Healthcare
Current Projects
Surgeons' non-technical skills (NOTSS)
Project leads: Prof Rhona Flin and Dr Steven Yule. Email: s.j.yule@abdn.ac.uk - Tel: 01224-273214
Jointly funded by the Royal College of Surgeons (Edinburgh) and NHS Education Scotland, this project (2003 - 2006) identified the non-technical skills (eg, decision making, teamworking, communication) necessary for effective surgical practice. A behavioural marker system to support training and development has been developed, and the NOTSS system is currently being trialled in Scotland.
Scrub nurses' non-technical skills
Project leads: Prof Rhona Flin and Lucy Mitchell. Email: l.mitchell@abdn.ac.uk - Tel: 01224-273212
This project has received two years funding (2007-2009) by NHS Education Scotland and aims to identify the non-technical skills (eg, teamwork, communication) which scrub nurses use whilst performing their role. Within the one year framework, the project will produce a review of the literature and determine the cognitive and social skills required for expert nursing practice during an operation.
Anaesthetists' non-technical skills (ANTS)
Project leads: Prof Rhona Flin, (School of Psychology), Drs Ronnie Glavin, Nikki Maran (Scottish Clinical Simulator Centre), and Dr Rona Patey (Aberdeen Royal Infirmary). For further information visit the ANTS pages, or email: r.flin@abdn.ac.uk - Tel: 01224-272341
Originally funded by NHS Education Scotland, we have been working with Scottish Clinical Simulation Centre (SCSC) since September 1999 investigating non-technical skills in anaesthesia. This project identified the non-technical skills (eg, decision making, teamworking, communication) necessary for effective anaesthetic practice developed these into a behavioural marker system that can be used to support training and assessment. The output of the first stage of the project was the Anaesthetists' Non-Technical Skills (ANTS) System, which contains fifteen skill elements grouped into four main skill categories with behavioural markers describing good and poor practice for each element. The ANTS System is now being evaluated in a number of trials organised by the Royal College of Anaesthetists to ensure it can be used reliably to assess anaesthetists' non-technical skills in both simulator and operating theatre environments.
Surgeons' decision-making in the intra-operative environment
Project leads: Prof Rhona Flin and Lucy Mitchell. E-mail: l.mitchell - Tel: 01224-273212
Funded by the Scottish Funding Council (2008-12), this project investigates decision-making and surgical performance. Most surgical decision making research has concerned pre-operative decisions and in contrast, there has been very little research on what happens during operations. Using techniques developed by aviation researchers, this project is examining how surgeons make decisions during the intra-operative phase.
Current studies include interviews with consultant and trainee surgeons to examine decision making and risk management in challenging cases and a questionnaire study of surgeons' decision styles and risk management.
Problem solving and cognition in anaesthesia
Project leads: Prof Rhona Flin and Dr Evie Fioratou.
E-mail: e.fioratou@abdn.ac.uk - Tel: 01224-272668
Funded by the Scottish Funding Council (2008-11), this projects investigates anaesthetists' cognition from a DEEDS (ie, Dynamical, Embodied, Extended, Distributed, and Situated) approach, focusing on the dynamic interaction between anaesthetist, surgeon, patient, nurses, and all external resources in the OR (eg, monitors, charts). The practical relevance to simulation training in terms of developing "scaffolding", embodied, and emergent experiences will also be explored.
System strengths and weaknesses in surgery
Project leads: Dr Steven Yule and Jill Wilkinson. E-mail: g.wilkinson@abdn.ac.uk - Tel: 01224 273213
Funded by the Royal College of Surgeons, we are collecting data from major colo-rectal surgical cases to devise a framework for measuring systems failures in surgery. These are failures which are embedded in the system (eg, organisational factors), and can potentially lead to the occurrence of errors during an operation. We will conduct a minute by minute account of cases, and will record interactions between the surgeon and the rest of the team. The condition and diagnosis of the patient will also be taken into account as well as the level of training and experience of all team members. From these data we will devise a framework for measuring systems failures in surgery.
An analysis of the cognitive and environmental factores underlying accurate dispensing behaviours in hospital, ward and community pharmacies.
Project leads: Dr Amy Irwin, Dr Kathryn Mearns and Prof Rhona Flin.
E-mail: a.irwin@abdn.ac.uk
Medication error is estimated to cost the NHS in excess of 300 million a year in associated expenditure, including: prolonged hospital stays, legal claims and readmissions to hospital. The process of dispensing medication to the patient is estimated to account for approximately 17.8% of medication error rates in the UK, based on reports to the National Patient Safety Agency reporting and learning system. The current research projct aims to look at the issue of dispensing error from a cognitive perspective.The work will encompass an analysis of dispensing practices in hospital and community pharmacies together with dispensing on hospital wards. An improved understanding of the situational and cognitive factors underlying dispensing error is vital in order to reduce error rates and improve patient safety. The current project will therefore examine the dispensing process using a mixed methods approach, potentially including: computer based simulations, task analysis, simulation studies, interviews and qualitative questionnaires. To date one computer simulation study examining drug selection accuracy has been carried out to completion. The results suggest that orthographic similarity between drug names can negatively affect accurate drug selection, with a significantly greater effect seen where more than one similar drug name is present within the same visual field as the target drug.
Patient safety measurement issues: What are reliable and valid outcomes and their underlying key processes?
Project leads: Prof Rhona Flin and Dr Jeanette Jackson
E-mail: j.winter@abdn.ac.uk - Tel: 01224-272247
Funded by the Scottish Funding Council, this project will identify methods of measuring patient safety outcomes and their underlying key processes within and across hospitals.
Handovers in healthcare
Michelle Raduma, School of Psychology. E-mail: michelleraduma@abdn.ac.uk
This PhD project is funded by the Scottish Funding Council (2007-10) and aims to investigate handovers in NHS Scotland. As overcoming problems in communication and coordination among healthcare practitioners remains a critical challenge to the improvement of patient safety, this project will examine communication failures during healthcare handovers, and in particular those failures that occur at shift-change. A literature review is currently being conducted in order to document and understand handover processes in various healthcare settings. This is with the view of reviewing available applications of interventions that can be used within NHS Scotland to improve handover.
Leadership and safety in acute healthcare
Sarah Parker, School of Psychology. E-mail: sarah.parker@abdn.ac.uk
The management style of front-line or team leaders is a critical factor in determining effective task execution and safety outcomes in high risk, high demand industries. Within health care, surgeons can be likened to team leaders, with responsibility for both the surgical teams's performance and the outcome of the surgery. This project focuses on surgeons' leadership behaviours and skills in the intra-operative setting and the impact that these behaviours and skills can have on team outcomes and the link between leadership and patient outcomes.
This PhD is funded by the Scottish Funding Council (2008-11)
Safety climate in Scottish hospitals
Cakil Sarac, School of Psychology. E-mail: cakilsarac@abdn.ac.uk
This PhD project is funded by the Scottish Funding Council (2007-10). This project focuses on safety climate in healthcare. A literature review was conducted on safety climate in healthcare post 2004 which showed that different measures have been adopted to investigate hospital safety climate and to measure patient and worker safety outcomes. There is evidence to suggest that safety climate dimensions within an organisation have direct and/or indirect effects on safety outcomes both for patients and workers. Therefore, it is important to measure the current level of the relevant cultural factors in the workplace, before designing any interventions to produce a change in culture. The main aims of this study is to measure the safety climate within Scottish acute hospitals, test the psychometric properties and the suitability of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire for a Scottish sample, and to investigate the relationships between safety climate and, patient and worker safety outcomes within Scottish acute hospitals, which would enable the development of a theoretical model.
Completed Projects
Organisational culture change in NHS Trusts: Creating safe places for staff and patients (Senior Leadership and Safety)
Project leads: Prof Lorna McKee (Health Services Research Unit), Prof Rhona Flin and Dr Steven Yule (School of Psychology). E-mail: l.mckee@abdn.ac.uk
www.abdn.ac.uk/hsru/UDOCC_safeplaces.shtml
Teamwork and team cognition in the intensive care unit
Tom Reader, School of Psychology. Email: r.fllin@abdn.ac.uk
This PhD project was sponsored by the University of Aberdeen (2004-2007). The thesis investigated teamwork and safety using error analysis, questionnaires, on-site observations and team performance modelling. It investigated causal factors underlying medical error in the ICU, communication between doctors and nurses, decision-making during ICU rounds, predictions of patient deterioration, and the formation of 'team mental models'. Teamwork was shown to be critical for safety, and consultant leadership to have a profound effect on teamwork and the development of a shared understanding for patient illnesses. Team leadership was also indicated to predict the communication behaviours of junior team.
Team leadership in the intensive care unit
Project leads: Dr Tom Reader, Dr Brian Cuthbertson, Prof Rhona Flin.
E-mail: r.flin@abdn.ac.uk
This project was funded by a Leverhulme Early Career Fellowship. It identified the team leadership behaviours that ICU consultants use on a day-to-day basis to ensure that ICU teams function effectively and provide safe and optimal care to patients. The aim of the research was to develop a taxonomy of leadership behavioural competences indicative of effective leadership in the ICU environment, with the purpose of the taxonomy being to aid in training and assessment.
Tel: +44 (0)1224 273210
Email: w.booth@abdn.ac.uk
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