Sarah Milton is an IOP Facilitator in Processing, Testing and Issue and blogs about her recent attendance at the SHOT (Serious Hazards of Transfusion) symposium in Manchester.
Last Thursday, I attended the SHOT symposium in Manchester. I had never attended a symposium before and did wonder if it would be a bit too grown up for me.
I needn’t have worried, it was a brilliant day. I met so many people both from the UK and worldwide with the safety of blood being the reason we were all together.
The day started with bacon rolls and a ‘Meet the Experts’ session. I joined the MHRA and Lab Errors table. A BMS from Brazil was very concerned about the amount of stress her staff were under which was leading to errors in the workplace; she wanted to know if in the UK it was the same and how were we dealing with the issue. Whilst there was not a definitive answer there was a lot of discussion around Human Factors and the training for it. I got the impression that she was quite relieved to discover that stress is universal!
Bacon rolls finished, (very nice by the way although I limited myself to just the one), a quick look at all the posters that had entered a competition and then it was into the lecture theatre to begin the presentations.
The first presenter was a lady who had received Apheresis Plasma for Thrombotic Thrombocytopenic Purpura. She talked us through her journey from illness to diagnosis and then onto treatment. I was nearly in tears. Recipient stories always make me cry. She finished her time with us by saying “I am grateful to the wonderful NHS staff who looked after me in HRI, Leeds and Newcastle; all the donors out there and especially to everyone who is working hard to ensure apheresis treatment remains as safe as possible for patients like me.”
This is why we do what we do, whatever part of the organisation you work in. We are truly lifesaving and life changing.
The human factors theme became the hot topic of the day with several speakers referring to ‘Never Events’ and the loss of confidence in the face of errors. Too many errors and our customers will soon lose confidence in us as a world-class, reliable service. One of the speakers – Trevor Dale – was a pilot with British Airways and now runs his own training company called Atrainability. The company offers Human Factors training. I was hanging onto his every word, it all made so much sense. He uses all the skills he learnt as a pilot to help teams overcome shut doors and blinkered staff. If you ever get the chance to see him in action, please go. You won’t regret it. I have had a think about my own human factors and improvements I can make. So I am going to make a start and not interrupt others. Wish me luck.
So I have come back to work raving about the importance of Human Factors and have discovered that NHSBT has its own Human Factors (HF) group led by Fidelma Murphy. The group are working to integrate HF across the organisation and have developed a training programme on Shine: it is easy to follow with some good top tips. The group are also doing some good work within CMT and RCI to name a couple of departments. If this has peaked your interest, please contact Fidelma for more information.
I ‘borrowed’ the below from the presentations – I hope nobody minds?
“It is important not to blame the individuals for what went wrong, but to understand why what they did at that time made sense to them.” Just Culture. Dekker 2007.
“Everything should be made as simple as possible, but not simpler.” Albert Einstein.
“Human Factors – failure of communication, distractions, interruptions, wrong assumptions, poor handover are all important contributory factors to errors.”
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