Euros a few years ago, and you look at England being beaten by Iceland. A very good example of a team against a collection of individuals, a team with a lot less talent, a lot less resources, beating a collection of individuals. England have sort of gone, you know, to turn that around. The thing is, if you’ve got talent in your team, and you perform as more than the sum of your parts, that’s where you get real success, and there’s no doubt that the NHS is full of talent. It’s full of highly skilled, highly intelligent, good people. Highly motivated. Well, you can kill their motivation by-, think, you can’t make people motivated intrinsically. People are either intrinsically motivated to do something or they’re not.
You can try and extrinsically motivate them for a while, with incentives or punishment, but we know that that’s very short-lived. You have to keep moving the goalposts. So, people who (inaudible 00:38:29), tend to be intrinsically motivated to start with, but you can destroy that motivation in various ways. Making them work in unsafe systems, and then blaming them when it goes wrong, is a very good way to destroy people’s motivation. Them not feeling appreciated, and not feeling that what they do makes any difference, that’s a very good way to kill motivation. People not feeling like they’re developing is a very good way to kill motivation, and of course, people that aren’t developing, ‘We’ll give them so training.’ Yes, but is the training working for them? That’s the key thing, isn’t it?
Owen Ashby:
Absolutely. It’s interesting, because of course, the NHS has a significant retention problem right now.
Ben Tipney:
Which of course is then one of the metrics you want to look at.
Owen Ashby:
Yes, absolutely. So, you talked about training and learning and directing people to apply bits and pieces, and those kinds of things, and as you know, a lot of what Cognisco is about is, to use a medical term, the triaging of training, and investment in training. It says, well, you know, ‘We can truly identify what people really need to do, so rather than people doing everything, they do the bit that they need to do to move forward.’ It’s also something we find, where people have seen for themselves that they have a learning requirement. They’re much more engaged in the remediation of that, or the intervention, than if they start off with having to go through the same sheet (mw 00:39:47) type stuff, and of course, in the NHS, it’s about keeping people in service. You know, on the job as much as possible, because resources are so finite. So, how do you see all that stuff (TC: 00:40:00) playing together, when you look at the kind of work that you do, and the kind of work that Cognisco does? How do you see those two things coming together?
Ben Tipney:
I think the first key thing you mentioned there was the resourcing issue. One of the biggest costs to any-, I mean, it’s the same for any organisation I guess, but particularly for NHS organisations, time staff are released from work to do other things is a huge expense. Especially in trusts that are understaffed in particular areas. I think, therefore, you have to make sure that what they’re released for is worthwhile. Of course, if you don’t do any investigations, you don’t do any, if you like, to use the term, you use the triaging, you’re guessing.
Owen Ashby:
Yes, absolutely.
Ben Tipney:
Who needs what, when, and in what way? Then, you are guessing.
Owen Ashby:
All you can do, isn’t it?
Ben Tipney:
Absolutely, and sometimes you get lucky.
Owen Ashby:
Right.
Ben Tipney:
Sometimes you get lucky, and yes, there is some argument for raising a general awareness. If you’re pretty confident that very few people understand a concept, there’s some argument for raising a general awareness, and there’s some argument for everyone feeling like they’ve had the same opportunity, but I think beyond very, very much a starting point, once you get beyond the introductory stage, it needs to be targeted. You know, obviously you talked about that competence and confidence trade-off. I see that a lot, where you do have different groups of people. Of course, if you’re-, you know, it’s a pretty quick way to demotivate someone who is both confident and competent in a particular area, to stick them through all the basic training. It’s not a good use of their time, it’s frustrating, it’s demotivating, and actually, you can turn someone who’s one of your key people into someone who’s really quite demotivated by doing that. Equally, if you’re expecting-, you know, we need to identify where people perhaps think they’ve got it, and they think they’ve got, potentially, good leadership skills, for example, but perhaps don’t, actually, you need to give those people the opportunity through appropriate development. Actually, one of the really key things for me is actually identifying the people who are already competent and confident, because from a resourcing perspective, you want to give organisations sustainability, and to me, one of the best ways to give people a sustained ability is to develop peer mentors. Again, very often when we’ve gone in, and in previous guys, when I did this work in a previous organisation, we did a lot of training, what we call ‘champion with (mw 00:42:39) champions’, which is a worthwhile endeavour, but there wasn’t enough work that went into identifying who those people should be.
Those people, enthusiasm is only one aspect of that. They need to be people of influence, but also, really have the competence as well, because otherwise, they might be sending the wrong messages, they might not have the right level of influence, and they can become disruptors as well as advocates. So, to be able to develop a group of people, in a sort of mentorship capacity, to then help the people who lack-, probably the people, you know, and I see that group in most organisations, as then being your people who will develop those who perhaps are competent, but they lack confidence.
Owen Ashby:
Yes.
Ben Tipney:
You know, they don’t necessarily need training. They need support and mentorship, to just keep building their confidence up. I think having a structure around that is incredibly important. To me, it’s also identifying not just groups of people who need different things, but also particular focal areas, for example. You know, particular areas of competence that might be lacking. So, actually, you can identify areas where perhaps broad brush forms of educational intervention are needed. Now, they may be classroom training, they might not be. They might be simulation, they might be various other things. So, I think it’s hugely important to collate the evidence that you need, to then decide, you know, for particular groups and particular areas, is this coaching input, is this a training input? What type of training input is it? Do they need individual input? Do they need group input? Who are your leading lights that you’re going to develop into the people who will carry this on when we’ve gone?
Owen Ashby:
I think again, at a simple level, what we often find is that most assessments or analytics are asking the wrong questions. There’s a level of confirmation bias built into it, specifically if I’m selling you learning. My confirmation bias is there to prove that you can remember the last seven out of ten things I’ve taught you. You know, that serves a purpose I guess, but what it doesn’t do is surface those people who really do know, but aren’t actually confident in applying that knowledge. There’s your latent talent, they’re the people who are going to leave if you don’t do something with them, but they are the people who we often find are the social leaders. They are people that actually, everybody else gravitates to. Nobody knows, because they haven’t got the title that’s associated with it, but this particular person in that particular environment is the only person who knows how to do it properly.
Ben Tipney:
It’s interesting, when you talk about leadership at all levels, in some of the work that we do. People think leadership is a-, A, I think it’s often misunderstood as leadership is the Pied Piper with people following behind. Yes, that’s one style of leadership, but there are a lot of other ways of leading. It also assumes that leadership is a position, whereas to me, leadership is about behaviour. Leadership is the way you do things, and like you say, social influence is a good way of describing it. You know, you can have effective leaders at all levels in an organisation. I think it’s identifying and giving those people the right support to get the best out of them, and not only does that give the organisation better (mw 00:46:09), as it were, but you keep people, because you know. We know the research from Harvard Business School, looking at intrinsic motivation, autonomy, mastery, purpose, these are the things that motivate people on an intrinsic level, you know? ‘Am I involved in decisions that affect me? Am I developing and learning? Does what I do make any difference?’ So, when people feel that they’re involved, they have ownership, and that what they do really makes a difference, they’re going to stick around. They’re going to keep contributing. Then, you link that back to having the culture where those people feel listened to, and everyone feels listened to. You know, it’s easy to say, harder to do in practice, and that’s why I say none of this is often a quick fix. I don’t really think there’s a one-size-fits-all strategy. Yes, we have a blueprint, so we have a high performance roadmap, if you like, as a starting point, but that roadmap will evolve differently for each organisation.
Owen Ashby:
So, that’s a kind of blueprint, DNA, that you work towards? I guess you make that right for everybody. You bespoke that for everybody.
Ben Tipney:
Yes, so there is obviously a starting point, you know. There’s a kind of template, if you like, that we would start with, and actually, quite typically, we’d start with senior leaders in an organisation, at an executive level. You know, that message has to be consistent, and it starts at the top, really. Obviously, people involved in risk and governance, in a departmental management perspective, and actually spending a day looking at that roadmap and saying, ‘How do we mould this right for you?’ Looking at waypoints. At each point down the journey, where are we going to be at? How are we going to measure success? What change do you need to see by this point? I think what’s happened with human factors is, you mentioned Martin Bromley earlier, and for anyone who hasn’t come across that name, isn’t aware, if you look at YouTube and put in ‘Just A Routine Operation’, it’s a very moving and actually, quite inspirational story. Martin, who’s a pilot himself so understands a lot of the nature of human factors, his wife died following complications in an avoidable incident, but has famously spent a lot of time saying, ‘It’s not about blame, it’s about learning.’ You know, it’s about why did what they did make sense at the time? So yes, for those of you who haven’t come across Martin Bromley, a name you mentioned earlier, who’s (mw 00:48:55) at the Clinical Human Factors Group off the back of the tragic death of his wife in 2005, which was an avoidable incident, but Martin famously has spent a lot of time over the last decade or more saying, ‘It’s not about blame, it’s about learning. It’s about understanding why that made sense at the time to those people.’ So, over the last, say, what? Thirteen years now, he’s been hugely influential in raising awareness of human factors in healthcare.
I think we’ve all got a lot to thank him and the CHFG for. It’s become, very much, a buzzword in healthcare, which is great in a sense there’s now a focus on it, and it’ll be interesting now, of course the previous health secretary, a lot of talk about it. Perhaps people in the NHS will give you a mixed response about that, on how much progress they think has been made.
Owen Ashby:
We have a lot of listeners in the NHS. I’m sure they’ve got an opinion on it.
Ben Tipney:
Yes, I’m sure there’ll be lots of opinions on what was done and not done. It would be (TC: 00:50:00) interesting to see whether it continues to get a focus now. One of the unfortunate side effects of that is that it became rather a tick-box exercise. You know, we’ve done some, in inverted commas, ‘human factors training’, which would generally mean, you know, people have done a one or two-day course, and it would be a relatively small number of people in the organisation, therefore, you know. I think we’re getting to the point now, where there’s an increasing awareness of the broader scope of what it really is. The discipline, but also an understanding that this is part of an ongoing improvement journey.
Owen Ashby:
It’s not a project.
Ben Tipney:
Yes, it’s not a single strand. It’s something, it’s almost a language and a set of principles that should underpin everything else that we do, and I think it should almost become, just business as normal. I think that’s the aim. So, our aim is to work in partnership with trusts over a period of time, to get them to a point where it becomes just part of everyday practice, just part of the everyday language. Like you said, you know, the NHS is full of really, much more intelligent people than I am, but when they get to that point, they’ll be the best people to know how to keep taking it forward. It’s getting to the point where they have that understanding.
Owen Ashby:
Definitely, of the people we work with, and collectively know in the NHS, there are those champions who, once they get it, are off and running with it, aren’t they?
Ben Tipney:
Yes, absolutely.
Owen Ashby:
They’re still getting blocked by some of the internal processes, and you know. Natural things, but hopefully, you can help them find a way through some of that, navigate some of those challenges.
Ben Tipney:
Yes, absolutely. Yes, that’s the idea.
Owen Ashby:
Brilliant. That’s been really fascinating, Ben. There’s a lot more to talk about, I think, about how teams and people come together, you know. The ability, sort of, self awareness for those people, and how people and processes work together.
Ben Tipney:
I’m sure there are many things we can pick up on another day.
Owen Ashby:
We’ll be coming round again and doing that again. So, how should people get hold of you if they want to get hold of you, Ben, to learn a bit more or to engage on a fascinating human factors-style talk?
Ben Tipney:
Yes, so you can look at our website, which is ‘www.med-led.co.uk’. Contact details on there, or just ‘contactus@med-led.co.uk’. You know, I’m on Twitter, not frequently. It’s amazing, these days, how people connect in different ways. Obviously, LinkedIn, and all the other things.
Owen Ashby:
They’ll find all your details on the podcast page, at ‘cognisco.com/podcast’ of course.
Ben Tipney:
Fantastic.
Owen Ashby:
In the interim, they might want to get in touch, so-,
Ben Tipney:
Yes, absolutely. Always interested to hear from people, and I think something to say that’s really one of our ambitions, is to be able to share the learning between organisations as well. I think that’s often an ambition within the NHS, and local organisations, to learn more from each other. Often again, it’s a capacity issue. It’s very difficult. People are very busy. So, you know, obviously we collate information from all the people we work with, and then with permission, of course, share that with the other organisations we’re working with, such that we can help to facilitate some of that cross-organisation learning. So yes, whilst we have our own inputs, we can help to develop that cross learning from trust to trust.
Owen Ashby:
Excellent, and hopefully, all sorts of other organisations will take the same approach too, in terms of learning and sharing best practice where these things are (mw 00:53:49).
Ben Tipney:
Absolutely.
Owen Ashby:
Brilliant, thanks very much Ben.
Ben Tipney:
Pleasure.
Owen Ashby:
Good luck with everything.
Ben Tipney:
We’ll chat again soon, I’m sure.
Owen Ashby:
I look forward to seeing you again soon.
Ben Tipney:
Thank you.
Owen Ashby:
Cheers.
Ben Tipney:
Bye.