Human Factors in Practice – Creating a fit between people and veterinary systems

Dr Hannah Godfrey BVetMed MRCVS, Community Lead at VetLed

If you make a mistake at work, how do you feel? Is your immediate thought ‘This is my fault,’ or ‘I should have known…’? It’s natural to feel guilt and regret when you make a mistake, and that might even lead to thoughts like ‘I’m terrible at this’, ‘I’m incompetent’, or ‘No one else would have been so stupid.’ But are these thoughts fair? Are they even realistic? Or is there another explanation?

What is systems thinking?

When we complete a task at work, especially if it’s a familiar task or something we do regularly, we often consider the task simple, and solely dependent on our own abilities (and maybe the temperament of the patient). But in reality, veterinary practice is complex, and even seemingly simple tasks can be impacted by countless factors. Take dispensing medication as an example. It might feel like a relatively simple task. However, if you break it down into steps, it actually involves checking the patient’s history, calculating the dose, printing the label, counting the tablets, signing and countersigning, and doing checks to ensure that the correct owner (and therefore, the patient) receives the medication. So, maybe not quite as simple as we thought.

But there’s more. Picture the same task but imagine the client has been waiting for half an hour for the medication already. They’re distressed by the news that their pet is unwell and one of the client care team has come through to tell you that their behaviour in reception has become quite challenging. How easy is it to complete the task accurately now? Would you be tempted to skip some checks to get things sorted as soon as possible?

Even in less extreme scenarios, a colleague could ask you an unrelated question while you were dispensing the medication, or you might have to take a client’s phone call. You might not have eaten lunch, or you might be feeling stressed or tired. All of these things could affect your ability to think clearly.

How can systems thinking help when I make a veterinary mistake?

If you make a mistake, it can be a lonely headspace to be in. You might feel solely responsible for the error, and your colleagues’ behaviour could make it seem like they hold you responsible too, especially if they avoid the subject or go quiet when you enter the room.

Systems thinking helps you see the bigger picture – all the interactions and connections involved in even routine work tasks that could contribute to an error. It’s not about making excuses for a mistake, but it allows us to proactively focus our energy on improvements to the system – from appointment booking and time management to dispensing or hospitalisation procedures – allowing us to grow as teams and individuals and provide even safer patient care.

But that’s not all, it also means that the weight of a genuine mistake isn’t held on one person’s shoulders, which could contribute to burnout and poor wellbeing.

How can systems thinking and a positive practice culture help reduce workplace mistakes?

A well-designed system makes it easy to do the right thing and difficult to do the ‘wrong’ thing. Just like a well-designed door should be instinctive to push or pull, and switching on a tap shouldn’t involve trial and error of twisting and lifting, well-designed and user-friendly protocols in work should make your working life easier, while making errors less likely.

Framing mistakes in this way poses an opportunity for the whole team to do some detective work. Looking for weaknesses in the system that could be improved gives everyone the chance to be curious and grow, working towards a common goal – better patient care. It also reduces blame and shame and contributes to a Just Culture.

Tips to get you started…

1. Look at the checklists and SOPs you already have at your practice. Are they used? If they’re not used consistently by everyone, every time, ask yourself why. Could they be made more user-friendly? Do you need to share some evidence with the rest of the team to get them on board? (We can help with this!) Check out our resources.
2. Want an easy way to reduce communication errors even when you’re stressed, busy, or tired? Try closed-loop communication within your team. Instead of you assuming that your instructions or request has been understood, the person you are talking to should repeat the instructions, and then you confirm their version is correct to complete the loop. Sound long-winded? It doesn’t actually take significantly longer!
3. Start recording any unexpected outcomes, whether on an online, nationwide database like VetSafe, or internal record keeping. This information will help you perform clinical audits and spot trends and areas within the system to focus on.
4. Introduce meetings to discuss any unexpected events soon after the event and after some time has passed (known as ‘hot’ and ‘cold’ debriefs). Both are very useful and will give different perspectives on how the risk of error can be reduced in the future and what support is needed for the team or individual.
5. Tune into Emma Cathcart’s talk at the Veterinary Human Factors Conference on 28^th February (replays are available if you can’t join us live). In her session, she’ll shine a light on how well-designed systems can change the way you work for the better. Get your tickets at here!

Summary

At the beginning of this article, you might not have known the term ‘systems thinking.’ Perhaps before now, you’ve felt solely responsible for any failings in the outcomes of the tasks and procedures you’re involved in… but is that really true? Hopefully, we’ve given you some food for thought, helping you to reframe veterinary error and build your curiosity rather than judgment when mistakes happen – because they do.