Welcome to the April '21 edition of our WingFactors monthly newsletter. To our new readers - our aim is to keep you updated with highlights from the previous month's simulations, with our 'Top 3 takeaways'. We'll also include updates on the WingFactors programme and share some aviation news, providing some tidbits from our industry. Happy reading!
Taking the lead. Observing teams consisting of similar experience levels has raised this question recently. There is a sense that by functioning with a completely flat hierarchy, the need for someone to define themselves as 'the boss' is not required. If individuals are functioning well independently then why the need to have a lead? In short, every team needs one. It isn't about being the loudest or most knowledgeable: it's about remaining a focal point for new information, coordinating, and making final decisions - with the assistance of an empowered team.
In aviation, inexperienced Captains tend to have a narrower ‘bandwidth' of control - a desire for profiles to be flown in a prescribed manner often leading to ‘micro-managing’. By utilising the experience of their co-pilots this can be avoided, but how? Flight crew use briefings and checklists as tools to increase ‘bandwidth’. By establishing ‘how’ a task is going to be completed, the distraction of second-guessing what the other pilot will do next is avoided. The Captain is then able to focus their attention on managing less predictable events such as the weather or changing Air Traffic Control clearances. This real-life example of an in-flight engine failure onboard a Swiss Airbus A340 is a great example of a Captain and Co-pilot operating with a defined hierarchy - albeit shallow. Notice how well they work together, strong monitoring, clear use of checklists, well-balanced workload, read-back, and they even had time to enjoy a coffee and a chocolate - all in a days work!
In true aviation style, we've created an acronym to assist in effective leadership:
Body position away from patient to maintain a clear overview
Communicate with the team (updates / feedback / algorithms)
Delegate - anticipate the next steps in pathway and allocate tasks accordingly
Empower team members to contribute towards meaningful decisions
Focus - remain calm, composed and review
Handover of information or handover of 'control' - How do we distinguish between a handover of information and a handover of 'control'? Does it always mean both? Should we assume that a more senior colleague's arrival indicates an immediate change in leadership structure? These considerations will vary day-to-day and for that reason, roles should be clearly defined and communicated to the entire team to avoid ambiguity.
In aviation, control can take several forms (communication, flying the aircraft, managing an emergency) and often remains fluid. There might be a situation during an in-flight failure when the Captain taking 'control' could potentially destabilise the aircraft's flight path. Equally, the First Officer may voice that they feel uncomfortable running a complex failure, at which point the Captain takes control. Perhaps aviation has the benefit of a consistent 'chain of command' through the overarching principle: 'The operating Captain is the final arbiter of safety for all passengers and crew'. Regardless, to ensure all crew members are clear in their roles and responsibilities, their positions are clearly stated and often reiterated during high-workload events. "I have control, you have the radios" / “I have the lead, you have the airway”.
What are your thoughts? - An open question is one which cannot be answered with a yes / no answer. Some of the best examples we have seen in simulation include:
During an in-flight malfunction, once the initial actions are complete and the aircraft is stabilised, we often ask our colleague the question: “Tell me what happened?” This provides an opportunity to think out loud and subsequently enables us to check for mutual understanding. We have designed the circle below signifying the inclusivity of open questions:
Our 'Customer Service / De-Escalation' training programme got off to a 'flying start' in March. Patient Engagement Lead, Wayne McCormack comments: “We are delighted to announce that the ‘Patient Engagement’ team have delivered our first training course to a group of Emergency Department colleagues at the NHS Whittington Health Trust. After many months of collaborative research through fact-finding ‘coffee mornings’, we were able to build a picture of where we could be involved and subsequently designed a bespoke 1-day training course. Our launch day was a great success, working with a cross-section of colleagues who all offered meaningful and fascinating input throughout the session. It truly is fantastic to have finally started these courses and I know I speak for the entire Patient Engagement team when I say how much we are looking forward to meeting and working with more of the staff in ED and other departments over the coming months.”
Earlier this month, WingFactors visited the team at Whittington Health Community Dental, kick-starting new conversations around Human Factors in the working environment. Interesting discussions included empowering the team and speaking up. We can't wait to return in the near future!
As part of our regular invitation to Wexham Park's registrar training sessions, we thought it would be interesting to turn the tables and perform our own simulation - receiving feedback from the clinicians. A ‘Flight Crew Briefing and Emergency Handling’ en route to Geneva was demonstrated, including examples of normal / emergency checklists and aviation acronyms. We had fantastic feedback from this session and look forward to demonstrating more ‘Pilot Simulations'!
Coffee, featuring Patient Engagement, has made its first appearance at The Oaks, Chase Farm. Our facilitated discussions were well received, with positive feedback, including: “I think it's great to have a different perspective from outside of the organisation, as we can get stuck in our ways of working and communicating with each other.” We already have future dates in the diary.
"Throw kindness like confetti"
I recently attended a talk by Bob Klaber, (Consultant Paediatrician and Director of Strategy, Research and Innovation at Imperial College Healthcare NHS Trust), discussing the role of Kindness in Teams. Dr Klaber describes Kindness as an 'underrated currency' - kindness is much more likely to lead to collaboration, and collaboration leads to better outcomes in care.
Dr Klaber emphasises the importance of creating a culture of psychological safety, whereby all team members feel empowered to ask questions and put forward their opinions, in a safe environment. Being a good team member involves both working well with others, and also helping other team members to feel valued.
[We rise by lifting others - #WeGotThis. Sending love & positive vibez to everyone! Mumtaz.] X
When overseas travel from the UK finally returns, the aviation landscape at London’s airports is likely to look very different. At Gatwick airport, the familiar sight of long-haul maroon-coloured tail fins and short haul flag carrier jets will be a memory from summer 2019. The very popular Norweigan Air have now ceased their entire EU-US long haul operation and most of the remaining major carriers operating to London airports have indicated that they will be flying at reduced levels for 2021 at least and possibly well into 2022.
Into this space, however, comes fresh faces. Norweigan has plans to re-invent itself as Norse Atlantic Airways in late - 2021, using mainly the same aircraft (Boeing 787s) and crew. The brand new kids on the long haul block will be JetBlue. They were one of the first ‘low-cost’ carriers (LCC’s) to enter the US market in Feb 2000 and have been highly successful. Interestingly, for a US-based and owned airline they chose the European Airbus A320 family (same as Captain Alex!), which caused a major stir in the land where Boeing is king. JetBlue have announced that they have secured slots into Gatwick and – crucially – the potentially lucrative hub of Heathrow, flying brand new A321LR (long range) aircraft. They boast the largest business-class seat going across the Atlantic, whilst promising low fares.
We all know the public’s pent-up demand for international travel, and from our perspective long may that last, but it looks like there will be hot competition when things finally start to open up. Interesting times ahead! Dave Fielding.
I was recommended this book by a fellow Aviation Human Factors Trainer. It looks at how Medicine has been incorporating checklists into their day-to-day operation through comparisons to other industries such as Aviation and Construction. The book highlights how useful checklists can be to ensure routine tasks are completed despite distraction and also how communication can be improved within a team dynamic through their usage. My favourite concept so far is the “Activation Phenomenon” - giving people a chance to say something at the start of a procedure seems to ‘activate’ their sense of participation, responsibility and willingness to speak up. Russell McDonald.
April signals the WingFactors-Whittington 'Pilot Sim' team's upcoming final judging day for the coveted HSJ 'Best educational programme for the NHS' award. Although the winner won't be announced until June, we can't wait to capture the judges imagination with our story!
As always, we greatly appreciate feedback and suggestions - if there is any content you would like to see in future editions please drop us an email! [email protected]. We hope you have a great April!
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