In 2014, Sangeeta Mahajan lost her only son, Saagar, to suicide. No one is immune - Globally, close to 800,000 people die from suicide every year. One person every forty seconds. We don’t talk about it. Let's break that silence.

Clearly distressed Saagar sat on a bench at a station for over two hours. Not one person reached out, and yet with his body on the tracks, photos were snapped to - TWEET! What part do each of us play? As a society, what have we become? Film director Jeanette Rourke created the film 1000 days to explore these questions through Sangeeta's personal blog: written every day for 1000 Days. Can a Mother survive the unsurvivable? You can learn more about the film here.

As well as the film and blog, Sangeeta undertook a case study exploring the human factors in suicide prevention.

This case study discusses the importance of human factors in maintaining patient safety in the community. Although the case relates to a patient suffering from mental illness, the principles discussed here are transferrable to physical illnesses. This article aims to describe some of these human factors and how they relate to the healthcare setting.

The GP curriculum and suicide
Professional module 2.02: Patient safety and quality of care state that:

  • The RCGP aims to improve the quality of healthcare by defining and upholding high standards for general practice education and training, aiming to improve health outcomes for all by promoting high-quality general practice at the heart of the health service.
  • As a GP you are in a strong position to influence the care of your own patients, that of your practice population and that of the wider healthcare community.
  • Understanding how and when to apply tools and metrics to improve the quality of care is a key skill that can and should be learnt during your training, as well as enhanced in lifelong learning
  • Working in partnership with your patients and understanding their needs is vital to improving clinical care and reducing health inequalities
  • Patients, their families, and carers have an important role in the assessment of health care; their views are therefore essential for the development of high-quality health care. Patients should be encouraged to be actively involved in planning their care and in the development of services at the practice level and beyond
  • How we learn from and share lessons regarding clinical care is an important marker of our personal and collective
    professional development

Patient safety

There are a number of definitions of what ‘patient safety’ and ‘safety culture’ encompasses. Although there is no single definition, there are a number of accepted characteristics which include:

  • Safety: Is ‘a dynamic non-event’ (Maurino, Reason, Johnston, & Lee, 1998; Vanderhaegen, 2015).
  • Safety culture: Is ‘the attitude, beliefs, perceptions and values that employees share in relation to safety in the workplace’ (Cox & Cox, 1991)

The NHS is recognised as a high-risk organisation, comparable to aviation, maritime, and nuclear industries, military operations, oil and gas production units, and policing in its ability to cause catastrophic damage to humans. Many structural, procedural, and organisational differences exist between healthcare and these other high-risk industries. Despite these differences, many argue that healthcare lags behind many of these ‘highly reliable’ industries. It is estimated that between 44000 and 98000 people die from medical errors each year in the US, which is equivalent to two plane crashes per day (Richardson et al., 2000). The number of patients damaged by medical errors is even higher. Most of these mishaps are not due to a lack of knowledge, but rather to the poor application of knowledge within complex clinical systems. In fact, 70–80% of all medical errors are estimated to be attributable to human factors (Dunn et al., 2007; Schaefer, Helmreich, & Scheidegger,1994).

Introduction to human factors

To err is human. Human error cannot be eliminated, but training doctors to develop their non-technical skills can minimise errors and mitigate disaster by early recognition and rectification of errors. Non-technical skills are defined as ‘cognitive, social and personal resource skills that complement technical skills and contribute to safe and efficient task performance’ (Flin, O’Connor, & Crichton, 2008). Although human factors training is an integral part of patient safety in acute settings, such as anaesthesia and
intensive care, it is now coming to the fore in communitybased medicine (Brennan, Rahman, & Reynolds, 2014). Human factors are at play not only in immediate reactions and interactions with people and environment, but also on a ‘slow burn’ as is the nature of primary care (Ahmed et al., 2014). Does awareness of human factors need to be addressed differently in primary care? All clinicians have a vital role in promoting patient safety that goes beyond technical competence. Highly publicised cases, such as that of Mid-Staffordshire NHS Trust, focus sharply on hospital care (Francis, 2013). However, in the UK over 300 000 000 consultations take place in primary care per year.

Click here to read the complete version original article published by Dr Sangeeta Mahajan (Consultant Anaesthetist, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, London) and Dr Craig Johnstone (ST7 Anaesthetic Trainee, St Georges School of Anaesthesia, Guy’s Hospital, London)

As a Churchill Fellow, Dr Mahajan travelled to the USA and Australia to bring back ideas to the UK on how best we can have meaningful safety-netting for vulnerable individuals. Her findings and recommendations can be found in this report:

Bridging the Gaps in Suicide Prevention