A Chat with ‘Human Factors in Paramedic Practice’ Editor, Gary Rutherford

With the release of Human Factors in Paramedic Practice just days away, what better opportunity to catch up with the book’s editor, Gary Rutherford? Gary talks about what compelled him to become the driving force behind this brand new book, his beyond-exemplary team of contributors and his hopes for the future for the discipline of human factors in paramedic practice…

Gary Rutherford

When did you realise you had a special interest in the field of human factors?

In the book’s Preface, I tell the story of the journey that I’ve personally been on with human factors. In 2006, I joined the air ambulance in Glasgow and, as part of your initial training, you complete crew resource management (CRM) training. The content is focussed on non-technical skills, for example decision making, communication, teamwork, leadership, situation awareness and how you can adopt strategies to be aware of and mitigate stress and fatigue, all of which can often be referred to as human factors training. Paramedics who do this training often find it interesting because it’s very different from the technical skills clinical training they’ve done up until that point in their careers. All of a sudden you’re introduced to this new topic, and I really enjoyed it too. Some of the content of CRM training considers how accidents happen, the limitations of human beings and how those limitations can be a contributing factor in those accidents. So, for a number of years I viewed ‘human factors’ to only be factors that are related to humans and how they interact with each other to ensure flight safety.

Martin Bromiley OBE

Then I heard Martin Bromiley speaking at a conference. I think it was in about 2010 he spoke at the Emergency Medical Retrieval Service Conference in Glasgow, a leading conference for aero-medical retrieval. He told the story of how his wife died and how the non-technical skills of the clinicians and healthcare staff involved were affected and sub-optimal on that particular day, as she went in for routine surgery. That was when I had a bit of a light bulb moment. I realised that this CRM, non-technical skills, ‘human factors’ training that we were doing wasn’t just applicable to aircraft safety. It was clearly applicable to patient safety as well.

So, my interest in human factors continued and when I left my role at the helicopter and moved into ambulance service education, I designed a module that was embedded within the paramedic top-up degree programme in Scotland. It covered some concepts related to types of human error, safety culture and non-technical skills and considered these theories in paramedic practice and pre-hospital care.

However, more recently, and this is a key point, I started to recognise that human factors is a much wider discipline than only considering error and non-technical skills. I was starting to read the work of Charles Vincent, Sidney Dekker, Erik Hollnagel, and of course Steven Shorrock and Paul Bowie, who have both contributed to this book. They were all describing how human factors is an approach to consider how humans interact with each other but also how they interact with other elements of the work system, then how that work system can be designed or strengthened to make it easier for people to do the right thing, or less likely to do the wrong thing. Other safety critical industries like nuclear power, oil and gas extraction and the rail industry use human factors as an approach in this way, and I believe that healthcare is starting to appreciate its wider application.

This means that there is a changing focus in healthcare from human factors are only about the humans, to human factors is an approach to take to consider the wider system, which has interested me further, particularly in my current patient safety role. I feel there is value in discussing the breadth of the topic with those working in pre-hospital care, which is what the book looks to do.

Can you tell us more about your initial contact with Class and how the project began?

I was the programme lead for the paramedic programme in Scotland and somebody from Class presented at a College of Paramedics group meeting, of which I was a member. Class were looking to publish a series of short books for paramedics. This was around the same time as Andy Collen’s Decision-Making in Paramedic Practice book was just being published. Human factors was one of the topics on which they were looking to publish. So, I contacted Class and asked where they were with this. I was maybe expecting them to say that a project had been started and was thinking I might be able to contribute. However, they advised me that no one had started a book on human factors and asked if I would be interested. I felt that I had a network of contacts who were interested in the subject and that I could possibly pull together a book with their contributions. And it all grew from there!

The authors of the book have been quoted as ‘premier league’ – can you tell us a little more about your team of contributors?

Recently, Scotland has grown a human factors community of like-minded individuals, which is expanding across the UK. Paul, Duncan, Steven, Rhona, Michael, Ben and Shelly were all connecting with each other and I became involved in some conversations and work streams.

I first ran the idea past Michael Moneypenny as we were working on some non-technical skills and simulation projects together. He thought it was a great idea and was very encouraging and supportive. I also made contact with Paul Bowie. He has co-edited a book on patient safety in primary care and I could see that he was leading on a lot of the human factors community of practice developments. He was keen to hear my plans and instantly said he would be willing to contribute. Paul has an amazing knowledge of traditional and contemporary safety science evidence base. He introduced me to Duncan McNab who is a GP and is undertaking a PhD in work systems, which was a bonus for the systems thinking chapter that I had in mind, which Duncan and I authored. They knew Steven Shorrock and suggested that I should get in touch with him. Steven has co-edited a book on human factors, is editor of a magazine for air traffic controllers and runs an excellent blog website – humanisticsystems.com. I dropped him a message on social media and arranged to meet him for a coffee. I remember being nervous going to meet him as I considered him to be such an expert! He was great to chat with and had some brilliant advice on the challenges of editing a book, which turned out to be very accurate. His chapter on the history and development of human factors is fascinating and will help readers understand the journey.

As I said, I was doing some work at around this time with Michael Moneypenny and also Ben Shippey, at the Scottish Centre for Simulation and Clinical Human Factors. Michael and Ben are consultant anaesthetists. Anaesthetists have been at the forefront of human factors for frontline clinicians and healthcare and were early adopters of human factors principles in healthcare. Michael was particularly supportive of the idea of including the chapter on the patient and I knew Ben would be keen to contribute to the situation awareness and decision making discussion. It was great to have them on board too.

I also made contact with Mike Christian. I didn’t know Mike beforehand but he had spoken at a College of Paramedics’ conference, I think it might have been 2018. I wasn’t there but I watched a recording of it later on. He did acknowledge the wider role of human factors but was then quite clear to his audience that he was speaking about the teamwork aspect of it. So, I thought, Mike is thinking along similar lines to me and he’s already framed and contextualised the topic for paramedics. It turned out he used to be a paramedic himself. He’s now a doctor, working on London’s Air Ambulance, who are renowned as being a high performing team.

Mike came on board and also suggested Neil Jeffers, chief pilot at London’s Air Ambulance. That was brilliant as Neil is also a CRM instructor. So, that felt like a great team for the teamwork chapter.

I didn’t know Jo Mildenhall either. Jo is a paramedic and had published an article in the Journal of Paramedic Practice on stress in relation to paramedic practice. I got in touch with her and explained what I was looking to do. I initially asked her if she would like to write a chapter on stress, but as my understanding of the aims of human factors grew, I asked Jo if she could adapt the chapter to have more focus on well-being and incorporate stress within it. Jo was keen to be involved and has done really well to put up with my many suggestions on how to frame this chapter!

It was also great to have Shelly Jeffcott contribute too. Along with her qualifications and experience within healthcare and other safety critical industries, she has a particular interest in how we design the system to make it easy for humans to do the right thing. So Shelly was really keen to do the human-centred design chapter and has incorporated some pre-hospital examples from literature and her experiences working in the Scottish Ambulance Service.

All of these people have been very supportive and I’ve certainly learned from them on the journey. I know more now about human factors than I did at the start and I agree with Rhona Flin that they are premier league!

Can you tell us about how you structured the book?

In Chapter One you’ll find reference to human factors onions. These are conceptual models related to the layers of human factors and work systems. Therefore, the onion concept was then used as a loose structure for the whole book. Each chapter is a ‘layer’, although I sub-divided a couple of layers and changed the order slightly.There are chapters on non-technical skills which are related to the layers of individuals and teamwork, however there are inner layers (and earlier chapters) related to the patient, human-centred design and systems thinking. Then we have the outer, organisational layers (chapters) related to learning from events and safety culture. I inserted the history, ‘human error’ and well-being chapters where they best fitted as other layers.

I believe the ‘human error’ chapter was added during the later stages of the publication process. Can you tell us more about this?

Yes, my initial plan had been to tackle ‘human error’ throughout the book to illustrate the challenges and limitations of practical application of the term. But I felt, after the review stage, where the draft script is critiqued by anonymised reviewers, that I hadn’t quite achieved that as well as I had hoped. So I drafted a short chapter on ‘human error’ to more explicitly discuss the term and some views from the literature on it.

I think it’s quite clear that most of the contributors don’t feel there is much value to the term ‘human error’, particularly if you use it as a conclusion to an adverse event review or explanation for something. If something has gone wrong or there has been an undesirable outcome, labelling it as ‘human error’ doesn’t really take us forward much at all. It limits the ability to fix the system and will likely lead to blaming individuals.

We are really just trying to encourage people to look beyond ‘human error’ to try to understand what led to it.

What were your key intentions with the book?

Class had stated that their desire was to publish books that were mainly at an introductory level on the subject. This aligned to my intention to produce a single resource that introduced ambulance staff to some of the key elements of human factors. When colleagues asked me more about human factors, they could be signposted to websites, e-learning and articles. However, I felt that there wasn’t an easy to read single resource that covered key themes and related them to their practice.

I was pleased that Rhona Flin described the book as accessible, as I was keen that the book would be easy to read while also being based on a sound evidence base. It is intended for a wide readership within ambulance services and pre-hospital care, with areas of interest for frontline clinicians, students, leaders, managers and those involved in education, procurement and patient safety.

This is your first book. You must be very proud of your achievement.

It was definitely a team effort to publish the book. I’m both excited and nervous, although looking forward to the conversations and developments that could come from its release. I hope that it will lead to more paramedic and ambulance service colleagues increasing their understanding of human factors principles. In particular seeking to adopt a systems approach to their thinking and to consider when they would benefit from further expert input.

This is the first UK book that has been written on the topic and applied to paramedic practice. It is pleasing that Martin and Rhona both suggest that it may also be of interest to other healthcare professionals. And your ultimate goals for the book?

I hope the book will encourage paramedics and ambulance staff to become interested in human factors or continue their journey in their understanding and use of principles. I believe this will be of benefit to them, to the services that they work in and ultimately to the people and patients they care for.

It would be great if the book led to further work, developments and research on human factors in paramedic practice and pre-hospital care. If anyone is looking for any ideas, then I believe there is huge scope for the principles to be considered within ambulance service control centre work systems and environments.

I’ve had a few conversations with colleagues across the UK about what could happen next in the application of human factors principles. Can we establish a network of interested paramedics across the UK? How do we get momentum in some of the principles in the book?

As mentioned before, this is your first book. Has it been a positive experience?

It has been a great experience and I’m pleased with how the book has turned out. There were a few tough periods of late nights and long weekends of writing and editing. I’d like to thank all the contributors for their efforts.

Working with Class was great. Lianne (Sherlock) had an excellent skill of reassuring me that everything was going to be fine when I was getting a bit stressed about progress. It can be stressful with edited collections as you’re writing your own contributions, managing multiple contributors, overlapping content, trying to keep a certain voice throughout the book but still allowing each contributor to have their own voice.

If anyone has an idea for a book, I would recommend getting in touch with Class to discuss further.

Any plans for the immediate future?

Immediate plans are to stay away from writing anything for as long as possible. I need a break!

However, I’m keen to see how the book is received, to see if anyone gets in touch and how we can generate some momentum in the principles or discuss how to further develop.

Gary Rutherford is the Patient Safety Lead for the Scottish Ambulance Service. He is also an honorary educational co-ordinator at the Scottish Centre for Simulation and Clinical Human Factors. He has completed a BSc in Paramedic Practice, gained the Diploma in Immediate Medical Care awarded by the Royal College of Surgeons, and completed post-graduate certificates in Teaching & Learning in Higher Education, and Patient Safety & Clinical Human Factors.

For more information on Human Factors in Paramedic Practice or to place an order, please click below.Gary was chatting with Lianne Sherlock, Senior Editor at Class, and their Events & Marketing Co-ordinator, Kate Anderson.

 

 

 

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Top Tips on Becoming a Published Author

Have you ever held a burning ambition to be a writer but have never really found the time or known where to start? Even with all the time in the world, writing isn’t always easy, as many of our published authors will vouch for! Should you be in any doubt about where to start, we’ve put together a few tips for budding and seasoned authors who want to focus their ideas while under lockdown and guard against the dreaded ‘writer’s block’.

Why Should You Write?

‘Whilst I was studying for my paramedic degree and my first Master’s degree, I kept returning to ethics and really struggled to find published material that applied specifically to paramedics. I guess I wanted to provide something to future students, and the profession as a whole, that wasn’t available when I was studying.’

Georgette Eaton, Author of Law and Ethics for Paramedics

Writing can be a really rewarding experience and there is nothing quite like seeing your ideas come to life in print. But before putting pen to paper it’s worth taking a moment to consider why you want to write? Most likely this will influence the kind of publication suited to you, although there are often several different motivations for writing.

The Message

Are you a persuader? The persuaders are those writers who have an ardent message they want to share with the world. For instance, they might want to challenge a commonly-accepted view or promote a better way of doing things.

Often persuasive writing will have a clear focus and should have a firm evidence-base to back up the writer’s arguments; however, it may be narrower and more subjective than a reference guide or educational resource. The aim of the writer is to make the reader believe in a particular idea or opinion – an obvious example might be an ad campaign but there are lots of other examples of scholarly, persuasive writing too!

Education

Are you an informer? Do you have knowledge about a particular topic which would be beneficial to share with the world? Do you have a talent for making large chunks of complicated information accessible and easy to understand? If so, perhaps you are an educator.

One of the really rewarding aspects of this style of writing is the impact it can have on thousands of learners, who may use your work as a resource as they develop into a profession or study for a course. This type of writing should cover the key aspects of the topic and usually aims to be clear and concise in order to facilitate learning. If intended as a reference guide, the text should also be objective and based on factual evidence.

A Creative Outlet

Writing can be a great way to express yourself and even when writing informatively, the author’s voice will often still shine through the text. Fiction is an obvious example of writing creatively – but, actually every style of writing can be classed as ‘creative’ as an author will still be making artistic decisions about material to include in order to bring the text together as a whole. Writing narratively, including analogies or case studies to demonstrate a point, all contain a strong element of creativity.  

To persuade, to inform, and to entertain are commonly perceived as the three primary reasons to write – and hopefully publish – material. However, as you have probably already noticed, there is usually significant overlap between these motives. Persuasive writing can be also educational and, despite what students may say, it’s entirely possible to be entertaining and informative at the same time… at least we think it is at Class Publishing anyway!  

Who Should You Write For?

‘Independent Prescribing for Paramedics arose from discussions with my colleague, as she was receiving enquiries from paramedics to undertake the Prescribing course and she was trying to find specific and appropriate resources that were not nursing orientated. There were none, so we thought we could write something’.

Amanda Blaber, Author of Independent Prescribing for Paramedics

Who are you writing for? This may sound like an obvious point but it’s actually a very important one. Again, your motivation for writing will have an influence on the potential audience, and this in turn will have an impact on the medium of publication and writing style. Keeping in mind your reason for writing as well as your intended audience can also help you make wise decisions about which material to include.

Different publishers will also cater for different audiences, and this is something to bear in mind when considering a publisher. Trade publishers will produce titles for a general audience, and commonly publish the kind of titles you might come across in your local bookshop. Academic and professional publishers, however, usually focus on a particular subject area and will likely target a specific audience, such as a profession or those taking an academic course. For example, Class Professional Publishing provide specialist resources for a range of healthcare professionals and students.

So How Do I Get Published?

A Proposal

Publishers may have slightly different processes, but professional, scholarly publishers, such as Class Professional Publishing, will often ask for a brief outline of your idea (also known as a proposal) before expecting you produce a complete manuscript. A good proposal will cover some of the aspects mentioned earlier, including the kind of text you have in mind and who you expect the readership to be. It should include the following points:

  • A description of the kind of resource you have in mind
  • The intended audience/level of readership for your project
  • A draft contents list with a brief summary of what each chapter or component will contain
  • How your proposed text might compare or relate to other resources already available
  • Your own experience and expertise within the appropriate field

You can download a copy of Class Professional Publishing’s proposal guidelines here. This should help you understand the kind of information we look out for when assessing a new publication.

Obtaining Feedback

The publisher should also be able to provide feedback on your proposal and will likely send this for external review before offering a contract for publication. Given the specialist nature of many professional or scholarly texts, it is generally helpful for both authors and publishers to obtain feedback before proceeding to publication.

Even so, it can be difficult opening your work up to criticism in this way, especially when you’ve worked hard on a project or an idea which is close to your heart. Feedback may be positive or negative but should be received as constructively and objectively as possible. Remember that once the text is published and available in the public sphere it will also be open to comment and, by this point, it may not be so easy to make any necessary amendments. The review process is also a good way of ensuring that you’re on the right track in terms of content and structure before the writing process even starts. This can save a lot of time and effort later on!

Stay Motivated!

‘I was once referred to as ‘tenacious’ – I didn’t understand what that meant at the time, but years on, my university lecturer was right. I am driven to influence the conversations we have regarding safety, and being an inclusive leader.’

Amanda Mansfield, author of Emergency Birth in the Community

There’s no beating about the bush, writing is hard work and takes a certain level of commitment and motivation. We’ve all heard of the dreaded ‘writer’s block’ and starting is often said to be the most difficult part of all. Whilst starting a project is certainly difficult, if you have followed the points outlined above and you have a solid understanding of your text in mind, then you’re already well on your way to becoming a published author!

A firm outline and structure is vital to maintaining focus and avoiding going off on tangents when writing. Some chapters may even begin with a list of objectives or learning points outlining what the text will cover – with this in mind, you don’t always need to start at the beginning; instead you may decide you want to start in the middle or even at the end.

Our advice is to keep writing and don’t lose heart… it may take a lot of time, effort and caffeine to bring a text together but seeing the final published result is always worth it. Equally do go easy on yourself too – writing is rewarding but it can also be hard and it can sometimes be difficult for outsiders to understand the amount of rewriting and editing which goes on underneath the surface of a seemingly effortlessly written piece of work. Above all, we at Class Professional Publishing are here to help – so if you have any questions or doubts about whether you have what it takes to become an author or if you’re feeling inspired to write then get in touch!

Why Work With Class?

Lianne Sherlock is our senior editor at Class, who commissions the new book titles and manages them through the entire publication process. She has worked in the publishing sector since 2008 and joined our Class team in 2017. Lianne is always happy to discuss new ideas for books so please do get in touch with her here: lianne.sherlock@class.co.uk.

You can also head to our Authors’ page for more information about writing a proposal or to view our author’s profiles.

 

“Class were absolutely fantastic. They were always on hand if I had any questions, put up with my constant re-ordering of chapters and finding new chapters to be included. The support throughout the project was fantastic…”

Georgette Eaton, Author of Law and Ethics for Paramedics

 

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The results are in!

We recently asked our twitter followers which JRCALC product they find the most useful when on call… These were the options:

  • JRCALC Clinical Guidelines 2019
  • JRCALC Clinical Guidelines 2019 Pocket Book
  • JRCALC App

After a huge response on Twitter, with over 130 votes, it was a close call between the JRCALC Pocket Book and the JRCALC app (iCPG/Plus) .

Here is everything you need to know about the three:

JRCALC Clinical Guidelines 2019:

Pages: 724

About:

The Joint Royal Colleges Ambulance Liaison Committee guidelines are the essential resource for paramedics. JRCALC combines expert advice with practical guidance to help paramedics in their challenging roles and supports them in providing patient care.

The book covers a wide range of topics, from resuscitation, medical emergencies, trauma, obstetrics and medicines to major incidents and staff wellbeing.

The 2019 edition of the book has been brought up to date with the latest evidence and developments in clinical practice and now incorporates essential content from the 2017 supplementary guidelines, including extensive guidance on maternity, sepsis, safeguarding, falls in older adults and pain management.

JRCALC Clinical Guidelines 2019 Pocket Book:

Pages: 368

About:

The JRCALC Pocket Book is the definitive guide to emergency care for healthcare professionals on the road and in the community. New to the 2019 edition are eight algorithms on managing birth, assessment charts for chemical incidents and updated tools for managing mental health illness.

The Pocket Book includes an extensive UK drugs formulary and Page for Age drugs tables which make medicines administration simple.

Being Pocketbook size, it’s small and light to carry around, taking up very little room. It has a waterproof, wipe-down front and back cover and easy to flick through, providing quick reference when on the job.

JRCALC app:

iCPG:

About:

iCPG is a digital version of the official JRCALC guidelines for ambulance service practitioners. It allows emergency services staff to access up-to-date guidance on medical conditions and drug dosages at all times and therefore helps to ensure best patient care.

JRCALC Plus:

About:

JRCALC Plus allows individual ambulance services to combine the national guidelines with their regional information. The app detects which trust a user is affiliated with based on their email address.

Finally…

Remember to follow us on our social media platforms to keep up to date with our news, sales, competitions and future polls. You can find us on twitter @classprofession, on Facebook @ClassProfessionalPublishing and on Instagram @ClassProfessional.

~Tara Hernaman-Wood

 

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