Safety II and Covid-19

Julia Unwin says the time is for us to notice what is happening now in order to learn from it for the future. The study of how people and systems are able to succeed within complex adaptive systems and constant changing dynamics is really important right now.  Complexity forces us to consider the dynamic properties of healthcare and the way in which it is constantly changing and its unpredictability.

In order to make sense of the now it may help to keep a diary of some sort and to notice  the things that are new that will shortly become the ‘new normal’, the new habits that we will develop. Consider the unexpected and emergent and notice what you did.  We can use this to help others who will be experiencing the same.

Help people adjust and adapt what they know to the new conditions or situations.

Help people create order out of the disorder.

In the study of human factors there are terms like ‘work as imagined’ and ‘work as prescribed’ and ‘work as done’.  Never more so is there a need to narrow the gap between what people think others should be doing (imagined), what they ask them to do (prescribe) and the work they are actually doing (done).  Closing this gap is vital – the experience from the frontline must be listened to and used to feed into the imagination of those building the policies or guidance to help prescribe what people should do.

In order for a system to be understood it is necessary to know what goes on ‘inside it’.

As the days go on, people are getting more and more exhausted.  Physical and mental fatigue is going to be their constant.  A word or two about resilience.  This word gets banded about implying that everyone just needs to ‘cope’ and it’s up to the individual to be resilient.  Resilience cannot simply be the responsibility of an individual, it is much better defined as the ability of the team or the system to monitor and adjust performance to achieve its goals even when the unexpected happens.  Almost every aspect of healthcare is dealing with this state of uncertainty and adjusting what they do to accommodate.  This is resilience, anticipating where you can, responding to what is happening and learning.

Caring for those that care must be at the heart of all planning.

Look after their physical health, wellbeing, everyday needs and start now with sourcing experts to help with their psychological and mental health needs for now and in the future.  Ask them what do they need and ensure that there are people who are obligated to meet that need.

Take five

Increase the flow of knowledge everyday.  Take five minutes at the beginning and end of the day to value and recognise everyones contribution, say thank you, and importantly ask what did we learn today that we would want the next shift to know, what did we learn today that we will take forward tomorrow.  Involve everyone – the healthcare assistants, the porters, the receptionists in these precious 5 minutes.  Keep the messages simple:

  • We need to look after each other in order to look after our patients
  • If you need help then here is the information for who to go to and how you get it
  • It is ok to not be ok – if you need a break say so – everyone will understand
  • What do we need to know today, what can we learn from yesterday and what can we learn for tomorrow

I know a lot of you are doing this already – and I know you know it works.  If you top and tail each day with this you will get a flow of knowledge from one team to another.  It is highly likely that people will be working with different people everyday – so taking this 5 minutes will help to create personal connections, help people simply say hello and introduce themselves to each other and to help with communication throughout the rest of the day.  Everyones contributions must be encouraged and valued, listen to them and involve them, tell them the truth and build the trust needed to quickly build a functioning team.