X marks the spot

Trigger warning: mild healthcare related topics

‘It’ll be easy to find, I’ve drawn an x where it is with a sharpie…. Pink of course’.?

I’m pretty on it when it comes to my healthcare. I keep an eye on all of my moles, I go for all my scheduled checkups, and have had regular reviews of my bloods, blood pressure, and supplement regime for a good while now. The first thing I’m going to premise this piece with so that the point of the piece lands is that following a (slightly arduous) process, I’m perfectly healthy and there’s nothing to worry about however, about 6 weeks ago, I had the dreaded moment where I found a lump. It’s not the first time I’ve gone through this process so knowing what I knew, I wanted to make it quick and easy to get the referrals I needed.?

It wasn’t the most obvious lump to find, and I know what I’m like under pressure in unfamiliar situations (perhaps another one for another time as there’s lots of interesting human factors related to this!) So this time, I wanted to ensure it wasn’t going to be difficult for either myself to keep an eye on, or for the doctors to find.

Ultimately, I wanted to ‘make it easy to do the right thing’.?

The above is a phrase that I’ve read, used, and promoted for a long time in my relatively short Human Factors career. It’s certainly not mine and I can’t claim it. But I really enjoy utilising it. It’s a key part of optimising human performance and achieving optimum outcomes. And yet so often in life, we see examples of where quite clearly equipment, process, procedure, tools, and ways of working have not been designed with making it easy for people to do the right thing in mind.

In my case, I decided that I needed to mark out the lump with an X in a sharpie to make it easy for me to locate, and for the doctor and nurses to locate too (the pink was entirely optional).?

We can see examples of things in our every day lives that quite clearly have not been designed with making it easy to do the right thing in mind, and generally these are the day to day things that really annoy us. On the contrary there are also some fantastic things around us that have been designed with this concept in mind and we generally all marvel at the success. Take for example connecting to Wi-Fi on my iPad. If I’m connected to Wi-Fi on my iPhone which has my device registered to my account, Apple have created this fantastic feature that allows me to share the password with the iPad without having to type in a long and complex series of numbers and letters. Genius. Designed to time save, enforce simplicity and largely keeps my blood pressure quite low. In this instance, the right thing was connecting to the Wi-Fi successfully (which I appreciate is hardly safety critical or of high stakes) but it all helps the user experience. Apple made it easy to do the right thing.?

However, and I’m going to demonstrate my own inability here to practise what I preach in my life, every time I get to my front door and pull out my keys, I have to spend a good 30 seconds trying to find the right key, inevitably end up trying the wrong one first before I successfully unlock my door. Again, trivial I understand,??but here is a classic example of where I’ve not not managed to implement this key concept, and have made it very easy to do the wrong thing by having a multitude of similar looking keys on one key ring.?

Ultimately whether I can connect to Wi-Fi or spend 30 seconds cursing my own lack of organisation is a fairly minor inconvenience, but take this concept into a safety critical or high performance setting and it can be an entirely different story.?

Let’s look at the example of using the appropriate PPE for a task. Firstly, the location of obtaining, removing and replacing worn PPE must be easy, quick and simple to find if we want to ensure that colleagues will utilise the appropriate PPE before commencing a task. If PPE is located far away from where a task should be commenced, then we’re not making it easy for them to do the right thing and wear it, so when we combine that factor with operational pressures, weather, shift working and normalisation of deviance, we can often find ourselves in a situation of work as done vs work as imagined. We imagine that people are going to do the right thing and wear the PPE but in actual fact, if it’s difficult to obtain, it’s more likely that we’ll see an attempt to conduct a task without it - the work as done.?

Staying on the PPE theme as it’s pretty universal to multiple industries, if then we don’t provide adequate PPE, for example for women we only supply male-fitting PPE that may not fit the form of a woman, we make it easy for women to seek alternative provisions that may not be organisationally approved, as it may be more comfortable and/or protective, again making it very easy to do the wrong thing.?

Another example that transcends multiple industries is that of safe walking routes. Imagined to provide a path for workers to safely travel from one area of a site or location to another, away from hazardous machinery or danger, when being designed they should be so with the thought in mind that we as humans will look to make our life as easy for ourselves as possible, often taking shortcuts or a different path if we believe it to be quicker. If a safe walking route therefore is complicated, difficult to find, or significantly longer than an individual’s route as the crow flies from A to B we can assume that humans are unlikely to follow it.?

And yet, the question will often come when something goes wrong ‘why didn’t they just follow procedure/ use the correct PPE/ consult the policy?’ Often with the individual receiving the blame for not doing the right thing and perceivably doing the wrong thing. Well firstly I’d put money on the fact that that person would not have been the first person to do the wrong thing, perhaps in fact something similar may have happened before or perhaps more likely is that the wrong thing is happening every single day, it’s just that others haven’t been unlucky enough to have been caught in an event yet.??Secondly, organisations should look to understand whether during the design of a policy or procedure, selection of tooling or PPE, those involved with the implementation or change were actually consulted. Were people asked what was needed, how was work conducted now, or what would make their lives easier??

One of the best ways to ensure we make it easy to do the right thing is quite simply to observe and speak to the colleagues who are using the equipment, tools, policy or procedure day in day out. For example observe how people get from point A to point B, ask people what they like and don’t like about their uniform and PPE, ask them why the procedure in place at the present is making their lives difficult, or why no one follows it. Consider mapping the processes out and compare with conducted observations to understand the work as done and work as imagined in practise and design out hazards early in process rather than design something around it much later on. These are the things that the human factors specialist can do and the profession advocates for to ensure the ways of working in your organisation are making it easy for people to do the right thing.?

Back to my x marking the spot. After we all had a little giggle at my pink sharpie, the doctor actually said that it was really useful. They explained that so often when people come in with lumps they want checking they can ‘lose’ them, particularly if they’re nervous. By marking it out, the doctor was able to refer me swiftly on for further checks, saving time and allowing for early treatment should I have needed it.?

PS - I wouldn’t be doing my job properly if I didn’t say to check yourselves regularly, and when in any doubt, please go and get yourself checked out by the doctor.?