Humanistic Systems

Suitably Qualified and Experienced? Five Questions to ask before buying Human Factors training or consultancy

Posted on 05/06/2018 by stevenshorrock

Ergonomics (or human factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance. (IEA, 2018)

This definition – accepted by human factors and ergonomics (HF/E) societies worldwide – emphasises that HF/E is a discipline and profession. A discipline is “a branch of knowledge, typically one studied in higher education”. A profession is “a paid occupation, especially one that involves prolonged training and a formal qualification” (Oxford dictionaries).

Practitioners of ergonomics and ergonomists contribute to the design and evaluation of tasks, jobs, products, environments and systems in order to make them compatible with the needs, abilities and limitations of people. (IEA, 2018)

This contribution tends to be made by HF/E practitioners in two ways:

as an external human factors consultant/trainer
as an in-house human factors specialist (a typical job description is here).

But how do we assess whether a practitioner is a ‘suitably qualified and experienced person’ (SQEP)?

This is an important question because there is so much at stake for system performance and human well-being, but it is not straightforward to answer. In this post, I provide five questions that will help. The questions are for reflection and discussion. They are not definitive. In considering these questions, the point is not necessary to answer “yes’ to every question. Some will be more relevant than others, and there will be exceptions. But especially where the answer to two or more questions is “no”, there should be careful consideration as to why this is the case.

The emphasis of this post is not on those who fulfill specific HF/E roles in-house (e.g., HF/E in medical simulation). In such cases, internal practitioners with HF/E-related roles may well have education and experience in a specific area of HF/E, and use this in their role. But they would probably not describe themselves as ‘HF/E specialists’ (just as I have education in counselling but would not call myself a counsellor). This post does not cover these in-house practitioners, though they may wish to consider the questions and what support they might need.

Rather, the post concerns paid-for HF/E consultancy and training, and also employment as an HF/E specialist, where one has to abide by ethical professional standards in the practice of HF/E.

Marco Bellucci CC BY 2.0 https://flic.kr/p/6okjAW

1. Qualification

Do they have a recognised qualification in HF/E?

There are several academic programmes in HF/E in the UK, USA, and other countries, which you can find via the relevant Society or Association in your country. Some of these programmes will be accredited by your national HF/E Society (the Centre for Registration of European Ergonomists offers is a guide to such courses in Europe).

An HF/E qualification gives reassurance that the person has undertaken an approved programme of study in HF/E, which addresses the relevant competencies (e.g., the CIEHF Professional Competency Guidance, or the Requirements for Registration of European Ergonomists in Europe). (But note that some qualifying courses are no longer offered and so may not be listed.)

Others academic programmes will not be accredited, but will offer a substantial component of HF/E as part of a mixed programme, or as a substantial part of (e.g., a major in) a programme in experimental psychology, industrial engineering, systems engineering, patient safety, occupational health and safety, etc. This is especially true in the USA), which only a small minority of the programmes listed on the Human Factors and Ergonomics Society website are accredited by the Human Factors and Ergonomics Society. Most Human Factors practitioners (HF being the dominant term used in the US) tend to have academic qualifications in psychology.

For specialist external HF/E consultancy and commercial HF/E training support, a university degree in HF/E (or closely related discipline, as listed by the HFES in the USA) will usually be necessary, and perhaps a higher postgraduate (e.g., Doctorate) degree in very specific circumstances (e.g., expert witness work).

2. Accreditation and Membership

Do they have an appropriate level of accreditation or membership of an HF/E related professional organisation?

Unlike some professions, the terms ‘human factors specialist’ or ‘ergonomist’ are not legally protected, or regulated (e.g., by the Health and Social Care Professions Council in the UK), and so are not regulated with titles that are legally protected (e.g. Registered Occupational Psychologist, Registered Dietitian, Registered Physiotherapist).

However, HF/E is subject to accreditation (e.g., registration, certification, and chartership) in many countries (e.g., UK, USA, Canada, Australia, NZ, and Europe as a whole). So perhaps the easiest way to have confidence in the competency of an HF/E consultancy, training provider, or individual practitioner is to check for accreditation. This varies throughout different countries. In the UK, the Chartered Institute of Ergonomics and Human Factors provides various accreditations via Chartership, which is conferred to those members who fulfil certain criteria. This includes “having a high level of qualification and experience and being able to demonstrate continuing professional development”. Additionally, different grades of membership of the CIEHF – Fellow, Registered Member, Graduate Member, Technical Member – reflect competency, proficiency and experience.

Member and consultancy directories of HF/E Societies and Associations are available to help. For instance, Members of the HFES can be seen here. Chartered Members of the CIEHF can be seen here. Registered Consultancies that are accredited by the CIEHF can be seen here. You can find other directories of individuals and organisations via the relevant Society or Association in your country. (Note that ‘Associate’ or ‘Affiliate’ Membership is, in most cases, available to anyone and indicates interest and commitment – since all members have to abide by the Code of Conduct – but does not provide assurance of qualifications or experience. Therefore a minimum membership grade for paid support should typically be Graduate or Technical Member.)

In some cases, those who identify as ‘human factors specialists’ will have accreditation via other professional organisations. Typically, these relate to psychology and engineering. Some human factors specialists will be Chartered Psychologists in the UK. (There are other organisations relating to psychology and human factors, often in specific sectors, but these are not recognised by the International Ergonomics Association, which is the umbrella organisation for Human Factors and Ergonomics worldwide. These other organisations also sometimes require members to purchase the organisations’ own training for accreditation, which raises questions that are beyond the scope of this post.) The point is that many who are accredited via another route (e.g., Chartered Psychologist or Chartered Engineer) may well be competent HF/E practitioners, but perhaps for specific aspects of HF/E and not in the whole score of HF/E, and may have a different perspective (e.g., more aligned with psychology) and different approach (e.g., more cognitive-behavioural, social-organisational).

Accreditation will require that the person undertakes appropriate continued professional development, and submits evidence of this. The is important, but difficult for buyers of consultancy and training services to assess. Accreditation and membership removes some of that burden, because the Society does this as a requirement of the person’s membership.

3. Code of Ethics

Do they abide by a code of ethical conduct from an HF/E-related society or association?

This issue is covered by Accreditation above, but it its worth considering specifically because it is so important. A person offering HF/E consultancy or training services who is a member of an IEA Federated Society will have to abide by the Code of Conduct of that Society. The person should be aware of the Code. In any case, the Code (e.g. the CIEHF Code of Conduct) will cover such ethical standards, such as:

working within limits of competence
representation and claims of effectiveness
supervision
respect for evidence
confidentiality
impartiality
probity
considerations of religion, gender, race, age, nationality, class, politics or extraneous factors.

Professional societies of other disciplines and professions (e.g., psychology, engineering, health and safety) will also have codes of ethical conduct, and while these will not reference ergonomics, they will refer to similar sorts of issues mentioned above, and so working within competence would normally be formally recognised as an ethical issue.

This is an important question to ask anyone offering HF/E services and training, or seeking a job as an HF/E specialist.

If the person is not operating under the Code of Conduct of a professional organisation, then the protections available are limited to those under the law.

4. Experience

Do they have experience in the HF/E work and in the domain of interest?

The question here is whether the person has relevant experience in:

the kind of HF/E work (e.g., interface design, fatigue assessment, human error identification, cognitive work analysis, manual handing assessment), and
the sector of application (e.g., manufacturing, oil and gas, aviation, healthcare).

The first is the more important of the two, since HF/E – more than many other disciplines and professions – applies across sectors. HF/E practitioners tend to spend time in several sectors in their career. However, sector knowledge is important and HF/E specialists with a deep knowledge of one sector will have a greater understanding of the stakeholders, activities, procedures, technologies, regulations, cultures, etc. So at a micro level of application (e.g., the design of display elements or manual handling), much in HF/E crosses sectors. But at a macro level (e.g., the integration of HF/E throughout an organisation), this is not the case. When it comes to training others in aspects of HF/E (e.g., short courses), experience in the sector is a huge advantage, if not essential.

If the HF/E specialist offering consultancy or training services is accredited, then issues will be covered by the Code of Conduct or Ethics of their HF/E Society or Association, and the person will have to abide the relevant requirements (it is the focus of several items of the CIEHF Code of Conduct).

5. Social recognition

Is the person recognised as an HF/E specialist by other qualified HF/E specialists?

It can be hard to know if a person is suitably qualified and experienced, though answering ‘yes’ to the above will suggest that the person is. But there will be occasions when people fall outside of one or more of the criteria above, but where HF/E colleagues and associated would say that the person is an HF/E specialist. This will tend to involve those who specialise in a specific aspect of HF/E, but perhaps do not call themselves human factors specialists or ergonomists (and perhaps use other terms, such as UX designer, interaction designer, etc), and who are not a member of an HF/E Society or Association (e.g., a Technical Member of the CEIHF). Such people may well use HF/E theory and methods appropriately, and may even be an recognised expert in the specialism. In this case, social recognition by experienced HF/E specialists will give a good indication.

Summing up

To sum up, here are the five criteria and questions that apply to paid-for human factors and ergonomics (HF/E) consultancy and training support and employment, that may help with reflection and discussion.

1. Qualification – Do they have a recognised qualification in HF/E?

2. Accreditation – Do they have an appropriate level of membership of an HF/E related professional organisation?

3. Code of Ethics – Do they abide by a code of ethical conduct from an HF/E related society or association?

4. Experience – Do they have experience in the HF/E work and the domain of interest?

5. Social recognition – Is the person recognised as an HF/E specialist by other qualified HF/E specialists?

The aim of these criteria and questions is to ensure that professional standards – including ethical standards – are met. The criteria and questions are frames above in the context of HF/E, but in fact they apply to any professions, such as psychology, dietetics, or physiotherapy. Proper consideration of the criteria and questions should help to protect organisations, individuals, and the integrity of the profession.

Work-as-Imagined Solutioneering: A 10-Step Guide

Posted on 03/06/2018 by stevenshorrock

Have you ever come across a ‘problematic solution’ that was implemented in your workplace, and wondered, “How did this come to be?” Wherever you sit in an organisation, the chances are that you have. Many problematic solutions emerge from a top-down process that I will call work-as-imagined solutioneering.

In this post, I will outline a typical process of 10 Steps by which problematic solutions come into being. Some of the steps may be skipped, but with the same outcome: a problematic solution.

At the end of the post, you will find 10 ‘Solutions’ from healthcare, provided by healthcare practitioners in a series of posts on this blog on the archetypes of human work. These solutions do not typify the process below (since the process that these solutions were subject to is not known to me). And the solutions will all probably have various advantages and disadvantages. The solutions simply provide rich and messy examples of unimagined and unintended side-effects. But you will be able to think of many others in your own context (please provide an example as a comment or get in touch).

Throughout the 10 Steps, I will use terms to describe seven kinds of systems that must be reckoned with when making changes in socio-technical systems (from Martin’s [2004] Seven Samurai framework).

Step 1. Complex problem situation

The process of work-as-imagined solutioneering starts with a complex problem situation. Complex problem situations occur in systems with:

a number of stakeholders with conflicting goals,
complex interactions between stakeholders and other elements of the socio-technical system (visible and invisible, designed and evolved, static and dynamic, known and unknown),
multiple constraints (social, cultural, technical, economic, regulatory, legal, etc), and
multiple perspectives on the nature of the problem.

Problems may well be interconnected to form a ‘mess’.

Step 2. Complexity is reduced to something simple

Complex problem situations are hard to understand and have no obvious solutions. This is unappealing to most people. Understanding complex problem situations requires that we seek to understand:

the various expressions of, and influences on, the problem,
the context system, including the stakeholders, their activities, the tools and artefacts that they use, the context or environment (physical, ambient, social, cultural, technical, economic, organisational, regulatory), and
the history of the context system.

One of the hallmarks of work-as-imagined solutioneering is a neglect of one or more of these facets of the problem situation or context system. This is partly because understanding requires:

high levels of field expertise – expertise in the work that is influenced by and influences the problem, whatever the work is,
an understanding of people (which can be approached via various disciplines: psychology, sociology, anthropology, community development, human factors/ergonomics, etc),
an understanding of socio-technical systems and the nature of change in such systems, and
sufficient expertise in a human-centred and system-oriented design process.

Once you have approached the problem situation in a sensible way, an analysis of stakeholder assets and needs should follow.

Unfortunately, once a problem is identified, the perceived urgency to do something creates pressure to be efficient, when thoroughness is required – a blunt-end efficiency-thoroughness trade-off. The required thoroughness is time-consuming and difficult. It requires specialist expertise and – crucially – bridging social capital to engage with field experts in order to get the understanding necessary to help, rather than hinder. [There is almost always a lack of expertise, and we should try to understand why solutions make sense to managers and leaders, and not simply berate them.]

So these critical activities (understanding the context system and problem situation, and understanding stockholder assets and needs) are often neglected. And complexity is reduced to something simple. For example, a mismatch between demand, resources and capacity is reduced to a problem of ‘poor performance’. A mismatch between work-as-prescribed and work-as-done is reduced to ‘non-compliance’ or ‘violation’. A mismatch between design and performance is reduced to ‘human error‘.

Step 3. Someone has an idea

While there may be little understanding of the complex problem situation, solutions are at hand. Past experience, ideas from other industries or contexts, and committee-based idea-generation or diktats from authority figures make a number of ‘solutions’ available. Examples include:

measures
monitoring arrangements
quantified performance targets and limits
commercial off-the-shelf products (equipment, artefacts)
checklists
procedures
standard training
processes
incentives
punishments
reorganisation or activities, processes and reporting lines
redistribution of power.

Most of these (aside from targets, in most circumstances) are not inherently Bad Things. The Bad Thing is introducing them – any of them – without a proper understanding of the context system and the problem situation within that context system. But it is too late,. The focus is now on the solution – the intervention system.

Step 4. Compromises to reach consensus

As the solution (intervention system) is revealed, people at the blunt end are now at the sharp end of a difficult process of design and implementation. There are disagreements and they start to see a number of complications. But the stability of the group is critical. The intervention system is put out for comment, usually to a limited audience and with the aim to prove its viability. There are further insights about the problem situation and context system, but these arrive in a haphazard way, instead of through a process of understanding involving design and systems thinking. Eventually, compromises are made to achieve consensus and the intervention system is specified further. Plans are made for its realisation. The potential to resolve the problem situation is hard to judge because neither the problem situation nor the context system is properly understood.

Step 5. The project becomes a thing unto itself

The focus now turns to realisation. The problem situation and context system, which were always out of focus, are now out of view. The assets and needs of all stakeholders were never in view, but the needs of the stakeholders who are invested in the roll-out the solution (intervention system) have been met: they can now feel reassured that something is being done. The need of corporate anxiety-reduction is now being addressed. Something is being done.

So the focus now switches from the intervention system to the realisation system – the system for bringing the solution into effect (management teams, resources, project management processes, materials, etc).

Step 6. Authorities require and regulate it

As the intervention system (the ‘solution’) gets more attention, authorities believe that this is a Good Thing. Sometimes, solutions will be mandated and regulated, and monitored by the with regulatory power. Now there is no going back.

Step 7. The solution does not resolve the problem situation

As the solution is deployed, it becomes the deployed system. This is not necessary the same as the original idea (the intervention system). Compromises have been made along the way, both by those responsible for the intervention system (compromising on aspects of the concept), and by those responsible for the realisation system (compromises on aspects of implementation).

The design or implementation (or both) of the solution meets a need (corporate anxiety reduction) but does not resolve the original problem. The original problem remains, perhaps in a different form. Never events still happen (Solution 4), a ‘paperless’ discharge summary process (Solution 6) still requires paper. The feedback loops, however, contain delays and distortion, which we will come back to.

Step 8. Unintended consequences

Not only does the solution not resolve the original problem, but it brings new problems that were never imagined. These include problems concerning system conditions (e.g., higher unwanted demand, more pressure, more use of resources), and problems concerning system behaviour (e.g., increased workload, unwanted workarounds).

Here are some healthcare examples:

A Duty of Candour (Solution 1) process results in a “highly bureaucratic process which has reinforced the blame culture.”

A Do Not Attempt Resuscitation (DNAR) form (Solution 2) results in patients being “subjected to aggressive, yet ultimately futile, resuscitation measures which may include multiple broken ribs, needle punctures in the arms, wrists and groin, and electric shocks” and nurses and paramedics working “in such fear of not doing CPR when there is no DNACPR that they may override their own professional judgement and do CPR when it is clearly inappropriate.”

Dementia diagnosis targets (Solution 3) result in “naming and shaming supposedly poorly diagnosing practices – published online. Setting doctors harmful tasks, leading them almost to “process” patients.”

A Never Events list (Solution 4) – similar to various popular zero harm initiatives, “ignored the potential for using never events as a stick to beat people up with, … ignored the potential for gaming the data, … ignored the potential for people to become fearful of reporting and the loss of learning as a result.”

A ‘paperless’ discharge summary process (Solution 5) actually results in more paper. Similarly, following the implementation of a computerised medical system, “work-as-done reverted back to the system that was in place before where secretaries still had to print results on bits of paper and hand them to consultants to action” (Solution 6).

Amidst these unintended consequences, the context system has now changed and there may well be competing systems that address the problem, masking the effects of the deployed system. For instance, along with a Central Line Associated Bacteraemia (CLAB) checklist (Solution 9) another deployed system was CLAB packs, “These put all required items for central line insertion into a single pack thereby making it easier for staff to perform the procedure correctly.” Which has the effect imagined?

Furthermore, there may be inadequate collaboration or support from collaborating systems and sustainment systems (which collaborate with the deployed system to achieve some goal or help it continue to function). Examples include blunt-end roles for monitoring, analysis, feedback, and the supply of tools, materials, and technical support. These stakeholders are typically far removed from operational work-as-done and do not understand the assets and needs of those who work on the front line. It may be that the deployed system cannot even function as intended, as designed or as originally implemented.

Step 9. People game the system

Many work-as-imagined solutions can be gamed, and it may well be locally rational to the people who do – rather than imagine – the work. This is typical of measures (especially when combined with targets or limits) and processes. Following are some healthcare examples.

Radiology request forms are meant to be completed and signed by the person requesting the procedure. However, “In the operating theatre, the surgeon is usually scrubbed and sterile, therefore the anaesthetist often fills out and signs the form despite this being “against the rules” (Solution 7).
On the introduction of Commissioning for Quality and Innovation payments framework (CQUINs) to drive innovation and quality improvement in the NHS, clinicians are “demotivated by the process of collecting meaningless data and are tempted to use gaming solutions to report best performance” (Solution 8), having informed the commissioners of problems with the deployed system and offering suggested improvements to the metrics (which do not fit the intervention system concept).

Checklists for the prevention of Central Line Associated Bacteraemia (CLAB) (Solution 9) are completed “retrospectively without watching the procedure, as they were busy with other tasks”.

Step 10: It looks like it works

The gaming, combined with feedback lags and poor measures, may well give the illusion that the deployed solution is working, at least to those not well connected to work-as-done.

After introducing the CLAB bundle (Solution 9) “very high levels of reported checklist compliance” were observed “followed by the expected drop in our rates of infection, confirming the previously reported benefits.” but the drop instead “appears to be due to the use of CLAB packs. These put all required items for central line insertion into a single pack thereby making it easier for staff to perform the procedure correctly.”

With the WHO Surgical Safety Checklist (Solution 10), “The assumption within an organisation at ‘the blunt end’ is that it is done on every patient.” despite “clear evidence that there is variability in how the checklist is used both within an organisation and between organisations”.

Of course, there may well be knowledge that work-as-imagined does not align with work-as-done, but this is an inconvenient truth. Too often, what we are left with is a separation (or even inappropriate congruence) of the four varieties of human work: work-as-imagined, work-as-prescribed, work-as-done, and work-as-disclosed. This is enacted in a number of archetypes of human work.

This is not the end of the process, but by this stage, the project team that worked on the originally intended solution (the intervention system) have moved on. The deployed system remains and now we must imagined a solution for both the original problem and the new problems.

In summary

Work-as-Imagined Solutioneering
Step 1. Complex problem situation
Step 2. Complexity is reduced to something simple
Step 3. Someone has an idea
Step 4. Compromises to reach consensus
Step 5. The project becomes a thing unto itself
Step 6. Authorities require and regulate it
Step 7. The solution does not resolve the problem situation
Step 8. Unintended consequences
Step 9. People game the system
Step 10: It looks like it works

Solution 1: Duty of Candour

Over the last few years there has been a call to enshrine ‘saying sorry’ in law. This became the ‘duty of candour’. When this was conceived it was imagined that people would find the guidance helpful and that it would make it easier for frontline staff to say sorry to patients when things have gone wrong. Patient advocates thought it would mean that patients would be more informed and more involved and that it would change the relationship from an adversarial to a partnership one. In practice this policy has created a highly bureaucratic process which has reinforced the blame culture that exists in the health service. Clinical staff are more fearful of what to say when something goes wrong and will often leave it to the official process or for someone from management to come and delivery the bad news in a clinical, dispassionate way. The simple art of talking to a patient, explaining what has happened and saying sorry has become a formalised, often written, complied duty. The relationships remain adversarial and patients do not feel any more informed or involved as before the duty came into play. Suzette Woodward, National Clinical Director, Sign up to Safety Team, NHS England @SuzetteWoodward

Solution 2: Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) form

A Do Not Attempt Resuscitation (DNAR) form is put into place when caregivers feel that resuscitation from cardiac arrest would not be in the patient’s best interests. These forms have received a significant amount of bad press, primarily because caregivers were not informing the patient and/or their families that these were being placed. Another problem with DNAR forms is that some clinicians feel that they are being treated as “Do Not Treat” orders, leading (they feel) to patients with DNAR forms in place receiving sub-standard care. This means that some patients who would not benefit from resuscitation are not receiving DNAR forms. As a result when these patients have a cardiac arrest they are subjected to aggressive, yet ultimately futile, resuscitation measures which may include multiple broken ribs, needle punctures in the arms, wrists and groin, and electric shocks. It is not unusual to hope that these patients are not receiving enough oxygen to their brains to be aware during these last moments of their lives. Anonymous, Anaesthetist

What is sad is that this is not an unusual story. Unless a person dying in Hospital or a Nursing Home has a DNACPR then CPR will be usually be done. CPR may even be done when a person in frail health dies at home without a DNACPR, because the paramedics may be instructed to do CPR ”Just in case it was a cardio-pulmonary arrest”. Nurses and paramedics work in such fear of not doing CPR when there is no DNACPR that they may override their own professional judgement and do CPR when it is clearly inappropriate. Recently a nurse was reprimanded by the Nursing and Midwifery Council for not trying CPR on a nursing home resident who, in my opinion, was clearly already dead. I know of a case in our Hospital in which CPR was started on a person whose body was already in rigor mortis. Dr Gordon Caldwell, Consultant Physician, @doctorcaldwell

Solution 3: Dementia Diagnosis Targets

There are high levels of burnout. A target-driven culture is exacerbating this problem. A typical example was when the government seemingly became convinced by poor quality data which suggested that dementia was under diagnosed So it decided to offer GPs £55 per new diagnosis of dementia. Targets were set for screening to take place – despite the UK National Screening Committee having said for years that screening for dementia was ineffective, causing misdiagnosis. And when better data on how many people had dementia was published – which revised the figures down – it was clear that the targets GPs were told to meet were highly error-prone. The cash carrot was accompanied with beating stick, with the results – naming and shaming supposedly poorly diagnosing practices – published online. Setting doctors harmful tasks, leading them almost to “process” patients, fails to respect patient or professional dignity, let alone the principle of “do no harm”. [Extract from article The answer to the NHS crisis is treating its staff better, New Statesman.] Margaret McCartney, General Practitioner, @mgtmccartney

Solution 4: Never Events List

When we created the list of ‘never events’ at the National Patient Safety Agency we genuinely thought that it would lead to organisations focusing on a few things and doing those well. We thought it was a really neat driver for implementation of evidence based practice (e.g. the surgical safety checklist). We ignored the potential for using never events as a stick to beat people up with, we ignored the potential for gaming the data, we ignored the potential for people to become fearful of reporting and the loss of learning as a result. We importantly ignored the fact that in the vast majority of cases things can never be never – that it is a fact of life that things can and do go wrong no matter how much you try to prevent it. There is no such thing as zero harm and the never events initiative unfortunately gave the impression that it could exist. Suzette Woodward, National Clinical Director, Sign up to Safety Team, NHS England @SuzetteWoodward

Solution 5: ‘Paperless’ Discharge Summary Process

Our paperless Discharge Summary process generated about 5 times as many sheets of A4 as the old paper system, as the ‘paperless’ prescription got corrected and refined prior to discharge. Then we still were told we had to print a copy to go into the paper notes and of course the patient has to have a paper copy because there was no way to email it to the patient. The software could not message pharmacy, so we had to print out the discharge meds to be sent to pharmacy, who then checked found the errors, got doctors to correct them, then another print out, and round again. There are so many paper copies that sometimes an earlier incorrect paper copy gets filed into the notes. Then, unless someone hits ‘Finalise’, the pdf copy never gets emailed to the GP at all. Dr Gordon Caldwell, Consultant Physician, @doctorcaldwell

Solution 6: Computerised Medical systems

With the installation of a fully computerised system for ordering all sorts of tests (radiology requests, lab requests, etc.) work-as-imagined (and -as prescribed) was that this would make work more efficient and safer, with less chance of results going missing or being delayed. Prior to the installation there was much chat with widespread talk of how effective and efficient this would be. After installation it became apparent that the system did not fulfill the design brief and while it could order tests it could not collate and distribute the results. So work-as-done then reverted back to the system that was in place before where secretaries still had to print results on bits of paper and hand them to consultants to action. Craig McIlhenny, Consultant Urological Surgeon, @CMcIlhenny

Solution 7: Radiology Request Forms

Radiology request forms are meant to be completed and signed by the person requesting the procedure. In the operating theatre, the surgeon is usually scrubbed and sterile, therefore the anaesthetist often fills out and signs the form despite this being “against the rules”. Managers in radiology refused to believe that the radiographers carrying out the procedures in theatre were “allowing” this deviation from the rules. Anonymous.

Solution 8: CQUINs (Commissioning for Quality and Innovation payments framework)

Commissioners often use CQUINs (Commissioning for Quality and Innovation payments framework) to drive innovation and quality improvement in the NHS. In theory, the metrics relating to individual CQUINs are agreed between commisioners and clinicians. In practice, some CQUINs focus on meaningless metrics. A hypothetical example: a CQUIN target for treating all patients with a certain diagnosis within an hour of diagnosis is flawed due to a failure of existing coding systems to identify relevant patients. Clinicians inform the commissioners of this major limitation and offer suggested improvements to the metrics. These suggested improvements are not deemed appropriate by the commissioning team because they deviate significantly from previously agreed definitions for the CQUIN. The clinicians are demotivated by the process of collecting meaningless data and are tempted to use gaming solutions to report best performance. This situation is exacerbated by pressure from the management team within the NHS Trust who recognise that failure to demonstrate adherence to the CQUIN key performance indicators is associated with a financial penalty. The management team listen to the clinicians and understand that the data collection is clinically meaningless, but insist that the clinical team collect the data anyway. The motivational driver to improve performance has moved from a desire to improve clinical outcomes to a desire to reduce financial penalties. The additional burden is carried by the clinical team who are expected to collect meaningless data without any additional administrative or job plan support. Anonymous, NHS paediatrician

Solution 9: Central Line Associated Bacteraemia (CLAB) checklists

The use of checklists for the prevention of Central Line Associated Bacteraemia (CLAB) is well described and has been taken up widely in the healthcare system. The purported benefits of the checklist include ensuring all steps are followed as well as opening up communication between team members. After introducing the CLAB bundle into our Intensive Care Unit, we saw very high levels of reported checklist compliance followed by the expected drop in our rates of infection, confirming the previously reported benefits. However, when we observed our staff it became apparent that they were actually filling in the checklist retrospectively without watching the procedure, as they were busy with other tasks. The fall in the CLAB rate could therefore not have been due to the use of a checklist and instead appears to be due to the use of “CLAB packs”. These put all required items for central line insertion into a single pack thereby making it easier for staff to perform the procedure correctly. Carl Horsley, Intensivist, @horsleycarl

Solution 10: WHO Surgical Safety Checklist

The WHO Surgical Safety checklist was introduced into the National Health Service following the release of Patient Safety Alert Release 0861 from the National Patient Safety Agency on 29 January 2009. Organisations were expected to implement the recommendations by February 2010 including that ‘the checklist is completed for every patient undergoing a surgical procedure (including local anaesthesia)’. All organisations have implemented this Patient Safety Alert and the WHO Surgical Safety checklist is an integral part of the process for every patient undergoing a surgical procedure. Whilst the checklist appears to be used in every patient, there is clear evidence that there is variability in how the checklist is used both within an organisation and between organisations. Within an organisation, this variability can occur between teams with differences in the assumed value of using the checklist and within a team between individuals or professional groups. Its value can degrade to a token compliance process to ‘tick the box’. The assumption within an organisation at ‘the blunt end’ is that it is done on every patient. Alastair Williamson, Consultant Anaesthetist, @TIVA_doc

Reference

Martin, J. N. (2004). The Seven Samurai of Systems Engineering: Dealing with the Complexity of 7 Interrelated Systems. Presented at the 2004 Symposium of the International Council on Systems Engineering (INCOSE). Available here.

Posted in Human Factors/Ergonomics, Safety, systems thinking | Tagged archetypes, change, committees, design, human factors, psychology, seven samurai, solutioneering, systems thinking, work-as-disclosed, work-as-done, work-as-imagined, work-as-prescribed | Leave a comment

The Loneliest Profession in Healthcare

Posted on 11/05/2018 by stevenshorrock

Steven Shorrock CC BY-NC-SA 2.0 https://flic.kr/p/HoF2kK

Health and social care is one of the biggest employers in developed countries, and the National Health Service (NHS) in the United Kingdom is one of the largest employers in the world. By some calculations, the NHS is the fifth biggest organisation in the world in terms of number of staff, calculated at around 1.5 million, or 1.25 million full-time equivalent. That figure does not even include temporary staff, general practitioners, dentists, optometrists, and other staff in the independent sector or private hospitals.

It is an organisation facing enormous demand. Looking at just a few headline aspects, the NHS deals with over 1 million patients every 36 hours, with over 16 million hospital admissions in 2015/16, over 23 million attendances at Accident & Emergency departments in 2016/17, and over 89 million outpatient attendances in 2015/16. In terms of NHS net expenditure, meeting this demand cost over £120 billion in 2016/17, and is expected to rise to over £126bn in 2018/19.

Not surprisingly, it is also a bafflingly complex organisation, in terms of: the variable and unpredictable nature of demand; the huge variety of staff roles and competencies; the incalculable number of different types of equipment (which are very often not designed according to ergonomic standards) and medicines (which often look or sound alike); the tens of regulators, professional bodies, and associations; the thousands of laws, regulations, diktats, policies, procedures, guidelines, and good practice documents for clinical and non-clinical staff; the complicated record-keeping and communication channels; the links to government agencies, local authorities, police and fire services, suppliers, independent providers, universities; and the interactions between all of these that make it such a complex sociotechnical system of systems.

Added to this are the elements of the system that cannot easily be seen, let alone counted, but strongly affect human behaviour, including: shifting goals, incentives, punishments, subcultures, and pressures from the public, media, regulatory and professional bodies, politicians, and associations.

You’d expect, then, that Human Factors/Ergonomics would be very relevant to the NHS (the two terms are seen as equivalent within the discipline, though the terms are used in different contexts). After all, HF/E is:

“the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance” (International Ergonomics Association).

Healthcare organisations should naturally be interested in human well-being, of patients and staff. It is obviously important that the NHS, as a system of systems, performs effectively.

So you’d also expect that many HF/E practitioners would be embedded in the NHS, directly employed by the NHS and its Trusts, just like quality improvement specialists, performance management specialists, human resources specialists, and indeed even staff who work directly with patients, such as Dietitians. After all, the role of HF/E practitioners is directly relevant to the effective provision of health services, as per the ‘7 key principles that guide the NHS in all it does‘.

“Practitioners of ergonomics and ergonomists contribute to the design and evaluation of tasks, jobs, products, environments and systems in order to make them compatible with the needs, abilities and limitations of people.” (International Ergonomics Association).

HF/E practitioners are well-embedded in a number of sectors, notably aviation, rail, defence, oil and gas, nuclear, manufacturing, regulation, product design, inclusive design, and UX. NATS – a provider of air traffic services in the UK and international airports, airlines and governments – employs around 25 qualified Human Factors practitioners (comprising Human Factors/Ergonomics practitioners and Psychologists). The Rail Safety and Standards Board (RSSB), Network Rail, London Underground, BAe Systems, QinetiQ (formerly part of the Defence Evaluation and Research Agency [DERA]), and other large organisations and regulators such as the Health and Safety Executive, all have long-established teams of qualified HF/E practitioners, who help to optimise system performance and human well-being by contributing to the design and evaluation of tasks, jobs, products, environments and systems in order to make them compatible with the needs, abilities and limitations of people.

Compared to any of these organisations, the NHS is enormous. To make one comparison, NATS is an organisation of around 4,500 staff – a third of the staff in some of Britain’s biggest hospital trusts. The NHS is 333 times bigger than NATS in terms of staff. Even individual hospital Trusts are enormous, with staff counted in the thousands, and up to 15,000 – three times bigger than the whole of NATS.

Of the 1.5 million members of staff, professionally qualified staff make up over half (53.8 per cent) of the Hospital and Community Health Service (HCHS) workforce (based on FTE). Healthcare obviously requires professionally qualified and accredited staff in order to provide effective services.

So how many professionally qualified HF/E practitioners are there in the NHS? It is not straightforward to answer, because ‘human factors practitioner’ (or human factors specialist, etc) and ‘ergonomist’ are not protected titles. Anyone may describe themselves as such (much as anyone can call themselves a ‘psychologist’, which is not a specifically protected title). But the profession of Human Factors/Ergonomics is Chartered in the UK, like others such as Chartered Psychologist, Chartered Engineer and Chartered Accountant. Chartered status in HF/E is conferred by the Chartered Institute of Ergonomics and Human Factors to those members who fulfil certain criteria. This includes “having a high level of qualification and experience and being able to demonstrate continuing professional development”, and operating under a Code of Conduct.

We can therefore count the number of ‘Chartered Ergonomists and Human Factors Specialists’ (CErgHF) employed by NHS Trusts, since a list of CErgHFs is published here. At the time of writing, there are 429 CErgHFs on the register. While there are others with various qualifications, and those who may have ‘human factors’ in their job title, the CIEHF is the only arbiter that provides a countable, unarguable category (as is the case for a Surveyor or Accountant) for the purposes of determining how many work in NHS Trusts.

From my own research, I have determined the number of NHS Trusts that directly employ a Chartered Ergonomics and Human Factors Specialist, and the number CErgHFs in the 233 NHS Trusts.

That number is 1.

Whichever way you look at it, the number is one.

To my knowledge, after researching the network of CErgHFs, one Trust employs a CErgHF as a Human Factors/Ergonomics specialist, and that one Trust employs – at present – one CErgHF.

Let that sink in for a moment.

An organisation of 1,500,000 staff and £120 billion expenditure.

If the number of HF/E specialists in NATS (which works in an ultrasafe sector – commercial aviation) were scaled up to the number of staff in the NHS, there would be over 8,000 HF/E specialists. Obviously, that is neither feasible nor necessary. But even if there were just one CErgHF per Trust, then there would be 233 CErgHFs in Trusts, plus those who should certainly be in other central bodies, such as NHS Education (NHS Education Scotland has a CErgHF working in an HF/E role), NHS Improvement, NHS Digital, etc.

Even one CErgHF for a Trust of up to 15,000 staff is, however, inadequate, especially given the thousands of so-called ‘excess deaths’ every year, and the apparent focus on ‘Human Factors’ in bodies such as:

The tens of thousands of so-called ‘excess deaths‘ should lead us to question why the NHS Trusts have only one Chartered Ergonomist and Human Factors Specialist. Even if HF/E could help prevent just a relatively small number of deaths and injuries, then we must ask why it is not being integrated professionally. HF/E focuses on many aspects of healthcare that must be designed properly in order to deliver safe, effective, and cost-efficient services, and relates directly to the work of the NHS, especially (NHS England):

In other industries, HF/E contributes to to the design and evaluation of tasks, jobs, products, environments and systems, for improved system performance and human well-being, in terms of:

the design and evaluation of equipment
the design of tasks and jobs
the design of physical and ambient environments
the design of policies, procedures, checklists, guidelines and job aids
human factors integration into management systems
human performance assessment and support
safety assessment (and risk assessment generally)
incident and accident investigation and analysis
staffing and manpower planning
shift design and fatigue risk assessment and management
stress management
communication design
safety culture and organisational culture evaluation
non-technical skills, team resource management, and (simulation) training.

Of these functions, the main focus of human factors integration in the NHS has been the latter. Many clinicians and educators have embraced human factors and integrated it into their non-technical skills, team resource management, and simulation training. It’s perhaps an obvious place to start, it’s vitally important, and it’s very well done (in fact, simulation training in some Trusts could teach aviation a thing or two – and has here and here). There are also a few individuals in the NHS with HF/E qualifications and experience, but who are not Chartered. Aside from a small number (mostly in Scotland), these do not work as HF/E specialists per se and/or are not performing the activities above for Trusts.

And there are Chartered HF/E specialists in medical device design companies outside of the NHS, and of course in consultancies and universities, who consult or conduct research in healthcare organisations.

More generally, there is significant interest in HF/E from clinicians; so much so that one would expect that it was actually integrated into the NHS. The term ‘human factors’ regularly crops up on social media and in conferences (though it could mean anything).

But none of this embeds a systematic consideration of designing for humans in healthcare, which is part of normal business in many high-risk industries. This can only really be done with trained and qualified practitioners, just as is the case with Physiotherapists, Dietitians, and Counselling Psychologists. In the absence of the HF/E equivalent in the NHS, front-line staff are having to do what they can, with the time they have, and otherwise work around and patch up problems in resources, constraints and environments that are:

not understood at the blunt end
always changing
not implemented or functioning as originally designed or imagined
often not ‘designed’ at all, and
degraded and stretched beyond design intent.

When things go wrong, it is patients, families, and clinicians who suffer the consequences.

And yet, of the 233 NHS Trusts, only one Trust employs a Chartered Ergonomist and Human Factors Specialist in an HF/E role, and that Trust employs – at present – one CErgHF.

It’s incredible. But it’s true.

Posted in Human Factors/Ergonomics, Safety | Tagged design, ergonomics, healthcare, human factors, practice, profession, safety | Leave a comment

Bonding and Bridging at the Philosophical Breakfast Club

Posted on 01/05/2018 by stevenshorrock

On 26 April 2018, I presented at the ‘Philosophical Breakfast Club’ (@philosophicalBC) conference on High Performing Teams (#PBCHPT2018). It was a remarkable conference bringing together healthcare professionals, psychologists, sports scientists, athletes, managers, human factors/ergonomics specialists, military officers and specialists, and others, My first conversation while having tea before the conference was with a spinal surgeon and bomb disposal expert. Throughout the conference I had many other fascinating conversations with people from a diverse range of backgrounds.

This leads me to the focus of my talk: collaboration at the interfaces, and what happens between teams, groups, professions, layers of management, organisations… In this post, I summarise the talk, slide by slide, with tweet-sized explanations.

This is a talk on bonding and bridging. It is about what happens with and between groups. I draw on my and my colleagues’ experience in over 30 countries over 10 years understanding groups and organisations psychometrically and ethnographically. 1/.

This infographic from #HindSightMagazine Issue 26 shows the scale and interconnectedness of the European air traffic management system. Many sources of data show how ATC is an very safe part of an ultra safe industry – commercial aviation. 2/

Air traffic controllers and others routinely state that teamwork is something they value most in creating safety, and they nearly always rate it very positively. Where problems do occur – as in all industries and organisations – tend to relate to interfaces between groups. 3/

Here is a small example. A new ATC centre was built and, during discussions, it emerged that there were now communication issues between controllers and engineers. In the old centre, controllers had to pass through the engineers’ coffee area. The new centre designed this out. 4/

In another example, problematic relations between two operational groups reached crisis point after a serious incident occurred, when blame turned inward between groups. There wasn’t sufficient trust and openness to cope with the outfall of the event. This had to be worked on reparatively. 5/

Another example involved inadequate coordination between an airport and ATC tower. The airport mandated a new procedure that increased ATC workload significantly and unsustainably. The impact was not understood. Other problems have involved procedures mandated by safety departments, with unintended consequences. 6/

Very few accidents are associated with ATC. One of the few occurred in 2002 in Überlingen over southern Germany. It involved problems of coordination and communication between engineering and ATC, as well as management, and the whole aviation system. 7/

This is a figure from the EUROCONTROL White Paper on Safety-I and Safety-II. To cope with especially problematic circumstances, incidents, emergencies, and the aftermath of accidents, we need to pay attention to collaboration during everyday work, and learn from ‘the best of what is’. 8/

It can seem that the design of organisations gets in the way of collaboration. We organise via ‘Divisions’ and ‘Departments’ (which, from the old French, means the same). Our org charts don’t show the demand or need for services, nor the customer, nor the flow of work and comms. 9/

The siloisation of work extends to all levels. This figure shows a slightly adapted ActorMap template (Rasmussen), which can be used to map interactions, and in conjunction with AcciMaps to understand issues at the interfaces.10/

The question is, where is the boundary of the sociotechnical system that you are interested in? We need to appreciate systems theory in order to understand teamwork and collaboration. Teams exist within a much larger interconnected network. (Beer – also part of a eco-consumer system [courtesy of Black Isle Beer].) 11/

So let’s turn to the work that we do, and how we imagine others work 12/

We understand the work that we do. It is hard to understand from afar, because it is complex and messy. It is characterised by variability, adjustments, adaptation and trade-offs between goals (efficiency-thoroughness, acute-chronic, tasks-relationships, etc). 13/

But when we imagine the work of others, our imagination of the work is vastly simplified and wrong in important ways. While work-as-done is dynamic, our imaginations are static. We all have a different image of others’ work. And they are all wrong. 14/

Many people, when reflecting on others’ imaginations of their work – expressed in artefacts such as policies, procedures, diktats, equipment, etc – describe two different worlds. We live in a state of Ignorance and Fantasy of others’ work. 15/

The relationship between work-as-imagined and work-as-done was the theme of #HindSightMagazine Issue 25 (free). It includes articles by professors of safety and human factors, controllers, pilots, and some clinicians. 16/

Erik Hollnagel made a distinction between egocentric and allocentric work-as-imagined. The former refers to our imagination of our (current and future) work. The latter refers to imagination of others’ work. The two have very different feedback loops. 17/

Within close knit groups, we are close to others’ work, and we tend to do similar kinds of jobs. So we can more easily imagine others’ work. We also form trust and reciprocity through our interactions – bonding social capital. 18/

Between groups – professions, teams, organisations – it is not so easy. It is hard to see and understand what others do, or why they do it (in the way they do it). We often lack trust and reciprocity. It’s hard to trust someone you don’t see. We lack bridging social capital. 19/

The issue of Safety at the Interfaces was the theme of #HindSightMagazine Issue 26. Here we explored interfaces between groups within aviation, as well as healthcare (@gasmanbax) WebOps (@allspaw) and communities (@CormacRussell). 20/

Some lessons that have struck me really strongly over the last few years have come from seeking to understand how communities work. It seems rare that organisations and professions try to understand communities, and yet there is much to be learned. 21/

One strand of practice is known as Asset Based Community Development – #ABCD. ABCD is an approach to understanding and developing communities from the inside based on that they have – assets – instead of what (we imagine) they don’t have – deficiencies. It starts with assets. 22/

A major figure in #ABCD has been John McKnight. He has worked in activist organizations and civil rights agencies, and learned the Alinsky approach to community organizing. He created a new Department at Northwestern University, to support urban change agents. 23/

Another major figure in community development has been Peter Block, known for work on organization development, community building, and civic engagement. He works on building the capacity of community to value its gifts and see its own possibility. 24/

I’m grateful to have been introduced to ABCD, and its history, via Cormac Russell (@CormacRussell). He has worked with communities in over 30 countries and has brought ABCD to many via @NurtureDev. Cormac is a faculty member of the ABCD Institute at Northwestern University. 25/

One of the many insights from #ABCD concerns boundaries and invitation. What are the boundaries of our groups? Is there an invitation at the edge? 26/

John McKnight recalled to Cormac Russell a story about John’s ‘County Labrador Retriever Owner Association’, where people and their Labrador dogs got together. One day, someone with a beautiful German Shepherd approached the group. But it wasn’t a Labrador. It illustrated something about the often arbitrary boundaries that we create and maintain. 27/

Boundaries between groups vary in nature. They can be situational, perhaps involving time or place. They can be physical, like a redesigned building that separates groups. They can be more personal, professional and social. Or they can be built into organisations and systems. 28/

Whatever kind of boundary it is that separates groups, it defines who is in, and who is out. It is usually clear to everyone on which side of the fence they are on, even though it may never be stated (see this interview in #HindSightMagazine Issue 26 with . @CormacRussell). 29/

Here is the challenge. Whether we think about our organisation, profession, group, team, association, community… “How can we keep expanding the limits of our hospitality. Our willingness to welcome strangers.” ‘Outsiders’ don’t dilute our group. They invigorate it. 30/

Another key aspect of #ABCD is about mindset. Communities – and people in organisations – are often seen through a deficit lens. So people are defined in terms of (imagined) needs. This is the wrong way to look and the wrong place to start. We need to start with their assets. This is also a way of thinking that resonates with Safety-II. 31/

It is valuable to discover the gifts, skills and passions of our fellows. What are they naturally good at – something their mother might point out? What have they learned as a skill? What are they passionate about? And how can we get these connected up between people? 32/

We want to increase participation in organisations and communities, and between the two. “Community building is about getting the greatest number of contributions by the greatest number of people” (from Looking Back to Look Forward). 33/

I think that this participation requires three things. The first is contribution or capability. We all have something to contribute, but this needs to be discovered. The second is the opportunity to show up and contribute. The third is the motivation or desire to do so. 34/

Increasing the diversity of contributions counters our ‘déformation professionnelle‘ – our tendency to look at things from our limited professional perspective. It also increases the quality of ideas and allows ’emergent expertise’ to emerge from our interactions. 35/

In getting our gifts, skills and passions connected, and in increasing participation from the greatest number of people, you don’t start at the centre. You start at the edge. This is a profound insight from #ABCD with implications for organisations and professions, too. 36/

A final insight I’d like to draw from #ABCD for the purposes of this thread concerns connection. We all have a role to play in getting people’s gifts, skills and passions connected, but we can learn from some people with particular roles or ways of being. 37/

In my podcast conversation with Cormac Russell, he highlighted four roles. Leaders crystallise issues that people can gather around, and develop followers. Networkers develop their network and may bring people together, but do so more opportunistically. Gappers link together functions and people at the edges or boundaries. Connectors connect in a special and natural way. 38/

You may have met neighbours/colleagues who are like this. They are well connected, see the best of others, are trusted & create trust. They believe in community & move around comfortably between different groups. They get joy from connecting people. They’ve no other agenda. They are connectors. 39/

You can listen to/read the whole discussion with Cormac Russell here. 40/

Asset-Based Community Development has affected my practice in some quite important ways. I routinely try to integrate #ABCD and Safety-II insight into safety, which is notoriously deficit-based, and organisational work more generally. How might you start discussions, observations, etc, on an asset footing? 41/

Here are couple of Editorials on the theme of this thread, from #HindSightMagazine Issue 25 and Issue 26. 42/

And that’s a wrap. It took longer than I imagined…but hopefully was helpful. Thanks for reading/listening. 43/43

Posted in Culture, Human Factors/Ergonomics, Safety, systems thinking, Uncategorized | Tagged ABCD, boundaries, collaboration, communication, community, deformation professionelle, diversity, emergent expertise, field experts, participation, safety-II, systems thinking, teamwork | 1 Comment

The Organisational Homelessness of ‘Human Factors’

Posted on 06/04/2018 by stevenshorrock

Most fields of professional activity have a settled home within the divisional and departmental structures of organisations. Operational staff work in operational divisions. Engineering staff work in engineering divisions. Everyone else tends to know their place: finance, human resources, legal, safety, environment, quality, security, corporate communications, and so on.

Not so for human factors (or ergonomics; HF/E). Within organisations that are large enough to have a divisional structure, ‘human factors’ can be found in a variety of divisions.

In this post, I outline four common homes for HF/E within organisations (after Kirwan, 2000), drawing on personal experience in each of the four organisational divisions in different organisations over the past 21 years, and some of the little literature on this (Kirwan, 2000; Shorrock and Williams, 2016). I conclude with some of the implications of organisational homelessness.

Photo: Dave Gray, Design by Division, CC BY-ND 2.0, https://flic.kr/p/9gPSJj

Human Factors in Operations Divisions

‘Human performance’ is, naturally, core to HF/E (but not equivalent), and in sectors such as transportation, energy production, manufacturing, power generation. and mineral extraction, HF/E is sometimes located in operational divisions of organisations. When housed here, HF/E practitioners may assist with the design and assessment of work, training, non-technical skills and team [team/bridge/rail] resource management, procedure and job aid design, observational safety, assessments and advice on fatigue and shiftwork, staffing and rostering, maintenance, personal resilience and confidence, stress management, safety investigation, quality improvement, and advice and support on human performance more generally. Such issues are reflected in texts such as Flin et al’s Safety at the sharp end and Davies and Matthews’ Human performance: Cognition, stress and individual differences.

Being close to operational teams and work-as-done can be especially rewarding. It is the only way to really understand The Messy Reality and Taboo issues. Problems and opportunities for work-as-done are hard to see from afar (if you want to understand risk, you need to get out from behind your desk). This divisional location can provide credibility with front-line operational staff, the beneficiaries of most HF interventions, and allow for the development of the relationships required for problem solving and opportunity management.

The other side of this coin is that there is a particular risk in Ops of becoming too close to operational staff, while also under the operational management structure. Independence can be compromised.

Housed in operations, human factors – as a design discipline – may also be in the unhappy position of inheriting upstream design decisions…and any resulting problematic situations. Without proper involvement to the design process, problems may come to light late in the design and development process. At this stage, there is considerably less opportunity for influence. HF/E practitioners in this context can also risk losing design skills, and also lose track of research; the research-practice gap can seem especially wide from Ops, where it tends to be valued least of all.

The shorter term focus of operations also brings an acute-chronic trade-off: when time is limited (i.e., all the time) handling today’s problems and opportunities leaves less time for future problems and opportunities.

Human Factors in Engineering Divisions

Human factors is, fundamentally, a design discipline. This is sometimes a surprise to some who perceive it as a behavioural (or ‘human performance’) discipline, which might be seen to be more naturally aligned with operations. However, human factors – by definition – operates primarily through design, not behaviour modification. This is exemplified by various textbooks, including old classics such as Sanders and McCormick’s Human Factors in Engineering and Design and Wilson and Sharples’ Evaluation of Human Work and, more generally, ISO 9241 – Ergonomics of hums-system interaction, especially Part 210: Human-centred design for interactive systems).

The international Ergonomics Association – the umbrella organisation for all HF/E societies and associations around the world – defines the profession as that which “applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance”. So HF/E specialists can often be found in engineering divisions of organisations.

In this organisational context, HF/E can help to address the design of equipment, tools, artefacts and infrastructure, such as control rooms, buildings, and signage. In such cases, the costs of not integrating human factors are extremely high. Compared to procedures and work routines in operational contexts, equipment, tools, artefacts and infrastructure are difficult and expensive to modify. Often, operations inherit design problems and have to adjust to them, sometimes with HF/E support in operations…

There are downsides to be aligned with the engineering divisions of organisations. Practitioners will tend to find they have to work within existing design and engineering processes, which may not be ideal for iterative human factors design. Being part of the design and engineering tribe brings some distance from operations – socially and culturally. As a result of organisational silos, the practitioner embedded in this context may well be closer to work-as-imagined and work-as-prescribed than work-as-done. Some who identify as human factors specialists – especially when previously integrated in safety or operations – will need to develop new design and engineering skills to be accepted. Designers and engineers, meanwhile, can naturally find it frustrating to have to pass a ‘human factors test’, or depend on knowledge that they do not have.

Human Factors in Safety (and Health) Divisions

Many organisations have a division of safety, focusing on operational safety (major hazards) or occupation safety, or both. Human Factors practitioners in this context – especially n high-risk industries – are likely support activities such as safety investigation, safety assessment (e.g., human reliability assessment), safety surveys, specific activities such as fatigue and stress management, and perhaps safety policy and the development of safety management systems. Safety departments may exist within a broader safety, health, environment, quality and, increasingly, security, in which cases other activities may be supported (e.g., concerning noise, vibration, the thermal environment, vision).

This context can be a good compromise between operations and engineering, affording close cooperation with both engineering project teams and operations, given sufficient attention to forging relationships across organisational boundaries. High level independent influence on strategic decisions (e.g., via safety management system requirements) can also be a benefit.

Safety divisions (and departments) are, however, often seen as external to both operations and engineering (both culturally and organisationally, requiring, for instance, internal contracting for services). HF/E may be seen as an interference, or supporting only one aspect of system performance (accident prevention), and not activities that support effectiveness more generally. Safety (and health) is only one of the goals of HF/E, which seeks to optimise system performance and human well-being.

Human Factors in R&D Divisions

For some HF/E practitioners outside of academia, R&D divisions offer a chance to do industry-centred research and development from the inside. Within government, inter-government or commercial organisations, HF/E practitioners conduct applied research on all aspects of the discipline – physical, cognitive, social, and organisational.

It is intellectually stimulating and offers a chance to generate and apply knowledge, with a longer time horizon (see Chung et al, 2016). It can offer the chance to imagine future work, and understand work-as-done now. From a professional development perspective, R&D offers the best chance to try to keep up with the impossible task of keeping up with the literature for any particular aspect of HF/E.

But of the four options outlined above, practitioners in R&D may experience the greatest distance both from front-line staff and senior management. This is reflected in outputs. As Kirwan (2000) notes, “There are three main types of papers, in order of importance to the company: trade journals, conference papers, and journal papers. The order of importance to the company and to the success of the unit is the reverse of the academic ordering of importance” (p. 668). This can be a surprise to practitioners. While Kirwan also noted, that “[journal] papers will be of greater perceived importance to the company if the HF group is located within a research division in that company”, there are in practice several barriers to publication as well as research application in organisations (Chung and Shorrock, 2010; Salmon and Williams, 2016), helping to explain the small minority of industry practitioners that author HF/E journal articles; as low as 3% in 2000 and 2010, compared to 76% and 81% of papers authored by research institution authors only, in the same years (Chung and Williamson, 2018).

This may reflect a decline in in-house HF/E R&D. Some major organisations that were previously heavy hitters in R&D no longer have a large R&D function, or no longer perform HF/E R&D.

Organisational Misfits…or Connectors at the Edge?

To many, the organisational homelessness of human factors brings confusion about the nature of the discipline and profession. Is it about design, or engineering, or operations, or safety, or health…? Human factors has a sort of identity problem.

This identity problem might be seen as fundamentally exogenous, existing in large part because of the functional structures of (especially) large organisations, which divide decision making from work, design and engineering from operations, research from practice, system performance from human well-being. These are all within the scope of HF/E; none can be excluded. But organisations are what they are, and command-and-control structures resist systems thinking.

So HF/E is indeed an organisational misfit, which might seem ironic since HF/E is concerned with the fit between system elements. HF/E is no more at home in operations, engineering, safety, R&D, or other organisational functions. Individual practitioners, may feel more at home in one context in particular, but will often be found at the edge of functions, interfacing with other functions at the organisational system as a whole. Organisations, meanwhile, may see a better fit for HF/E in one division, or indeed – perhaps ideally – spread over several. But there is no universally appropriate home. Traditional organisational structures are simply at odds with systems disciplines that work across functional divisions, especially those that do not reflect the flow of work or influence in a system.

For any individual practitioner, experience of a variety of organisational functions is helpful to understand the internal processes and sub-cultures that exists within organisations, and to identify the formal and informal bridges that exist, or can be built, between them.

So organisational homelessness can be a weakness, but also a source of strength. As a systems discipline, HF/E sees the whole, and focuses on interaction and influence, not just parts. As well as providing technical HF/E support, practitioners using an HF/E approach might ideally combine a systems and humanistic approach, mediating, bridging and connecting different organisational functions as connectors. This quote, from an interview on learning from communities with Cormac Russell, describes well this ideal:

“There are people who are loosely called ‘connectors’ at the edge, who move quite fluidly. I think about them as multicultural in a sense, in that they can move in between any groupings really but they have that competency and capability.” Cormac Russell

In organisations that divide by design, bridging is just as important as bonding…or more so. Organisational homelessness can help practitioners to navigate different worlds, without getting entrenched in one.

References

Chung, A.Z.Q. and Shorrock, S.T. (2011). The research-practice relationship in ergonomics and human factors – surveying and bridging the gap. Ergonomics, 54 (5), 413-429. [pdf]

Chung, A.Z.Q., Shorrock, S., and Williamson, A. (2016). Chapter 9: Integrating research into practice in human factors and ergonomics. In S. Shorrock and C. Williams (Eds.), Human factors and ergonomics in practice: Improving system performance and human well-being in the real world. CRC Press.

Chung, A.Z.Q., and Williamson, A. (2018). Theory versus practice in the human factors and ergonomics discipline: Trends in journal publications from 1960 to 2010. Applied Ergonomics, 66, 41-51.

Davies, D.R. and Matthews, G. (2013). Human performance: Cognition, stress and individual differences. Psychology Press.

Flin, R., O’Connor, P., Chrichton, M. (2008). Safety at the sharp end: A guide to non-technical skills. Ashgate.

Kirwan, B. (2000). Soft systems, hard lesson. Applied Ergonomics, 31, 663-678.

McCormick, E.J. and Sanders, M.S. (1992). Human Factors in Engineering and Design. McGraw-Hill.

Salmon, P. and Williams, C. (2016). Chapter 10: The challenges of practice-oriented research. In S. Shorrock and C. Williams (Eds.), Human factors and ergonomics in practice: Improving system performance and human well-being in the real world. CRC Press.

Shorrock, S. and Williams, C. (2016). Chapter 8: Organisational contexts for human factors and ergonomics in practice. In S. Shorrock and C. Williams (Eds.), Human factors and ergonomics in practice: Improving system performance and human well-being in the real world. CRC Press.

Posted in Human Factors/Ergonomics, Safety, systems thinking | Tagged design, engineering, ergonomics, human factors, organisational culture, organisations, practice, research, safety, systems thinking | 1 Comment

Human Factors and Ergonomics: Looking Back to Look Forward

Posted on 25/02/2018 by stevenshorrock

During the second world war, the United States lost hundreds of planes in accidents that were deemed ‘pilot error’. Crash landings were a particular problem for the Boeing B-17 ‘Flying Fortress’. The planes were functioning as designed, and the pilots were highly trained, but made basic errors. In 1942, a young psychology graduate, Alphonse Chapanis joined the Army Air Force Aero Medical Lab as their first psychologist. Chapanis noticed that the flaps and landing gear had identical switches that were co-located and were operated in sequence. In the high-workload period of landing, pilots frequently retracted the gear instead of the flaps. This hardly ever occurred to pilots of other aircraft types. Chapanis fixed a small rubber wheel to the landing gear lever and a small wedge-shape to the flap lever. This kind of ‘pilot error’ almost completely disappeared.

A few years later in 1947, experimental psychologists Paul Fitts and Richard Jones analysed accounts of 460 errors made in operating aircraft controls, through interviews and written reports. They noted” that “It has been customary to assume that prevention of accidents due to materiel failure or poor maintenance is the responsibility of engineering personnel and that accidents due to errors of pilots or supervisory personnel are the responsibility of those in charge of selection, training, and operations.” Fitts and Jones took a different slant altogether. The basis for their study was the hypothesis that “a great many accidents result directly from the manner in which equipment is designed and where it is placed in the cockpit.” What had been called ‘pilot error’ was actually a mismatch between characteristics of the designed world and characteristics of human beings, and between work-as-imagined and work-as-done.

Fitts and Jones considered a range of problems, including operating the wrong control, failing to adjust a control properly, forgetting to operate a control, moving a control in the wrong direction, unknowingly activating a control, and being unable to reach a control when needed. The flap-gear substitution error, and many other ‘pilot errors’ were actually problems of cockpit design. They concluded: “Practically all pilots of present day AAF aircraft, regardless of experience or skill, report that they sometimes make errors in using cockpit controls. The frequency of these errors and therefore the incidence of aircraft accidents can be reduced substantially by designing and locating controls in accordance with human requirements” (p.2). They went on to specify design measures for controls and displays (concerning standardisation, simplification, sequencing, interlocks, and other aspects of compatibility of controls with human characteristics and expectations).

These and other studies brought into focus the ‘obvious fact’ that human performance cannot be separated from the design of tasks, equipment and working environments. We can’t just train and supervise human performance. We have to design for it. Accidents associated directly with cockpit design are now extremely rare, and in 2017 there were no passenger deaths from flights in commercial passenger jets.

The birth of a discipline

Research in the US and UK concerning real work in real environments during and after WWII formed the beginnings of the discipline that was termed ‘human factors’ (US) and ‘ergonomics’ (UK). It was not the intention of early researchers to form a new discipline. Rather, “the intention was much more modest, namely, to facilitate discussion, information exchange and collaboration between scientists working across a range of specialisms” (Waterson, 2016). These specialisms were anatomy, physiology, psychology, industrial medicine, industrial hygiene, design engineering, architecture and illumination engineering (Murrell, 1965).

Over time, human factors/ergonomics (HF/E) became a distinct discipline, with its own societies. The first was the Ergonomics Research Society in the UK in 1950 (now Chartered Institute of Ergonomics and Human Factors), following by the Human Factors Society of America in 1957.

Despite the different names for the discipline, a formal definition has been agreed, via the International Ergonomics Association – the umbrella association for national HF/E societies and associations. The definition is accepted by member societies around the world:

“Ergonomics (or human factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.” (International Ergonomics Association)

Another simpler definition was provided by the late John Wilson, who later deﬁned ‘systems ergonomics and human factors’ as follows (extract):

“Understanding the interactions between people and all other elements within a system, and design in light of this understanding.” (Wilson, 2014, p.12)

Simpler still, HF/E is sometimes referred to as ‘design for human use’.

HF/E takes a scientific approach to understanding and design, including the generation and application of associated theory, principles, data and methods. Decades of scientific research in a range of contexts have enabled a sophisticated understanding of human needs, limitations and capabilities, influences on human performance and wellbeing, human influences on system performance, and patterns of interaction between human and other system elements – physical, technical, informational, social, organisational, political, and economic.

Designing interactions

HF/E focuses on the design of these interactions. This differentiates HF/E from other design and engineering disciplines. For industrial applications, a good shorthand for this is ‘work’. So HF/E seeks to optimise the design of work, but with a focus on work-as-done, and not simply work-as-imagined (see also EUROCONTROL, 2016).

Interactions occur at different levels. At a micro level, we have basic interactions such as pulling a lever, pressing a button, turning a dial, or hearing an alarm. At a meso level, interactions combine, bringing more complexity, such as communication and coordination between a pilot, co-pilot, and cockpit. At a macro level, the number of elements and interactions, and associated complexity, increases further, perhaps expanding to air traffic controllers, air navigation equipment, ground staff, airport, airspace, management, regulation, etc. As the lens widens, so does the number of stakeholders, and the number of goals, needs and system or design requirements that need to be considered.

These interactions occur in a context, and context is critical to HF/E. If I turn the wrong burner on my stove (which I do, very often), it is not a problem. I simply turn it off and now I know the correct dial to turn. If I want to be sure I can bend down to look at the little diagram, but often I can’t be bothered. A similar action for B-17 pilots resulted in retracting the gear instead of the flaps, and accidents. A similar action for an anaesthetist might inadvertently turn off a continuous-flow anaesthetic machine because of a badly positioned power switch. If the consequence of my turning the wrong burner dial were more severe, I would bother to check the little diagram often, but I would still make mistakes, mostly because the layout of the stoves is incompatible with the layout of the dials, which look identical and are co-located. If the consequences were indeed more severe, cooker designers would be forced to design dials to be compatible with burners, along with other designed safety features

HF/E in practice is a blend of craft, engineering and applied science. The approach tries to make system interaction and influence visible. It uses methods for data collection, analysis and synthesis, to understand and map system interaction at every stage of the life-cycle of a system or product. HF/E can therefore help in the design of interactions in the context of:

artefacts (e.g., equipment, signs, procedures)
designed environments (e.g., airport layout, airspace design, hospital design, lighting)
planned organisational activity (e.g., supervision, training, regulation, handover, communication, scheduling)
work and job design (e.g., pacing, timing, sequencing, variety, rostering, critical tasks)
emergent aspects of organisations and groups (e.g., culture, workload, trust, teamwork, relationships).

I like to think of human factors and ergonomics as rooted – to some extent – in four kinds of thinking:

systems thinking, including an understanding of system goals, system structure, system boundaries, system dynamics and system outcomes;
design thinking, including the principles and processes of designing for human use;
humanistic thinking, emphasising human agency, awareness, wholeness, intention, meaning, values, choice, and responsibility; and,
scientific thinking, purposeful thinking that aims to enhance scientific understanding by problem specification, hypothesising, predicting, observing, measuring, and testing.

The ultimate goals of this design activity are to optimise human well-being and overall system performance. Some argue that this joint ‘and’ purpose characterises the unique holistic nature of HF/E (e.g., see Wilson, 2014). In practice, it means optimising for several goals concerning the effectiveness of purposeful activity (such as efficiency, productivity, maintainability) and particular human values (such as safety, security, comfort, acceptance, job satisfaction, and joy). Some goals are usually of higher priority than others for particular applications, but they often conflict and compete, requiring practical trade-offs and compromises.

Since the 1950s, HF/E specialists – practitioners and researchers – have come from various academic backgrounds and increasingly a wide variety of professional backgrounds and industries. They work with all sorts of people at all levels: consumers and service users, front-line and support staff, supervisors and senior management, regulators and policy makers in almost all industrial sectors (see Shorrock and Williams, 2016, for an overview).

Human Factors/Ergonomics is booming in certain sectors, where success seems to have begat success. ‘Ultra safe’ sectors such as air traffic management, rail and nuclear power in the UK have well-developed HF/E capabilities. NATS – the UK’s en route air traffic control provider – has a human factors department that has been staffed by 20-30 full time HF/E specialists and psychologists over the past 15 years or so. The Rail Standards and Safety Board (RSSB) and Health and Safety Executive have long had a mature and effective human factors capability, as have the nuclear and defence industries. All provide HF/E services in all aspects of the different sectors, from concept design through detailed design, prototyping and simulation, construction and commissioning, operation and maintenance, and decommissioning.

But the success has not been evenly spread, and has not matched need. It often appears that those sectors with the greatest need – healthcare, road transport, and farming, for example – benefit least in terms of HF/E practitioners in applied roles. Seventy years after Fitts and Jones’ seminal reports on controls and displays, quite basic design problems remain in many industries.

In healthcare, for instance, different medicines look alike and sound alike, despite the presence of official guidance informed by HF/E. There are thousands of machines with design problems so basic as different number formats; in a single hospital, one can find pumps with keypads that are like a telephone, like a calculator, or a keyboard. This shows how far ahead of its time was the work of Chapanis in the 1940s.

In fact, it was Chapanis who designed the standard telephone numerical keypad configuration that is in use today on every telephone and smartphone around the world. He tested six configurations of buttons, two vertical, two horizontal rows, and different three-by-three arrangements. All of these variations can still be found in safety-critical equipment. And most of the problems in using controls that were analysed by Fitts and Jones can be found in in safety-critical equipment used for mining, oil and gas extraction, agriculture, forestry, fishing, manufacturing, construction, recycling, digital products, telecommunication, transport, and healthcare. There may be several reasons for this.

Just three of the numerical interfaces that a clinician may use.

Branding

One reason may be a failure of branding and marketing. HF/E specialists have not come from marketing backgrounds are not typically good at it. For a start, HF/E is a discipline and profession with two names, seen as equivalent in the discipline, but different in industry and the media (with ‘human factors’ associated with accidents, and ergonomics associated with ‘design’, Gantt and Shorrock, 2016). Its focus on ‘system interactions’ appears to be lost to many outside of the profession. It doesn’t have a clear elevator pitch, and is not instantly recognised and understood by the public in the way that HF/E specialists would like it to be (with ‘ergonomics’ being associated with office furniture, and ‘human factors’ being associated with nothing much).

Staying technical

A second reason may be a failure of ambition and lobbying. Sherwood-Jones (2009) argued that “many ergonomists are committed to an entirely technical career and have no aspirations to management. … The consequence of staying technical is of course that you will be ignored, overruled and brought in when it is too late to do anything useful, but not too late to demonstrate that ergonomics can fail.” There are few (often no) qualified and experienced HF/E specialists on company boards, in national regulators (even aviation), or policy makers, let alone governments. While aviation is often seen as a paragon of HF/E, only one national aviation administration maintains a high level of expertise and research programme in the discipline: the United States Federal Aviation Administration. With a few exceptions, it seems that HF/E specialists have been happiest at the micro and meso levels of interaction design, and not at the macro level, despite the systemic adverse influence of top-down interventions on system and human performance (e.g., government performance targets, see Shorrock and Licu, 2013).

Shortage of HF/E specialists

A third reason may be a shortage of qualified HF/E professionals (accredited, certified, registered or chartered by relevant societies and associations) situated in industry and government agencies. This is also associated with limited demand and a shortage of HF/E courses. In many countries, there are few or no HF/E professionals even – or especially – in sectors with the highest number of ‘avoidable deaths’.

Taking the UK as an example, in England there are 233 National Health Service Trusts – providers of urgent and planned health care (‘secondary care’). NHS England is an organisation of over 1 million staff, with a planned expenditure for 2017/18 of over £123bn. It espouses a focus on patient safety, and its focus areas for 2017/2018 clearly require HF/E expertise, including improving investigations, reducing medication error, and “an approach to patient safety is widely recognised as world-leading” (NHS England, 2018). The number of qualified full-time HF/E specialists in NHS England care providers can be counted on one hand. In fact, only one out of 233 NHS Trusts employs any Chartered Ergonomist and Human Factors Specialists.

There is some excellent training for clinicians in aspects of behavioral human factors, such as team training, team resource management and non-technical skills, and many Trusts have their own advanced simulation facilities and staff. This does not, however, address the underlying design problems that remain, and at best may provide awareness of these, and compensatory behavioural routines.

Rising popularity

Despite the shortage of HF/E specialists, HF/E is becoming more popular. Over the last decade or so, the term ‘human factors’ and HF/E issues have gained currency with an increasing range of people, professions, organisations and industries. This is a significant development, bringing what might seem like a niche discipline into the open, to a wider set of stakeholders. In healthcare, there is now significant participation in discussions about ‘human factors’, which can be seen especially on twitter. The same can be seen in other industries, especially new sectors such as web operations and engineering. Front-line workers know that HF/E is relevant. It’s kind of obvious that work should be designed for human needs and characteristics. The difficulty seems to be in getting commitment for resource at upper levels.

A two-pronged solution

The criticality of HF/E is not in dispute. So how to gain more traction on designing for human wellbeing and system performance? One way is of course more training opportunities. Another is more lobbying for HF/E posts in commercial, governmental, and intergovernmental organisations. Certain roles, typically involving a wide and deep level of content and method expertise will always require highly qualified and experienced HF/E practitioners (e.g., certified, registered, chartered). For instance, these specialists are now higher demand, and having greater impact, in medical device design and pharmaceuticals. But this h as been tried for decades, with limited success.

So the other half of the solution is to spread HF/E to others, who might be familiar with certain aspects of HF/E theory and method, practicing certain aspects of HF/E design, or advocating or evangelising HF/E principles, but not HF/E specialists as such. The founders of HF/E were not HF/E specialists then (and were probably too specialised to ‘qualify’ as HF/E specialists today!). So this is where you come in. If the idea of designing for human use to optimise performance and human wellbeing appeals to you, then now is a good time to think about how you might learn more, and integrate HF/E in your practice.

References

EUROCONTROL (2016). HindSight: ‘Work-as-imagined and work-as-done’. Issue 25. Brussels: EUROCONTROL

Fitts, P.M. and Jones, R.E. (1947). Analysis of factors contributing to 460 “pilot error” experiences in operating aircraft controls. Dayton, OH: Aero Medical Laboratory, Air Material Command, Wright-Patterson Air Force Base, 1947.

Gannt, R. & Shorrock, S.T. (2016). Human factors and ergonomics in the media. In Shorrock S. & Williams, C. (2016). Human factors and ergonomics in practice: Improving system performance and human wellbeing in the real world. CRC Press.

Murrell, K.F.H. (1965). Ergonomics: man in his working environment. London: Chapman and Hall.

NHS England (2018) Patient safety. Accessed on 10/01/18 at https://www.england.nhs.uk/five-year-forward-view/next-steps-on-the-nhs-five-year-forward-view/patient-safety/

Sherwood-Jones, B. (2009). Usability assurance (blog). Accessed on 10/01/18 at http://processforusability.blogspot.co.uk/2009/10/usability-assurance.html

Shorrock, S. and Licu, T. (2013) Target culture: Lessons in unintended consequences. HindSight: Safety versus Cost. Issue 17. 10-16. Brussels: EUROCONTROL.

Shorrock S. & Williams, C. (2016). Human factors and ergonomics in practice: Improving system performance and human wellbeing in the real world. CRC Press.

Waterson, P. (2016). ‘Ergonomics and ergonomists’: lessons for human factors and ergonomics practice from the past and present. In Shorrock S. & Williams, C. (2016). Human factors and ergonomics in practice: Improving system performance and human wellbeing in the real world. CRC Press.

Wilson, J (2014). Fundamentals of systems ergonomics/human factors. Applied Ergonomics, 45(1), 5-13.

For more information on HF/E degree courses in the UK, see here. For shorter courses in the UK, see here.

For more information on HF/E degree courses in the USA, see here.

For information on other HF/E societies and associations and educational opportunities, see here.

Learning from Communities: A Conversation with Cormac Russell

Posted on 11/01/2018 by stevenshorrock

The study of communities and community-building activities can provide important insights into collaboration within and between organisations. Over the last 21 years Cormac Russell has worked in 35 countries, with communities, agencies, non-governmental organisations and governments. This post includes the podcast and transcript of a conversation between Cormac Russell and me, about learning from communities.

A short edited version of the conversation can be found here in HindSight 26.

Key Points

Healthy communities have permeable boundaries to allow people in, and to create space for people who are inside to be able to get out.
Communities have ‘connectors’ at the edge, who connect people and help create community. Connectors are trusted and gift-oriented.
People can be seen in terms of their gifts, skills and passions. Discovering these and connecting them between people is at the heart of asset based community development.
Professions have become more siloed, and the effect can be to ‘other’ those people who are not in the silo.
Organisations can help to understand interdependence via small group conversations.

<Intro>

1:46

Steven Shorrock (SS): Cormac Russell, thank you for making the time to talk to me on this podcast from a series called Inquiries from the Edge. I wonder if you could just take a moment to introduce yourself the listeners to who you are and what it is that you do.

Cormac Russell (CR): Sure, so it’s good to be with you Steve, and good to be participating in this conversation, this inquiry. I suppose the space that I hold dearest is just this love of community, and an interest in how to grow community. My formal credentials around that are that I am an ABCD faculty member, and ABCD stands for asset based community development. So there is an Institute that essentially is at the centre of trying to understand how people, you know, living in indigenous communities in small bounded places can get powerful. And we have spent a long time thinking about people all over the world. So I personally, over the past 21 years, have been working in about 35 different countries at that neighbourhood or small place level. Really thinking about power as distinct from empowerment – really thinking about how people themselves get connected and grow power. And the methodology that we use is called, as I have said, asset based community development. So I have a little bit of responsibility around promoting that the approach in the UK. So that is another appendage to my name I am Director of ABCD in Europe.

SS: So you talk about community there. What in your mind makes community a community? What defines a community?

CR: Yes it’s a great question, and I think a question that could probably tie us up in knots in a lot of ways, but the working definition that I think a lot of people seem comfortable with is that it is a group of related people. What they are related to or what they are related by is, kind of, perhaps academic. What I really like to do is ask the question ‘where is community?’ because I think today that if we want to talk about ‘what is community?’ we could have so many disembodied examples.

I regularly hear people refer to groupings of people as communities and when you enquire into the reality, you find that there are a lot things that are excluded. I would personally think about when I think about community, I would think about culture. I think about economy. I think about environment, the place, if you like – built and natural. I think about the associational life of the community but also the capacity of the community to welcome others that are not currently in the community into that space.

So I think…I’m a little bit hesitant about just defining community as a related group of people. I often say that if you are standing on earth there is more community happening under your feet then there is above the ground. You know, so community means an awful lot of things and the fullest definition for me is a group of related people that are also related to the place that they are in, in some shape or form, are creating a culture together that will prevail beyond them, and have some way of making exchange happen.

05:38

SS: Right, so that relates to the reason for our conversation today, really. As you know I am the Editor in Chief of a magazine called HindSight, which is directed primarily at air traffic controllers and also pilots. It’s a safety magazine produced by EUROCONTROL. And the next edition of HindSight is called ‘Safety At The Interfaces’ and it’s about participation between different groups of people. Now the interesting thing is, some of those groups, especially tightknit groups such as air traffic controllers and pilots, will sometimes use the word ‘community’ to describe their groups. So what are you’re thoughts on that and what makes these groups different to the natural communities that you work with?

CR: Well I think, there is a paradox, in this because I guess that what people do when they are describing themselves as being in a community is that they are trying to say that these are my people, and we have a way of being in relationship with each other. And so one doesn’t want to say anything that dishonours that or makes people feel ‘less than’. But it feels to me that that maybe what they are actually experiencing and trying to describe is a peer group. And to an extent what they are experiencing within that peer group is many of the experiences that we have when we create community and maybe even family. You often hear people talk about their fraternity as a family or as a community, but it does seem to me that if we wanted to be little bit more precise, I think what would be talking about is a group of people who are associating with each other and their shared … you know, what helps them to be related is the fact that they are all, in this instance, of the same discipline. And so to me that’s probably a peer group. Now it’s interesting isn’t it because to an extent you might say that that’s splitting hairs but if you think about another peer group, if you think about a peer group of people who are in recovery from addiction, they also have other aspects to their lives, you know, outside of that peer group, and a healthy peer group would encourage those different aspects to their lives.

The interesting thing, I think, about a peer group is that it’s a group of people who are together by consent rather than control. So there’s something that is consenting about them being in relationship with each other and that’s something maybe to explore because I wonder when, you know, you have a group of, say, people who come together and form a golfing club in an institution like yours. They’re peer group as well, right? They are related by their affinity to golf, and to each other. How that dynamic is different than a peer group that is organised around discipline would be really interesting to think about that and what kinds of dynamics and behaviours are created within those contexts.

SS: So related to that in your book, which is called ‘Looking Back To Look Forward’, you interview a pioneer in community development, Professor John McKnight. And he related to you story about a group that he once belonged to called the ‘County Labrador Retriever Owner Association’. I wonder if you can recall the story because it relates to something you’ve just mentioned?

09:52

CR: My recollection is that John was talking about having a strong affinity to dogs. He’s a great lover of dogs, and so we were talking about what we would call associations. So this Labrador Association just had this wonderful love for Labrador dogs, so he felt at home. Until a different breed of dog, so I think they were around doing whatever they do in the park or whatever it might be, parading their dogs, admiring each other’s dogs, then feeling good about the praise they were getting for their own dogs. And then walks in to the association somebody else with a breed of dog other than their breed, and suddenly there was a kind of internal consternation in the association. “What do we do with this?”

So he was relating the story to make the point, I think, that they are an affinity group. They have an affinity for Labrador dogs. That there is a paradox, at one level that affinity to dogs allows them to be in a deep relationship with each other but at another level the minute that somebody outside of that affinity group comes in, the group locks down. And that invisible boundary around the group that says “this is the in-group and there’s the out-group” suddenly becomes very apparent by the behaviour.

“Every community, every peer group, every affinity group, has this invisible boundary that says to the world “these are the people who are in, and these are the folks who are out”.

So the very thing that allows community forecloses on community. He was trying to relate this idea that every community, every peer group, every affinity group, has this invisible boundary that says to the world “these are the people who are in, and these are the folks who are out”. So his challenge to us, I think, was to figure out how you could blur, or how you could create permeability around those boundaries. And to an extent that’s kind of the challenge of community. Its not to be able to grow a closed hermetically sealed circle like an awful lot of affinity groups online are, for example, they are the same like-minded people who vote the same, live in the same kind of house, think the same, look the same. And we have seen how populism has grown, you know, in recent elections and recent public decision-making as a consequence of this. So he’s really pointing that out to us and that this is pretty dangerous, this kind of tribalism, but it can feel cosy and it can feel warm and fuzzy at the same time.

SS: So he was saying what holds us together is the belief that we have the best breed of dog. And maybe as professions, professions of all sorts, think that we are the best breed of profession and we have to have a boundary around our profession which may be a social boundary, it may even be physical boundary. So thinking back to air traffic controllers, they work in an operations room, an Ops room, which may be a tower or a radar centre, but there is tight security and it’s for good reason, it’s not easy for anyone to get in or out. So there are all kinds of boundaries around this group of people. But the question then is, is that boundary always a good thing and when do we need to create that permeability in the boundary in order that air traffic controllers can interact with others that they need to interact with in order to create safety both in the short term and in the long term?

13:55

CR: I suppose in a sense there is a tension here in the question because the one thing that we don’t want to do is get into a dualism or a polemic that says having an identity around our discipline, and having fraternity allows us to feel good about what we do, is not necessarily bad. So how do we get the best of it, but as you say allow it to breathe, allow it to be open.

“It isn’t just allowing people in. It’s also about creating space for people who are inside to be able to get out on to do other things”

It’s interesting, it isn’t just allowing people in, I think, it’s also about creating space for people who are inside to be able to get out on to do other things. Because my sense of it is if you go back to the Labrador idea and the Labrador dogs, what held them together was certainly this sense of, Labradors you know it’s the best thing, but actually in truth there’d be quite a few people who are reasonable and who maybe don’t hold that is tightly or as firmly. But in order to maintain their affinity and their membership of the group, they kind of have to play a game. They have to become socialised into almost “we are the best”, so there is that kind of tribalism piece.

And I think there is something about saying, how do we free some folks up inside those groups who are probably more pro-social, who are probably more at the edge anyway, and can just operate in the interface. Because everybody isn’t at the centre of the community circle. They are quite…people are spread all over. Some are more at the edge. Some have a foot in and a foot out. So I think some of it is about being able to say, well actually if we look closely at it rather than definitively saying, you know, we got a set of pilots or we’ve got a set of air traffic controllers, there effectively is an invisible exclusion zone around them. To be saying, well, in actuality they are probably quite a few who behave like that but quite a few at the edge who are trying to figure out how to negotiate that interface themselves. And we talk a lot about this idea that, you know, when you think about the edge, I think that there are a number of people at the edge. So there are probably people who are loosely called ‘connectors’ at the edge, who move quite fluidly. I kind of think about them as multicultural in a sense, in that they can move in between any groupings really but they have that competency and capability.

“So there are people who are loosely called ‘connectors’ at the edge, who move quite fluidly. I think about them as multicultural in a sense, in that they can move in between any groupings really but they have that competency and capability.”

And then I think there are people who are good brokers. They are not necessarily… they may not necessarily be people who are good relationship builders, but they are good askers. So maybe they have an authority or they have a leadership position, that says you know what, I’d like to have different conversation and I’d like different people. So in a sense I think that’s possibly a role you play. You kind of occupy a gap between these worlds.

So I think that when we set out the terrain, if we did a map of the terrain I think it would be helpful to be really cautious about how we diagnose or how we fix our map onto the terrain. And say, you know, the map is not the territory. The territory is much, much more blurry and there are a lot of covert double agents, kind of moving in between all of these bubbles. And so maybe one of the questions is how do we liberate them more, how do we open up and maybe give them the power to have those conversations that begin to shift and change the dynamic.

SS: So you use this word ‘connectors’ and that’s something that you have wrote about on your blog and it’s something I’ve heard you speak about. So rather than asking, I guess, who are they, what is it that connectors actually do?

18:12

CR: Well what can I find helpful to think about this how a ‘connector’ is different to a ‘leader’ and a ‘networker’. And then kind of get into how they, what are their practices or what is it that they do. So I feel, and this is a very, very reductive way of describing it, but I feel that leaders are really, really good at crystallising issues that people can get around, so they can grow a followership. Not even necessarily around themselves, but around a vision or an issue, and they can hold some stewardship around that. They are the good ones.

“I feel that leaders are really, really good at crystallising issues that people can get around, so they can grow a followership.”

So we need leaders and I think networkers tend, to my mind, to be, and I don’t mean this at all negatively, but they tend to be quite opportunistic in the way that they bring people together. So they kind of sense the network being about a job of work or being about very intentional exchanges. So I think entrepreneurs are really good networkers. But there is a lot of thought going to who owes who favour and who is good for a favour. There is a lot of transaction, I think, in networking.

For me, I think what distinguishes a connector from a networker or a leader is, number one I don’t feel that a connector, when I am in a relationship with a connector and I see what they are doing, in the relationship, I don’t feel like they are trying to sell me anything, or sell me out. I don’t feel they are trying to impose an agenda upon me so this is kind of inverting your question. I’m now telling you what they don’t do. And I will get to what I think they do.

What I think they do or what I experience them doing, because there are connectors in my life, is number one, I think they are gifted-oriented. So I see them being able to see in me something that I can contribute to somebody else. So I see them looking for that. I don’t, typically I don’t, believe they know that they are. I think that’s just instinctive. Most of them just come born that way. But they are very, you can see it in their interactions, they are almost looking for the hook within you that will join the hook that they have discovered in somebody else. And you can see it in their facial expressions, you can literally, I now recognise, there is recognition, it’s almost like an aha moment when they spot that and I suppose that because they are gift-oriented they’ll spot that through by eliciting, through questions.

So they ask questions, you know. “What do you like to do?” “What are your hobbies?” So you will kind of find that. And in the moment when they hear you say something that they think will either add value to somebody else they know, in terms of their quality of life, or will in some way, maybe, bring something into a space that wasn’t there before, they will say something like “you know I know somebody and I think that you would get on with like a house on fire”. So what’s really interesting about them is two things. One, they’re questioners, they’re revealing gifts, that’s one. The second, is that they are seeing how those gifts, right, so they spotted your gifts and they spotted the gift of another person and somehow they instinctively know that just spotting gifts is not enough. So just doing the discovery is not enough. They then know that they’ve got to connect those two gifts. So two unconnected gifts is reprehensible to a connector. They want to see them connected, so they will make those connections. You will literally find yourself one-minute having a conversation with them and the next minute walking down the street or walking down the corridor, and being introduced to somebody and them say things like well there’s no time like the present and suddenly you’re been carried along. So somehow they feel welcome to do that and you don’t feel like you’re going being to stalked or you’re being bullied in the process. And I think the final thing they do is in the connecting they will often, not always, but they will often say something or do something that suggests that you both act in some way together, or if it’s three or four. So they’ll will suggest that you mobilise.

“Two unconnected gifts is reprehensible to a connector. They want to see them connected, so they will make those connections.”

SS: So they will put a seed in your mind.

22:39

CR: That’s right, exactly. And the final thing they do, often, is they then lead by stepping back. They disconnect. It’s really interesting. So this isn’t what a networker does. The networker, kind of stays close up to the network because they need something back from the network. Whereas I find the connector will disconnect. Not in any kind of antisocial way but it’s kind of like “ah, that’s that done now”. So there is a sense of altruism in it, you know, in that they are getting something back but they’re getting something back in terms that allows them to step away.

If we go back to our conundrum of earlier on around the boundary circle that hasn’t got enough permeability, then one of the ways of creating permeability is to find the connectors within each of those circles and help them relate to each other.

23:39

SS: So in my professional life, And I guess listeners who are thinking about their worklife, I certainly met several connectors who, they’re often in professional associations and, so they often act in a voluntary capacity. Sometimes they don’t, they don’t want any kind of Association. But what they do is, as I experience those people, is they reach out between professions, between sites. So between one site that may be in one city on one site that maybe in another. And also even between organisations. So they I guess maybe people who are just connectors in their everyday life, but I see people naturally do that kind of thing at work. So they reach out, they maybe controllers, and they reach out to the safety specialists, they reach out the engineers, they form those kind of connections. So is that the kind of person that you’re thinking about?

24:38

CR: Absolutely. And in the community context what we would try to do, is we would try to find some kind of way of revealing those connectors, and getting them connected together. So you are creating, you’re optimising possibilities. So they are there naturally, they are in prisons, they are in organisations, they are in families, they are in are communities and, in the sense of communities of place. So it is beginning to say, okay well if they are there, how is the culture currently nurturing what they do naturally anyway, or is it stifling it? And if it is stifling it, how might we, rather than get stuck in that narrative and that story, how might we disrupt that constructively and innovatively? And that’s where community building and community organising comes in think.

25:37

SS: Another thing that comes to mind there is that those connectors, when I think about one thing that holds them together or something they may have in common, is that they are trusted and that can be, I think, something that differentiates them from leaders or from networkers who may or may not be trusted, but I sense connectors are always just naturally trusted.

CR: Yes, Absolutely.

SS: That, I guess, it would be a defining characteristic?

“I think it’s really striking isn’t in life generally that when you are in relationship with somebody that isn’t trying to get you to be interested in them but is genuinely interested in you and has an interest in other people, that that’s kind of uncommon.”

CR: I think they’ve earned those credentials. I think it’s really striking isn’t in life generally that when you are in relationship with somebody that isn’t trying to get you to be interested in them but is genuinely interested in you and has an interest in other people, that that’s kind of uncommon. And therefore you’ll find that trust builds very, very quickly with people who behave like that. And what is interesting about them is that even though trusted, they are not in any particular rush. So they are going at the speed of trust. They will read the pace really well. So that’s the other thing. I mean the example I gave you was quite a quick snappy example but I’ve seen connectors patiently take their time to build relationships with people and really very thoughtfully wait for that moment when they, by instinct, felt it was the time to connect or it was a time to introduce something. They are also able to tune in to where people are at in their lives and will make those introductions, those connections, based very much around that.

27:33

SS: Something that you mentioned earlier was that people with this connecting capacity are ‘gift-oriented’. I am wondering if you can say a little bit more about what you mean by people’s gifts and how that is relevant to this whole thing about connecting different groups and even connecting people within the same group.

CR: Well I suppose, maybe just to give some definitions around it first of all and then maybe talk a little bit about it in general terms. If you think about a person in terms of their capacities, just to broaden the framework a little bit, I think about people as having gifts, and what I mean by that is stuff that they are just born with, they do naturally. So they didn’t learn necessarily, it’s just a part of their make-up. So I think some people may be very patient, for example. It’s not something that I would say most people would think of definitively as a skill. You know if you say to somebody, “How did you learn to be so patient?” “It’s just my nature, it’s my temperament.” [Dog barking] We know as parents, we have seen it in our children, we see children very, very early on display temperaments. So I think that is the domain of gifts.

And it is very, very interesting, you know, to think about how different genders, actually, in our experience doing a community work we find, we very rarely get away with starting a conversation with a man about “what are your gifts?”. So it is much easier for us to go to the second expression of capacity, which is skills, with men. With women, I think this is a vast generalisation, but, you know across 21 years, 35 countries, you can begin to make some common observations and there are certainly, there are gender preferences around how to start a conversation and grow trust. This is something that connectors know, actually, instinctively as well. So it’s much easier for me to start a conversation with the man about his capacities if I start about his skills, you know. “What have you learned?” “What could you teach?” “What three things do you know well enough that you could pass on to a younger person that you might mentor?”, as opposed to “What are your gifts?”. And it’s really striking and it feels like it has a gender relationship in whatever way you understand that fluid concept.

So the skills piece alongside the gifts is interesting but skills are broadly, you know, as you would imagine that they would be, are things that we’ve acquired, and things that perhaps we’ve refined enough to either feel that we have learned them, and we can therefore find a way of expressing them to the world, whether it’s a craft, you know, or it’s a knowledge skill. So we often talk about the skills, you know, that are head-based skills; things that I know and I could teach somebody else. And skills of the hands, so crafts, you know. Saddle making, I have a cousin who is a saddle maker and he could perhaps, if he had enough patience, teach me that. But I think he has also got a gift for it, he has got a flair for it as well as a set of skills. So we see you these marching together.

“I think you can have a gift and the skill and never express it.”

I think the third thing I think about in terms of capacity is passion. And the way I would make the distinction between a gift, a skill and passion is, I think you can have a gift and the skill and never express it. So I can be very gifted at something I don’t even know. And I think there’s are lots of people in organisations and in life generally outside of the organisational world, in what some people call the life world, you know, outside of institutions, outside of contracts, who have gifts that they don’t know they have. Now the interesting thing is that connectors are really good at helping them see those. So this assumption that we know what our gifts are, or even our skills, is to be challenged.

Now a passion is by definition different because a passion is something somebody is taking action around. They might not be particularly good, but they feel passionately about their kids so they take action to do something and the action might be that the lobby, you know, for better medical treatment for their children. But they are incredibly shy person by nature. So it’s not their gift to speak out, and they have no public voice. When they stand up to make a presentation they would rather somebody shoot them. It’s that fearful for them. So they don’t have a skill around public speaking but somehow at that moment the passion for their child mobilises them to speak out, even though their voice is shaking.

So this is really interesting in my mind, somebody can have those three capacities and to an extent, you know, a lot of our work is about people helping people discover what they are and then contribute them to other people. That’s how you build community, right? You show up and you make that contribution. So that’s what I think community is about. But you can’t make that contribution until somehow you know that within yourself. Now you can go and spend 10 years in therapy to discover it or you can get involved in community life and dynamically it starts to get revealed. Or you can do both.

33:28

SS: So joining those two things up there, you’ve talked about gifts, skills and passions as our three capacities, which is a useful way of thinking about the contributions that we can make, I think. And the last one of those was passions. Now thinking about the issue of the interfaces between the various professional groups, or the interfaces between various locations of work, or the interfaces between different organisations, it strikes me that those passions are a critical bridge that could be built to connect up disparate groups such as traffic controllers and safety specialists and engineers and meteo specialists, and all of the other kind of specialists that we have in the aviation world that live in silos. So I am guessing a way forward is to look for, well, what do you as professionals in these different groups care about enough to join together and take action on it, for safety or for any other thing – value – any other thing that you care about?

CR: That is certainly one way in. I think there are other entry points and to an extent it might be a scattergun approach. So I think it’s really interesting to just take an environmental perspective on this for a second and say, you know twenty, thirty years ago, if you look at the way organisations would have kind of come together and figured some of the stuff out, certainly a very big part would be having clubs and groups and associations that were about passion and interest as opposed to discipline. And so I think that what they do is they soften out the boundaries. They say, you know, here are a whole set of differences that’s are very demarcated.

“The only way you can have that conversation is to talk about what you can’t do. And that demands a certain humility”

That’s what we do I think in the institutional world we demark. So we elementalise and we talked about specialisms. And the specialism becomes a big part of my identity so I start defining myself by what I am and by what I am not. And a big part of what we are trying to do is, I guess not feed into that while honouring it at the same time. So one of the ways might be, okay well what are some of the areas of common ground where we need each other? “What are the things we can do together that we can’t do apart.” So in a sense that’s an invitation to go right to the very edge of your specialism and be honest about the limits of what you can do. The only way you can have that conversation is to talk about what you can’t do. And that demands a certain humility.

So it’s the opposite of, we are together rah rah rah, aren’t we great. Well yes we are up to a point, but actually let’s have a mature adult conversation about what we can’t do, because I think that moment you can really invite other people into that interface space. People that we need. So it’s the gift conversation, but institutionally, it is saying: “You have a gift that we don’t have. We need it. We can’t do without you. Come in.” That’s the great siren call of community. “You have a wonderful singing voice. We have a choir. I don’t know if you’ve heard it. It’s pretty awful. We need your voice. Come in.” But to an extent that’s, kind of, that is what the connector does at the edge, you know. But it’s also able to bring all the folks who are maybe a bit reticent inside the circle as well, and so you know guys, you know, just listen to yourselves for a second. So there is something about, and we don’t want to put to much burden on the connector here, but definitely there is something about having that conversation at the interface that says it’s in our self-interest.

SS: So what I’m thinking as you’re telling a story is it reminds me of some of my professional experience with these fault lines and the kind of fault lines that come to mind are, For instance between air-traffic controllers and safety specialists. Between air-traffic controllers in tower versus an approach unit downstairs. Between staff of all kinds on two different sites within the same organisation. Fault lines also between staff at different levels, so at management levels and the line controller, engineer and so on level, that’s very common. I’m wondering what would be practical ways, then, for professional groups to begin to address some of those fault lines. I’m thinking maybe of both formal ways or structured, systemic ways but also informal ways.

38.40

“When we are in our silos we ‘other’ the people are aren’t in out silos. And we deify the people who are, ourselves included.”

CR: That’s right. I think that’s wise. So again you’ll know more about what would work but I think there’s a rich lane to tap into, and again the point I was making, I think of my father working in Shannon airport and I think it was 41 years, and one of the big parts around how he interfaced, he was ground control manager in Shannon airport in Ireland for a good number of those 41 years, and the way he interfaced and the way he kind of brought people together was very much through fun and food and celebration and conviviality. So the pitch and putt club was a big way of doing that, ensuring that, you know, really challenging the idea that everybody has their own separate Christmas party, and actually saying, no we need to find a way of having, and the Christmas party he always saw as really critical because that was where family came in and where they would, you know, do things. He was very insistent on linking in with the community. So finding ways of being involved in bringing kids on trips to Lapland and things of that nature. Always trying to find ways that he would would bring people in to personal relationship with each other, and connection wasn’t about their discipline. So that was something I learned from him by watching him and he just instinctively understood that if you connect people by discipline they tend to go deeper into their silos but if you connect them by human affinity and by care and compassion and passion, and things like that, they find ways of building relationships that make them more inclined to challenge their silos. Because you are humanising. You are humanising the folk that are ‘the other’. And that’s the problem, you know, when we are in our silos we ‘other’ the people are aren’t in out silos. And we deify the people who are, ourselves included. And so a lot of that attempt to just give people the opportunity to be in relationship with the ‘other’ is, I think, is absolutely gold dust.

41:00

SS: So rather than air-traffic controllers having their own annual barbecue or whatever, actually just having a barbecue where you invite people, you flatten the hierarchy that is implicit and you flatten all of the power distance and the power relations and you create an opening around the professional boundary, that’s what you’re talking about. But doing that in an informal way rather than through a project or through a program or something like that.

“If you try to change the paradigm from within, then all that happens is that antibodies are created to kill off that attempt.”

CR: That’s right. And it’s really interesting because to an extent, if you take the idea, the theory of paradigms, one of the things that Kuhn – the guy who popularised paradigms – would say is that at the edge of every paradigm are ideas that are floating about the place, often disconnected. And it is when they become connected productively that new paradigm form. So it is very much thinking about going to the edge and creating that space. But if you try to change the paradigm from within, then all that happens is that antibodies are created to kill off that attempt and that is why systemically the more effort we put into trying to mentally work out the problem and break down the silo and facilitate different conversations the more rigid, almost, the structures and the silo becomes.

So I think finding playful ways at the edge is really, is very worthwhile, and not just, and the other thing that is interesting and maybe is problematic for your context, is not just thinking about the community as being the institution. But I think what I really appreciate about what my father did was he found ways of creating permeability that invited families in, and invited the wider community in. So he talked a lot about the community being the families of the people who were employed and their wider neighbours. And he talked a lot about this idea that the airport was a citizen among a much wider set of relationships. So the idea that Aer Lingus needed to be a good citizen and in that instance., you know, they had a job of work to do because they were an airport and thinking about how they related to other people. So from anything is basic as noise management right through to making sure that there were days that people could come and maybe, people who would never fly in plane various reasons could have the experience. So I think what he was really instinctively doing was quite systematic in other ways because over the years he was breaking down silos.

“Most police officers I know today talk about their role in relationship to other police officers or to first responders. They talk about their discipline. And so that’s a silo within a silo, in that sense.”

Now interestingly, today if you look at the way that group of people organise, and compared to, say, the way they were organised so 20 years ago, I would say that they have become more siloed. So it’s much, much harder, you can see it four example, It’s really hard to get a group of people to come out to sustain the pitch and putt club, you know. And what that tells me is we’re living in different times. We’re living in times where people are maybe little bit more family-oriented, a little bit more self-oriented, and people are organising around their discipline. We see that now not just in the aviation industry, Steve, we see this in policing, we see this in all of the helping professions that, you know, 20 years ago if you looked at – this is true I think right across Europe – if you how people thought about their job of being a police officer, for example. They would’ve talked a lot about their beat, where they policed, the place, the people, the neighbourhood, the town, the village. Most police officers I know today talk about their role in relationship to other police officers or to first responders. They talk about their discipline. And so that’s a silo within a silo, in that sense. But it’s worth paying attention to it.

So as we try and crack this nut it’s important that we don’t put on rose tinted glasses and look back into the past and, kind of, “okay, you know, let’s recreate what worked 20 years ago” because whatever we do we have to do on the basis enabling people to find ties that bind across silos, that are relevant to the way people live their lives today.

But certainly if there are barbecues that are being organised by silo, a very simple way of maybe thinking about breaking that down would be to suggest that. Now another way would be to say, well, okay so what we want to get to is we want to get to a shared barbecue. But we know that there may be some resistance to that. So how might we systematically go with that based on what we’ve talked about in our conversation. Well what we might initially do is we might invite a group of connectors from each of those silos to work together towards organising a joint barbecue because they will bring people to the barbecue. Where as if we just try and impose it top-down because we think it’s good idea, its going to break the silos, we probably won’t achieve it. So this is a way of taking something that’s very organic and being a little bit more intentional or systematic about it.

47:02

SS: And I guess what that might do is reveal some of the interdependencies that exist. So between all of those silos, and you’ve mentioned there police. It’s the same I think with all of the medical specialties who are in a medical silo, but then there are multiple silos within that medical silo. But in fact the work that anyone in any profession, in any silo does is only meaningful in its interactions with all of the other people that are involved in that. So the work of air traffic controllers means absolutely nothing except in the context of their interactions and interdependency with pilots, with engineers, with meteorological specialists, with aeronautical information specialists, with safety, quality, and all of the other groups that you can imagine that form the aviation system. So in a sense the group on its own is only special in relation to all of these other groups of people that they are interdependent with, right?

48:13

CR: Absolutely, absolutely. And so that principle of ‘better together’ is something that has to be revealed… I don’t think that we can, we won’t win that argument by stealth of argument. That is something that people need to feel in their bones because the initial impulse is to think that we are conceding, or we’re giving something away or we are losing something, and it’s only when people feel that actually there’s something really valuable, and something to be gained, in fact something quite natural about working this way, and thinking this way, and practising this way, and I think that that’s where the intentional community building comes in. Because that’s now what we’re talking about this. So there is this ideal that says we are better together and then there is a whole set of practices that says well as human beings we like in organising in small groups and that’s as it should be. So what we are really trying to create it is both.

And the minute people think that to be part of a bigger federation, I have to – Catalonia is a case in point, in Spain. And this notion of nation state, or the federation. And we see it in the UK with Brexit, and Europe.

“You can continue to hold your intimate small group connections, while at the same time getting the benefits of the wider relationships and we are going to figure out how to do that in a way that gives you both ends.”

The trick is to be able to say to people you can continue to hold your intimate small group connections, while at the same time getting the benefits of the wider relationships and we are going to figure out how to do that in a way that gives you both ends. And I think a lot of what we do is we give people an ‘either/or’. We say, either you stay in your silos and we will just figure out how to extract the best of you and we will have a separate team of managers who just put that together after-the-fact as best as we can. It will never be perfect. And we just accept that is just the way of the world with a big system.

Or we say to people, you know, part of what we have to do in systems is something we have probably never done which is to build a community that allows mass localism, so that you can have that sense of community, that sense of affinity, that sense of security that all human beings need – to be part of a team, to be part of the group. Which you can’t get past, you know, probably 3 to 5 to 6 people, in a sense of, you can stretch it. A lot of sociologists talk about, Ian Dunbar talks about 150, you go past 150 people and you really into the realm of acquaintances. I think it’s probably overgenerous the most of us. So we know all of this. So I think a big piece, no one individual can figure this out. So I think when you have complex groups and systems together, being able to say you can be Catalonian and you can be Spanish at the same time. And we’ll figure out how that happens.

“You can welcome the stranger at the edge. They won’t compromise your intimacy. In fact they will enhance it.”

And this goes back to the whole question of networkers. I think that networkers federalise. Connectors say you can have the intimacy while also building and proliferating the potential for growing in all kinds of different directions. So you can welcome the stranger at the edge. They won’t compromise your intimacy. In fact they will enhance it. And that’s the role you play in a sense. And that’s a little bit different than connector. I think that’s the role of the animator or the community builder. Beginning to find those connectors and have those conversations, can be sometimes mentored, sometimes trained, sometimes hold attention, but make meaning out of that. Giving people the opportunity to really understand “what’s going on here?”, and being able to say “Ah, alright now, your concern is, you’re going to be giving up something. Let’s find a way of making sure and that you’re not at a loss”. And I think that that’s part of what hardly ever gets teased out.

“So we need to have that social contract conversation. What are your wants what are your offers?”

And that’s why Peter Block’s work is important. The small-group conversation. And being able to have lots of small group conversations that intentionally permeate to allow people to move between those conversations. So I think that’s something else to think about. How can we be intentional in our conversations and involve people that are dissenting and saying “no I don’t agree” and being able to articulate that? Because I think an awful lot of the reason that we’re not building community is not because people are activity dissenting. It’s not because we have a Catalonian outbreak. It’s because people are paying lip service to our attempts to break down silos. They say “oh yeah totally agree, loved that training it was awesome, definitely. I’m going to be this, that or the other.” And then they go back to business as usual. So there is something, I think, about being able to facilitate those kinds of conversations and welcome out the dissenting voice, but inviting people to take their complaints and turn them into requests, and inviting people to articulate what they want as well as what they are prepared to offer. So we need to have that social contract conversation. What are your wants what are your offers? And I think that begins to open things up. And the fluid way of doing that is to create more associational life. Like in the informal spaces as well.

54:16

SS: Okay well I think that’s probably a good time to just wrap-up and I think from this conversation, things that have struck out to me are issues of what’s the difference between a community and a professional group. We had a discussion about the boundaries of groups and the positive and more negative aspects of boundaries. We talked about the role of the connector. The crucial role of the connector in connecting people within a community but also connecting people across different professional groups and how they might be able to help what the role of the connector might be. And we talked about informal ways of groups getting together so you mention things like the pitch and putt, you know, and we talked about the barbecue. The informal unstructured ways that connectors might use to connect different groups of people. So in my world whether they are controllers and engineers and safety specialists and pilots or whatever. Rather than always going down the more formal route. Those are I think some of the things that stick in my mind when it comes to the question of the interfaces between different groups between different locations and how we can improve collaboration between those. Is there anything that I’ve missed in that short summary, Cormac?

55:51

“Your organisation can show up in very intentional ways to help those things find expression and get connected up as well.”

CR: No I think that covers and I suppose, beginning to recognise that your organisation can show up in very intentional ways to help those things find expression and get connected up as well. The animating piece as important. And in those points of interface you can begin to seed some really interesting conversations and maybe even practices around having conversations. So beginning to have sessions that start with appreciative enquiry or encourage groups talk about their theie wants and there offers. All of that will open up new spaces.

SS: OK well Cormac Russell thank you very much for joining me and giving your time to talk about your experience of community and what insights that might offer us in thinking about professional groups and the boundaries and interfaces between thank you very much.

CR: Thank you, Steve. It’s a pleasure, take care, thank you.

<Outro>

57:58

Posted in Culture, systems thinking | Tagged ABCD, assets, collaboration, community, focus groups, groupwork, safety-II | Leave a comment

1. Qualification

2. Accreditation and Membership

3. Code of Ethics

4. Experience

5. Social recognition

Summing up

Further Reading

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Step 1. Complex problem situation

Step 2. Complexity is reduced to something simple

Step 3. Someone has an idea

Step 4. Compromises to reach consensus

Step 5. The project becomes a thing unto itself

Step 6. Authorities require and regulate it

Step 7. The solution does not resolve the problem situation

Step 8. Unintended consequences

Step 9. People game the system

Step 10: It looks like it works

In summary

Solution 1: Duty of Candour

Solution 2: Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) form

Solution 3: Dementia Diagnosis Targets

Solution 4: Never Events List

Solution 5: ‘Paperless’ Discharge Summary Process

Solution 6: Computerised Medical systems

Solution 7: Radiology Request Forms

Solution 8: CQUINs (Commissioning for Quality and Innovation payments framework)

Solution 9: Central Line Associated Bacteraemia (CLAB) checklists

Solution 10: WHO Surgical Safety Checklist

Reference

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Human Factors in Operations Divisions

Human Factors in Engineering Divisions

Human Factors in Safety (and Health) Divisions

Human Factors in R&D Divisions

Organisational Misfits…or Connectors at the Edge?

References

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The birth of a discipline

Designing interactions

Branding

Staying technical

Shortage of HF/E specialists

Rising popularity

A two-pronged solution

References

See also

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Key Points

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