Good evening everyone and welcome to tonight's practise management webinar. Our topic is adaptive thinking for practise teams, how to thrive in a rapidly changing world, and I'm delighted to introduce to you our speaker, Dan Tipney. Dan provides an array of insights into human performance gained from his perspective across numerous disciplines.

Formerly as an international athlete and sports coach, pilot instructor, and currently as an airline pilot and human factors trainer. Dan led the human factors training programme at a major UK airline and has since developed non-clinical training and in practise support to both veterinary and healthcare professionals. He represented Great Britain both as an athlete and a coach, and has a great passion for supporting teams so that they can consistently achieve their goals.

Across all fields, Dan has consistently observed positive change as a result of non-technical factors, including leadership, communication, well-being and systemic support tools such as checklists. Underpinning much of his work is the study of human behaviour and the associated impacts of workplace environment and culture. At VetE, Dan collaborates with experts from veterinary medicine, aviation, psychology and healthcare training with the mission to enhance performance in practise to the reliable delivery of clinical skills.

If you have any questions or comments for Dan as we go along, please hover your mouse on the screen, click on the Q&A box, and we will cover as many of these as we can at the end of the session. But without further delay, let me offer a warm welcome to the webinar vet Dan, and over to you. Lovely, thank you, Jackie and lovely to see you all tonight.

Thank you very much for joining. I'm just gonna start sharing my screen now, so hopefully that will, that will come through as expected. So please let me know if it's not.

So yeah, really glad you can join me tonight for this, what I, what I think is very, very important, and I guess maybe a slightly unusual topic in some ways. And, and I, I, I, I think it's really interesting at the moment. Because we've been through, as I don't need to explain that, you know, a very interesting 18 months or so.

And, you know, given that you already work in very dynamic, often unpredictable environments, whether that's because of, you know, unpredictable nature of the patients themselves, the clients, but also just because, you, you can't, you can't fully predict what's gonna happen in terms of emergencies, in terms of, You know, because of changing shift patterns, it's, it's a very challenging environment. But as you, as I've said, add to that what's happened over the last 18 months, and there's just been such an enormous requirement for adaptivity, for change, and the with the resulting impact that's had on everybody. And what I want to do tonight is bring in some of the science around.

Adaptivity in, in a sort of patient safety context, look at the models that are a particular model that's out there. And, and I kind of apply that to ways of thinking, strategies, but also sort of mindsets, ways of framing things that can help yourselves, your teams, navigate the, the, the sort of this new sort of phase I suppose we're in, which is, figuring out what things are gonna look like, from this point forward, are they gonna stay the same? But also very much acknowledging that regardless of what's happening in terms of our global pandemic, we've also, you, you work in, in this, in this very, challenging, as I said, dynamic environment, as it is.

And, and I want to bring to you some of the sciences available to us, looking at that, that very specific element of, of adapt adaptiveness and, and, and, unpredictability from some of the work from in, in healthcare. As Jackie said, I, I come from originally from a non-clinical background, as an athlete, as a coach, as a pilot, but the, the, my, my recent focus and what I, and what I now do, is very much focused on supporting veterinary teams, individuals, practises. With a whole array of non-clinical support mechanisms.

So whether it's through workshops like this or in practise support, 1 to 1 coaching, there's a team of us that, that are bringing the principles of human factors, much of which has come from what we've learnt about, you know, human performance from aviation. As I said, also from elite sport, from psychology, from what we've done in healthcare, it's not about the clinical skills, but it's about helping teams to reliably deliver their technical or clinical skills to achieve the best outcomes. And that's the, the very much the, the, the approach that I'm coming from, for you tonight.

So the objectives for the session, want to talk about adaptivity in the context, of your role, and, and of course the role your team practise, . I want to really kind of raise this conscious awarenessness of, of that, that need for adaptivity. And I think it's something that at some level we're all aware of, but it's really, again, looking at, some of the sciences around this, and, and, and actually, particularly in these, these very challenging times at the moment.

But as I said, going forward, this is, this is something that's a factor in, within, within the practise environments, all the time, regardless of, of what we're experiencing. And I really want to look at the areas, so from the work that I've done, the research that I've done, my experience of the work that I've done with teams. I think it's for, for me it's very clear that the ability to adapt, the ability to thrive in rapidly changing, sometimes unpredictable environments, usually come down to something related to one of these three things, curiosity, communication, acceptance.

And so that's really how I want to, sort of split up the, the work we're going to do tonight. And then really look at how to apply these principles, . In within your teams.

And I'm gonna always sort of refer to what I'm talking about as one of two things. I, I'll either talk about something because it's more of a mindset, the way we can frame things, the way we can think about things, the way we can maybe talk about things, or, or maybe some more of a specific strategy, something we can sort of more tangibly do, and I'll try and always make it clear which one of those each little section we're talking about is. But I'm gonna base a lot of what we're gonna talk about tonight on a model.

And it's a model from two particularly inspiring individuals from the world of patient safety in healthcare. called Rene Amalberti and Charles Vincent. And, Renee Alberti was a leading, patient safety figure in France for, for a number of years, co-authored 10 or so books and, you know, published, over 100 papers.

Charles Vincent's, . Started as a clinical psychologist, has been a professor of psychology, but has led a number of leading patient safety programmes for UK, healthcare organisations. So, really, really interesting work with two of them.

And what they did is they came up with a model because they recognised that we can't approach safety, you know, our ability to do work, you know, to, to, whether it's within healthcare or not, we can't approach. How, how, you know, how, how we do work safely in the same way in every context. And in fact, within healthcare, that's very much the case within veterinary, that's very much the case.

Because some elements of work, you know, and we'll we'll kind of break this down, require the need to be more adapted than than others. And and the the the the level of adaptivity that's needed, and again, hopefully this will all make sense as we as we carry on the session, will determine very much how you approach. The work that you're doing.

So there's a part, part of the reason for showing you this is because it's actually a very useful model, for other reasons. But we're gonna focus then on the kind of ultra adaptive end to then to then use the, the principles in there to, to sort of then as a basis for the rest of the session. But I just want to talk, so I'll I'll talk about that part initially.

So, and, and I'll give you some examples of what might fall into this kind of ultra adaptive category. But, but the most obvious one would be your kind of emergency situation. So for those of you, if you come from a referral setting, you know, if you've got an ICU for example, that would very much be where we are.

But if you're in a first opinion setting, then, you know, the, the, the sort of occasions where you might get, you know, a patient who, who comes in. For, for something, you know, unexpected and needs emergency treatment and, you know, you, you, you weren't to know exactly what was coming. This kind of ultra adaptive, what we mean by taking risk is the essence of what we do.

What we mean is that you can't avoid the fact that that patient could come to you in a very vulnerable situation. And so the risk that they could, they could have all sorts of different complications is there, and you can't avoid it. And so the way that we function in The way that we thrive, the way that teams thrive in that is based around, you know, they call it power to the experts.

It's around kind of the, the, the underlying message is you can't have a procedure for everything. You have to enable people to have the autonomy to be able to, to sort of learn from moment to moment, from day to day, from shift to shift. You have to enable them to support each other, you have to enable them to, to, to, to understand their limits.

And, and that's very much how the strategies that enable people to do that. In the middle of the of this kind of model we've got, you know, situations where, where risk is there, it's not sought after, you know, it's, it's not kind of inherent, sorry, it's it's, it's not . That the very, at the very heart of what's being done, but it's inherent.

So like, an example of this might be surgery, you know, scheduled surgery, where you can't necessarily have a procedure for everything, but actually a lot of the time, there are, there are many situations of surgery where actually if you follow, particularly when you think about moments where checklists are used, you know, if you follow particular processes and you do them in certain ways, the vast majority of the time, they will go as expected. But of course there are going to be moments where unexpected events occur, whether it's because patients, you know, present bleeding that wasn't expected, or, or, or, or different, different unexpected events. So you can have procedures, you can have methods in place that, that help you to, to, to achieve a reliable outcome, but you can't necessarily know that's going to be the case.

And so the, the, the processes need to be appropriate. That. And then this ultra safe category is one where we're kind of excluding risk altogether.

If we can avoid it, then we exclude it. So, you know, you know, and then there are areas of healthcare and animal healthcare that fit into this category. You know, if you think about a lot of non-essential imaging or low risk anaesthesia, you know, you do whatever you can to just avoid the risk in the first place.

And, and that's generally the best way of doing it. So it's all about follow procedures, every single time, you know, with, with, with very little exception to that. And we, we have to be very clear about where we sit in, in that scale when we are doing a, a, a type of work, you know, so in practise, you know, what, you know, particular element of practise, you know, fits into which category, and therefore, how do we want to, address that or how do we want to approach that particular area.

So we can look at how it falls into this based upon the, the, the sort of the statistical safety, and we can start to look at different areas from all. Sorts of professions that might fit into these categories. As, as I mentioned briefly, you know, they, they, they, they refer to trauma centres very much your sort of A&E, your, your emergency treatment and would fit into that ultra adaptive scheduled surgery being in your sort of high reliability and ultra safe being radiotherapy or low risk anaesthesia, you know, and, and my background, aviation.

You know, aviation is a classic example of ultra safe, because, you know, if there's a thunderstorm at the end of the runway, you just don't take off until The wrong way until the thunderstorm's gone. If the airplane's not fixed, isn't safe to fly, you, you, you wait till it's fixed. You know, there's no necessity.

But when it comes to patients presenting to you with, with things, you know, with, with, with situations, you know, if a patient's brought to you having been involved in an accident on the road, there is no option to just say, well, there's too much risk, you know, for us. We, you know, we don't, we, we think that the risk of complication, you know, of, of treating of health. In this patient is too high, that option isn't there.

So the way we, the way that we improve safety in those areas has to be appropriate to, to that. And, and so I think it's a very interesting model and, you know, I, and I present it to you because it's something that I think is worth exploring for that reason. But what I want to do tonight is focus on this, this ultra adaptive and, and what we can see is that, is that the research, the work in this area.

Shows us that teams that thrive in these unpredictable environments, you know, armed forces that are working in, in wartime conditions, you know, Himalayan mountaineering is another example they use, you know, you know, as I said, emergency healthcare, which, which, you know, you will have experience of yourselves, in, in, in, in the veterinary context, . Requires a very specific approach. And what a lot, what I want to do is talk about some particular strategies and and methods and, and mindsets and and tools that are really focused on a lot of those things, the peer to peer learning, how we can give and receive dynamic feedback, knowing our own limitations.

But actually a lot of it comes down to this personal resilience and and and how we can. Sort of thinking ways, communicating in ways that, that sort of fosters that. And that's what I want to talk to you about tonight.

But as I said, the whole model is really, really useful because, as I said, if the way in which we would approach, one, you know, a way of improving patient safety for low risk anaesthesia would be very different to the way we would approach improving safety for, you know, a, a patient presenting in a, in a, in an emergency, and everything in between. And so that's that, but I said, that's almost a sort of separate talk in itself, but worth, worth being aware of and certainly worth, . Exploring further.

So I want to start off by talking about curiosity because curiosity, is just such a, a, a, a, a, a basis I suppose for us being in, in a positive mindset to embrace and engage with the, the unknown. We are, we are inherently as humans fearful of uncertainty and, and doing, taking conscious and intentional steps to embrace that uncertainty, to engage with it, particularly. During times of, I, I, you know, they said that the last 18 months has had unprecedented use of the word unprecedented.

But, you know, unprecedented change, but already working in, in a, in a, in a, a working environment which is so dynamic and and changeable as it is, this kind of curiosity. So important. So I'm gonna start, start off by, there's a bit of a philosophical one to start with.

So, as I said, it's a slightly different talk in some ways because some of the things we're gonna talk about are directly related to evidence from patient safety and healthcare. And some of them are a bit more philosophical, but do relate to elements of psychology. So, this is quite an interesting one, but as I said, we, I said, the different elements we're doing tonight, some of them are are mindset based, the way we think about stuff, and some of them are strategy based, and this is very much a mindset one.

And this is actually an extract from a book called Art and Fear, Observations on the Perils and rewards of Artmaking. So I, I bet you didn't expect to hear about clay pots and art making tonight. Not an, not an area that I would claim to be an expert in, but I do like the message from this story.

Something you might have heard before, so I'd be interested to know if that's the case. So it's basically, it's a story about a ceramics teacher who announced on the first day of school that they were dividing the class into two groups. So all those on the left side of the studio, they said would be graded solely on the quantity of the work they produced, and all those on the right solely on the quality of the work they produced.

So the procedure was quite simple. On the final day of class, they'd be bring they bring in, the bathroom scales, and weigh the work of the quantity group. And, you know, 5, I think it was on like 50 kg was rated as an A, 40 rated as a B, and so on.

And those being graded on quality needed just to produce just one pot, and you know, the, the briefing was it had to be the perfect pot to get an A, with course with associated criteria. To come grading, you know, a, a, a really, I think interesting fact emerged, the works of the highest quality were all produced by the group being graded for quantity. So it, you know, kind of, it emerged that whilst the the the quantity group were were busily sort of churning away piles of work just trying to do one, do another one, do another one, and learning from their mistakes and, and, and, and sort of embracing that and being curious, the quality group sat and theorised and, and sort of, you know, stewed over that, that perfection.

But often at the end had, had, had less to show for it. And so I think it's just a really interesting message and of course, as I said, it's a philosophical one, but I think particularly when it comes to. You know, the, the, the situation we're in right now, we, we, you, you, I no doubt have been in situations in leadership roles that, you know, the, the various roles that you're in.

Over the last 18 months where you've had to try new things. You've just been in uncharted territory and you've had to do things that have felt really uncomfortable. And it's easy just to say, well, be more curious.

But sometimes, like having a slightly humorous and slightly lighthearted and detached reference point to think about, you know, and, and having a language, I, you know, when I heard this, you know, a group of us that that work in sort of this field, heard about this story and, and we sometimes Say to each other when we're having a bit of a challenging time and we're having to try things. And, and some of them, and some of the things we're having to try isn't going as well as we'd we'd hoped, especially I think when 18 months ago, you know, we used to do most of our delivery from training and workshops in person, and then we suddenly had to do all of it online. .

And with varying degrees of success, I suppose, initially. And, and that, that kind of, we, we just sometimes say to each other, like, you know, plays, and, and, and it's funny how, how it didn't take the problem away, but it just helped that kind of mindset of curiosity, you know, not afraid to fail, you know, that, that promoting that, that sort of growth mindset, and seeking opportunities, rather than, sort of fearing them. So, as a mindset, I just think that for me is, is quite interesting.

For me, this, this language though around being curious rather than critical. This is much more for me a strategy because it relates to a lot of what we know about how we respond to things that don't go as expected. The example that we've got here on the aircraft is a, is a very well known, accident in aviation from 1977 in Tenerife where two aircraft collided on a foggy runway.

And there was an awful lot of learning points from this. It was in the very early days of black box recorders, and a huge amount of merged and it. Emerged that, as was the case for the majority of accidents in aviation, that that, you know, the, the, all the primary contributing factors were were about human fact you know, were, were about humans being humans, as in the people involved all knew what they were doing and the aeroplanes were working OK were working well enough.

But the accident occurred because of things like assertive communication, because of, or or or on the day lack thereof, or because of the culture that that created a very steep hierarchy authority gradient between the co-pilot and the captain of the blue aeroplane. Because of the impact of stress, because of the way that they. Brains made assumptions when they heard particular words and assumed that they were cleared for takeoff when they weren't because of the confusion around types of language.

But because as a profession, they have the opportunity to be curious and actually look at this black box recorder and, and, and actually say, well, I'll tell you what, let's instead of saying that the captain of that blue aeroplane, who had 21 years experience, who had 12,000 hours flying experience and was, you know, a senior member of their their crew. Instead of saying he should have known better, and it's his fault, and that's the the the case closed, they asked the question, why did it make sense to at the time? Why did it make sense for that captain to start that takeoff, even though on the face of it, it makes no sense at all because there was another aeroplane on the runway.

But because the approach toward this accident was, why did it make sense to him at the time? They were able to learn a huge amount from this, and it was a huge turning point in aviation safety. Because what we gained from it was an understanding about how we can help crews with assertive communication, how we can improve culture in within, within the profession, how people can cope better under stress.

You know, how we can use more specific language to help prevent making assumptions. We can also approach, use the same approach with ourselves and you know, being curious about, you know, when we reflect on things that we've done. And, instead of, instead of immediately, sort of criticising or, or, or, you know, looking for flaws, being curious.

You know, why did it make sense to me at the time to do what I did? Because it always does. Whenever we do something, even if on reflection, we, we, we, we, we, we realised it wasn't what we'd have, you know, what we would do if we did it again.

It, it will have always made sense at the time. And the question is why? And if we can get to the bottom of why it made sense to us or to them.

When something didn't go as expected, we're in a much better place. And so for me it's a strategy because it's a very, very particular question that we can ask others, of others, of our team, but also of ourselves. Who knows?

Again, we're kind of slightly back to a philosophical one here, but this relates to, again, this very strongly relates to a few other principles that I'll relate to later. So this is about a story, this is a story of, some of you might have heard, again some of you might have heard of, of a farmer who, who used an old horse to till his fields. And one day, the horse escaped into the hills.

And when the farmer's neighbours sympathised with the old man over his, his bad luck, the farmer replied, Well, you know, bad luck, good luck, who knows? And a week later, the horse then returns with a herd of horses from the hills. And this time his neighbours congratulated the farmer on his good luck.

And reply was, well, you know, good luck, bad luck, who knows? Then when the farmer's son was attempting to tame one of the wild horses, he fell off the horse's back and broke his leg. Everyone thought this was very bad luck, but the farmer's reaction, bad luck, good luck.

Who knows? And then some weeks later, the army marched into the village, conscripted every able-bodied youth, they could find. And when they saw the farmer's son with a broken leg, they obviously let him off.

And of course, the response, good luck, bad luck. Who knows? And I think.

It's a story, but for me it was another one that I read and it really resonated because actually. It's not, it's not as simple as just saying, well, OK, let's all just think like that. Of course it doesn't just suddenly make it easy to, to, to, to have that approach.

But actually being open to possibilities, not being attached to a particular outcome and not seeing things as digital, noughts and ones or black and white, you know, things aren't just broken or fixed. And when we're in these very changeable unknown times, there's an awful lot to be said for that. And actually in lots of ways, when we, when we look at this, this is, this is interesting, some of the work we've done with a psychologist in our team.

That actually, a lot of this comes down to the definition of resilience. You know, a lot of the, a lot about resilience is actually not being defined by a particular outcome in a particular moment because that outcome doesn't define the next outcome. But it also means that who knows what what next and .

It's, it's, yeah, I think it also relates to this area of certainty, which we're gonna talk about a bit more later and our sort of fear of certainty and how that can and and why that could be so difficult, but I think, I think just . That, that mindset of, of, you know, it, it doesn't mean that we can't celebrate things that we, we, that we're pleased for. But it does mean that we, that we have that, that continual, openness to, to not really, to not, to, to not, as I said, being attached to a particular outcome at a particular moment.

And actually when we look at a lot of the, if we look back to that model of ultra adaptive principles, resilience within teams and. And the ability to say, OK, whether it's on a grand scale around the fact that, you know, a whole load of people have just had to self-isolate, and it's, it's a, it's a, you know, this, this week, the changes that's going to mean to the working patterns of week are ability to see patients. It's very hard to sometimes have that, that, that kind of approach, which is, you know.

You know, who, who knows, you know, it, it, it, it's, it's, it's an outcome in this moment, but it doesn't necessarily define the next outcome. Or whether it's a specific outcome within, you know, within surgery or during a procedure, being able to, to sort of have that, that healthy ability to, to acknowledge what's happening right now, but without being attached to it. So.

Yeah, a bit, as I said, a bit of philosophical one, but it does come back to this kind of principle around resilience, which, which is a huge element when it comes to, to adaptivity. So, curiosity and and that sort of whole mindset around it and the questions that we can ask is, is, you know, and there's something that we, you could, lots of different ways we could talk about that, but for me that's, that's a sort of a way of summarising it. So communication is another huge area when it comes to adaptivity, and there's a, there's a, this one's a little bit more, I suppose, if curiosity is a, is a bit more philosophical, the area of communication, the role of communication when it comes to, you know, adaptivity, is, is maybe a little bit more, you know, practical.

And, and, you know, tangible in some ways. So one particular area is around briefings. Considering this, you know, discussing challenges and solutions, the Clinical Human Factors Group is run by someone called Martin Bromley, who is a very, for those of you that have, have, had a chance to, to explore the the world of human factors.

Will, and have come across any of his work. He's, you know, he's, he's been very inspirational, has been a, a, a, a leading figure in, in terms of, applying human factors principles to improve patient safety in healthcare. And it's following the very sad death of his late wife, who, who passed away during, an, an era during anaesthesia, in 2005.

And he started, he's a pilot who, who has an interest in human factors, in, in, in, in lots of, lots of ways similar to, to my background. And he, he started the Clinical Human Factors Group, which is a charity. And it's since grown over the last 14 years, and it's been a huge turning point in terms of, how much, how, you know, improvements in patient safety and healthcare.

And. When the they they've got a huge sort of collection of experts from around the world working with them. And at the beginning of the pandemic, they, they got together because they realised that this was not only a crisis for for world health, but this was a this was a crisis for healthcare teams, and it was putting them under huge pressure.

And they came up with some, some guidance, just some ways some simple ways of helping healthcare teams to cope under this enormous pressure. And again it was, it was, they were being asked, they had to be so much more adaptive than they had previously, you know, you had, you know, endoscopy nurses who were suddenly having to work in, in, you know, in paediatric intensive care units. And people working way outside their comfort zone or their their their their their training or their experience level, because they had to get the job done.

And when they came up with this guidance to working under pressure, one of the key things that they, that they advised and and recommended was about briefing. And encouraging people to speak up. So, so, you know, although these things might sound really obvious, these particular sort of moments of communication, opportunities to encourage people to speak up, but particularly these briefings were key opportunities to help people, to help teams to, to deal with these difficult, these, these, these very challenging times.

And I want to just kind of explore that a little bit more now, but I think it's interesting to see that that that's, that's the, one of the key pieces of advice that came from this work. So, in terms of the briefings then, what they, what they talked about, you know, what I, what we often talk about is, you know, what is a briefing, and it's not necessarily the opportunity to talk about everything that's gonna happen, you know, over that, during that procedure or during that day, or, you know, and particularly in aviation, this has been a big shift. And a briefing now is very much the opportunity to say, you know, for this flight we're about to do, what's different about today?

What could really catch us out? And, and you, you have a 2 or 3 minute, you know, opportunity for two people on a very, in a very level, you know, on, on a very, even, sort of open in an open way, to just, to just discuss that, whether it's specific things about the weather or, you know, the high terrain for the mountains around or whatever it might be. And, and you discuss the implications of those and, and what you collectively want to do to, to, to make it safer.

And we're looking at models that have been used in healthcare, this is kind of a, a, an example of the sort of model in different healthcare teams that can be used to trigger those kind of conversations. And it's just a chance for veterinary teams, again before a procedure or at the beginning of the day. But usually this is more a, you know, sort of dynamic, so it's more, you know, about to, you know, to to perform a particular procedure or, you know, and, and it's, it's the ability to, to recognise what stands out about today, what's different about what we're about to do, what could catch us out.

Talk about and Teampo is really just the the the things that that might want to, it's not necessarily like a list that you follow every time, but it's a way of mentally thinking to yourself. If we're gonna have that conversation, what sort of things might I want to think about? Is it that someone's new to the team that we've not worked with before or someone who's in the team hasn't done this procedure before?

Is it that we normally have a particular piece of equipment that's not available today? What implications might that have? Is it that we're doing it in a different room?

What implications might that have? Is it, is it, is it, and in your mind you're thinking and you're just saying, OK, what's different about today? And what do other people think, and if nothing else, it's the opportunity for maybe the more senior member of the team to just say to everyone else, hey, you know, if anyone sees anything that doesn't look right, then just speak up.

And it flattens that hierarchy. So, so that's, and just a few snippets again from some of the, some of the advice from the Clinical Human Factors Group, who's, you know, brief the whole team, even if it's really rapid and short, at the beginning of a shift or at the beginning before you do whatever you're gonna do in the context that you're working in. You know, it's a chance to check understanding, not making assumptions about insights and knowledge.

It's a chance for those in leadership roles to lead by being open and inclusive. I really like this expression. Ask questions first, lead second.

Giving people, particularly more junior members of the team, the opportunity to feel safe within their team, to feel included, and to, to, to explicitly help them so that they know that if they have a concern, if they're the ones that see something that's not right, they will bring that to the attention of of who needs to know. And again, as I said, encouraging everyone to speak up, this authority gradients. This, this, this sort of hierarchy that exists between, decision makers and the rest of the team, is something that we have to explicitly and consciously address every day.

It can't just be assumed, and that's something that we've learned very, very clearly from these examples. So that's briefing, the debriefing is also a really, really important one. You might remember from that model we talked about, ultra adaptive teams, they learn from experience, peer to peer learning, and they're constantly figuring out, you know, what happened today, how can we be better tomorrow, what happened today, what happened on that procedure with that patient and how can we be better next time.

And they've got a very conscious and intentional way of doing that. So again, example from from the from the same guidance from the 10 points was debriefing. To help them learn from experiences, partly because things can play on people's minds.

So if someone's had a difficult day or something didn't quite go as they'd expected or they're worried, people, it's so important they have the opportunity to, to, to, to work through that, and, and providing that space for them to do so is so important, and teams that can do that. Again, when we come, when we talk about resilience and their ability to cope and to move on and, and, and be in the best place to go and do it again tomorrow, this is a huge factor. And so at the end of a shift or at the day, at the end of a procedure, debriefing, sharing thoughts, enable learning, and it's a big factor when it comes to well-being.

But it has to be normal and it has to be regular. So there's a few models that we can use. We can either use a model which is based around the 3, you know, essentially 3 main categories that, that we know we need to address, you know.

People's feelings, what they need and what they're asking for. And we can do that in different ways. Debriefing is literally a hot debriefing is something that happens, you know, relatively soon after a procedure or a day, and it's just a chance to just make it more normal, to just say, right, OK, you know how we're doing?

How was that? And I think the thing is, these things are relatively normal maybe after something exceptional's happened, a patient crash or, you know, something really out of the ordinary. But how, how regularly do these kind of conversations happen on a normal day?

And on a normal day, particularly over the last 18 months, I guarantee that there's an awful lot that people have had to cope with and have learnt and can continue learning about. If that, if that few minute window is there and is normalised. So, you know, just say, you know, maybe a more senior member of that team, how are we all doing, how are we feeling?

Opening the window to kind of say if, if someone's struggling, even if not then, they might do it later. What did we learn? Sorry, what do we, what do you think we did well?

What did you do? What do we do, what do we do well, and what do we learn? And those are kind of needs, you know, this kind of, this, this the reason I put that in the needs category is because we all have a need to, to want to master and to improve and to learn.

Requests. I like, I really like this question, how could I, or how could we have been more helpful? When I was at, when I was learning to fly, in one of the airlines I worked for, at the end of the day when I was the one being trained, one of the very senior captains said to me, you know, just before we, we, we got off the aeroplane, said, oh, just quick chat, is there anything I could have done today that would have made your day easier?

And I, I, I was gobsmacked. I, you know, I thought, well, I'm the one being trained, but I thought just, it just resonated as such a nice way of opening that door to have a quick debrief. Because after that, we inevitably just had a quick chat.

It was only a few minutes. But we had a quick chat about how the day had gone, and I inevitably then learned a few things and, and it was a, it was a very nice way of, of just starting that conversation. So that's one way of doing it.

Another way is something that's, that's come from the Edinburgh Emergency medicine and. Centre and they have developed something called stop 5. And stop 5 is, you know, it doesn't have to be 5 minutes, but, you know, they've kind of given it sort of an arbitrary 5 minutes.

But really this is, this is just an opportunity to have what they would call a hot debrief, and it might be after a particularly challenging experience, but it might just be at the end of the day, and again it's trying to normalise those conversations so that. It doesn't seem weird to do it. And it takes time for people to have the courage to start having these conversations if it's not normal.

Because, you know, if it's not the norm and someone says, hey, you know, stop 5, quick chat, at the end of the day or at the end of a procedure, people might be like, why? But once it's normal and people really and start to feel and experience the benefits, it, it it becomes sort of a self-sustaining process. So yeah, top 5, summarise the case, things that went well, opportunities to improve, and then points of action responsibilities.

And there's obviously some more guidance there, so something that's, you know, is, is accessible online. So this is a hot debrief framework. It's something that would happen, you know, immediately or very soon after a day or a procedure, led by anyone.

It's, it's confidential, it's brain free, so it's, you know, it's not about who did what, it's, it's purely just, you know, a chance to, to check in with each other. And this is what, this is what the evidence is showing us, the teams that are very, very good in these adaptive, challenging, unpredictable environments are good at doing this because it enables learning, it, it, it flattens hierarchies, it improves the sort of wellbeing and the resilience from a day to day basis. Leading by example, so ask for feedback, you know, particularly those in leadership positions.

So saying, you know, is there anything I could have done which would have made your day easier? That's the question that that captain asked me, and it's just stuck with me ever since, and it's a question I've asked many, many times myself because I just think it's a really nice way of, of opening that, that door. You know, other ways of doing it.

Do you have any suggestions or feedback for me? Because the best way of helping other people to be open to feedback, you know, especially if they're in junior or student positions, is to ask them for feedback yourself. And, a, you normalise that process.

So we're trying to normalise feedback and debriefing, but also, you can't help but sort of eventually start to ask that question back if people keep asking you. And so, again, it becomes a, a, a self, a self-sustaining process. So the role of communication, particularly when it comes to briefing and debriefing, what we talk about before, what we talk about after a day or a procedure or, you know, and not just the ones that are really, really difficult.

The more we normalise that and find those few minutes. And that's the challenge, is finding a few minutes, but actually the reality is it is a few minutes, . We, we know that there's huge benefits there.

So the last thing I'd like to talk about is the role of acceptance. And this for me is, is, is really important. Again, we're sort of straying towards the I I suppose the slightly more philosophical side of things again, but I, I think we're bridging the gap on this one because you know, it's, it's a really, there is lots of science around acceptance.

And a lot of it starts from this, that, that actually, when things are changeable, when things are unpredictable. Whether it's because of a, of the pandemic and because of, yeah, right now, the risk of teams having to isolate and the impact that's gonna have on patients in the business and the rest of the team, or whether that's just because when things happen unexpectedly, a patient has an unexpected reaction to something, a sudden, we certainly have sudden blood loss during surgery, you know, those sudden changes are. Trigger emotional responses.

And they trigger emotional responses because the, the emotional part of our brain, our, you know, part of our limbic system, doesn't know the difference between a real threat and a perceived threat. And change, you know, uncertainty is quite threatening to us. And so, again, whether that's in a moment of of sudden uncertainty, what's Going on with this patient or uncertainty because how are we gonna make if if suddenly old people have to isolate, how the hell are we gonna keep the practise running.

That uncertainty is very, very threatening and the part of our brain that is triggered is designed to effectively shut down the part of your brain you need to think and to to rationalise and to communicate. And the hardest thing sometimes is to be able to accept that, is to be able to almost recognise that that's what's happening, and, and to see that. But what we do know, and this is actually what a lot of elite sports has helped us with, is that people and teams who are able to frame.

These, these experiences as challenges, and it's not easy, but the ones who are consciously able to, to, to see that emotional response occurring. And actually acknowledge that and frame it as a challenge rather than as a threat. Particularly when they start to embed that as a language within their teams.

They are ones who, who are less affected by them. But the very starting point is to be able to accept that I am having that emotional response because this uncertainty is threatening, because I'm a human being. So interesting, that kind of bridges the gap, I suppose.

And the reason, of course, for the saber-toothed tiger, as well as, as well as it just being a, a, a, a pretty, A pretty interesting picture. It's it's also, you know, the, the, the sort of stereotypical threat, you know, the, the trigger for our threat response in a world, many thousands of years ago. But of course our brain, our, our limbic system and our and our body, you know, in in an evolutionary sense, haven't changed significantly since that world, you know, 20,000 years ago.

So acceptance, there's some, some of you may have heard of someone called Eckhart Toll. He has written a book called The Power of Now and a few other, very interesting, if, if possibly slightly out their books. I'm not gonna claim to, to, .

Find every word that Eckhart Toll has written easy to absorb, but there is some stuff he's written and some videos he's done which are very, very powerful, and he talks a lot about acceptance, and I really like this quote that's come from one of his videos. Whatever you accept, you go beyond. That's a miracle.

And what he means by that is if we can't accept something, we're stuck with it. If we, if, if we can't accept the fact that right now we feel frustrated or we feel worried. And we, and we, and we are, we, we, we get stuck with it.

And I think sometimes we have a fear that accepting something is somehow giving up on the willingness or the the desire for change, you know, it's almost like, well I just have to accept that I feel that way and that's the way it is. Rather than seeing acceptance as a really positive way of saying, OK, well, yeah, that is how I feel right now, or that is the way things are right now. But what next?

And if we see it like that, the way I like, I I almost like to have this as a visual that acceptance is the exact middle ground that sits between rumination, which is where we kind of go over and over and over something. I can't believe I did that. I can't believe what if this happens, what if that happens?

What, you know, and repression, which is when we're going, no, don't feel it, don't wanna know. Don't, don't, I know I don't feel what, you know, I don't feel those things and, and I, and I don't want to hear about it. Acceptance is the exact middle ground because rumination and repression are unhelpful, we're very hard to move beyond, we get stuck.

But acceptance is that, that middle ground and having that visual for that. And that kind of willingness to almost go, OK, the only way through this is by acknowledging it. That's all very well in principle, but in terms of how we do that, this is a strategy that I've certainly found helpful, and I've, and some people that I've coached and worked with have, have, have certainly found very helpful.

And it's about connecting our feelings, how we feel. And this isn't about being too soft and fluffy, this is really looking at science and saying our feelings, our emotional state is one of the things that we, we can't question, you know, we, the activity within our amygdala and our limbic system is unquestionable. And so our emotional state is a real thing.

And it can be triggered. All these different emotions can be triggered by array of different things. And of course that list is, there's the list is an awful lot longer than those ones, but I think it's interesting because sometimes I think we're all inclined to think about how we feel is either good or bad or happy or sad, rather than all the different types of feeling, emotional state that we can, that we can experience.

But actually, if we're able to acknowledge what it is we're feeling at the end of the day. If we feel a bit angry or we feel a bit, you know, we might be feeling great, feel excited. But if it, if particularly if it is something that we are struggling with, we feel a bit nervous, we feel judged, we feel isolated.

Being able to positively identify that. But then realising that our brains are sense making machines and they want to make sense of the situation, so you've gotta give them the chance to do that. You've got to help them and say, OK, so you feel this, why might that be?

It's not about trying to solve the problem, it's just trying to make more sense. Now SCAF is an acronym that was developed by someone called Doctor David Rock in 2010. He's a neuroscientist and he's done lots of work on leadership.

And these are, these are the domains that he in in social, professional environments are are massive influences towards our behaviour and and how we function. And he's basically saying based around our human needs, these are things that to some level, all of us crave and and need and, and, and, you know, affect us all. The sense of status, who we are within the world.

We all care about it a bit. So, and it's OK to care about that a bit. We all certainty, you know, certainty is based around our need to be safe, you know, if you think about a world many thousands of years ago.

Autonomy, it's something we all crave to some extent, some of us more than others. Relatedness is kind of, you know, relationships, a sense of belonging, a sense of connection with other people, because that's a social need and it's very, very strong. And fairness, you know, wars have been started, many wars have been started because of a lack of a sense of fairness.

These are things we all crave and some of us in different, you know, if, if you imagine that we all sit on a scale somewhere in every one of those areas. But if we're able to, instead of just either ruminating or repressing the fact that we feel sad or, you know, offended or nervous or angry, if we're able to kind of just take a minute to go, what is this feeling? And then to ask ourselves, well why might that be?

Maybe I feel a bit. You know, angry right now, because something that somebody did today questioned my sense of status. It didn't feel fair.

And actually, you know, I'm also a bit nervous that it's going to affect my, my relationship, you know, and, and going through those needs and actually saying, yeah, OK, actually that makes sense. It doesn't solve the problem. But it's, it's a way of finding that acceptance, it's a way of finding the middle ground between ruminating and repression, because we're kind of able to help our, our sense making machine of our brain and go and help them, help it to to sort of say, OK, well that is how you feel.

And I think this is why. And it's a massive starting point in terms of finding that acceptance. And it's associated with that.

It's something that I feel very strongly about when it comes to acceptance, having the confidence to do nothing. So I'm just gonna tell you one more story. This is about an aeroplane, that, that, that, that was involved in a very interesting incident in 2010.

This is an A380, the super jumbo, this is the biggest passenger aircraft in the world, on a flight from London to Sydney. And it was stopping off for fuel and passengers in Singapore. And on the way out to Singapore, they had a massive uncontained failure on one of the engines and bits of engine went flying and cut through different electric power lines, hydraulic lines, and they had 53 consecutive failures on this aeroplane, all coming up one by one.

And they were losing power to things, they were losing control of things. And the captain of that aeroplane, and they, they, they dealt with this incredibly, you know, they were up there for 2 hours dealing with things one by one by one, and they ended up landing safely with no injuries 2 hours later. And the captain afterwards talked and talked a lot about you know, his experience.

And one of the things he said that I found particularly interesting was this quote here, that there was no startle effect, no panic, the cortex, you know, the part of our brain we need to function, you know, took and maintained control, and then we were able to sit on our hands and initially do nothing. And then what we knew how to do. And I just think that must have taken enormous courage for someone who's in charge of a 600 tonne aeroplane.

With 44, you know, with nearly 500 people on board. To be able to see all these failures and actually just take a moment to say, just wait a second. Breathe, what's going on?

What's happening, what do we need to do? Go. And he, interestingly, the reason he talked so so so so clearly and so and so inspiringly I think about this event is because he had a real interest in neuroscience.

And he knew that this startle effect, this emotional response was very powerful. And even though it only took a few seconds. The fact that he noticed it, he recognised it, he paused.

And then he knew what he had to do. Meant that it was a for me that's a form of acceptance because although acceptance can come in many forms, but in that moment, he was able to see it. He was able to accept that that's what's happening.

He was able to to just take a brief moment, which must have been really hard because 2 seconds will feel like an eternity when all those alarms are going off. And allow him to make sure he makes the right decision. Something that many people in similar situations haven't done.

And I find it very inspiring. And I love that expression to sit on your hands. Now in a cockpit you can physically do it if you want to.

But of course in some situations you can't, but metaphorically it's a great expression. So, yeah, having the confidence to do nothing, you know, how many events in life need an immediate response? You know, when we have a a rock falling from a great height towards our car, possibly.

Interestingly, COVID and people coming within our space sometimes triggers that feeling that we need to respond immediately. But actually, how many things, whether it's in a clinical situation, you know, how many things do we have to respond? When I say immediately, I mean within, within 3 or 4, you know, within 3 seconds.

And actually the list is very small, but we feel often as though we have to. And sometimes being able to accept that that emotional response, to feel like we have to respond and recognising that and accepting that in that moment is actually our ability to then, to, to then have have the best outcome. And this is a quote from Victor Frankl who some of you might have heard of an Auschwitz survivor.

Talks about, you know, a, a lot about their, you know, his experience and how he, you know, adapted and grew from this awful experience. And, you've probably heard this before, that it's a, but it's a great quote. Between stimulus and response to space, in that space is our power to choose our response.

And that's kind of where he says, you know, our response lies, our growth and our freedom. But I think often we feel like we have to react, and I like this idea of the difference between reacting and responding. Reacting is what we do.

Probably without thinking, you know, and, and responding is having that presence to accept. What's happened, what our emotional response is, and then choose our response. So that metaphor will sit in your hands, when it's appropriate to do so.

As I said, sometimes that might be over a period of minutes, hours or days to be able to say, actually, how am I feeling right now? What might this be about? What's going on?

Or it might just be over a period of seconds to go, wow, that was a shock. OK, yep. Take a breath.

I know what's going on. Now I know what I need to do. And it's the same thing, it's just that sometimes it's condensed over a much shorter period of time.

And the, the, the theme here is that it's all about our ability to cope with unpredictable, startling, challenging situations. And that's, that's the link here is all about activity, whether it's over a large period of time, about our ability to adapt to pandemic, post-pandemic life and all the challenges or within a moment when something happens, it takes our surprise. It could be an email from someone that shocks us.

And instead of responding in a, in a, an emotional way, we have the the presence to recognise and accept that emotional response. And And respond, in a way which is consistent with, you know, what we, we might feel is appropriate. So in summary then, we talked about considering adaptivity in the context of your role in practise.

And what that means, what that might mean for you or your teams. Really raising this conscious awareness of the need for adaptivity, whether it's, you know, as a at a at a large over a period of time in terms of managing the practise or whether it's in a moment. And looking at the models that exist in terms of what the science shows us, helps people and teams to work well in these adaptive.

Unpredictable and what you might call high risk environments, because when things are unknown and uncertain, there is therefore risk involved. And we, we used cur curiosity, communication, acceptance as the kind of the basis for, for those kind of considerations, because for me, those in, in, in almost every way, everything in this within this, this, you know, this, this theme of activity come back to one of those, in some way or other. And understand how to apply these principles.

And as I said, sometimes it's a mindset. You know, clay pots, who knows? And sometimes it's more practical in terms of how we have briefings, how we can flatten those hierarchies within teams, encourage those conversations that enable learning from one day to another.

So I hope that's been so useful, interesting. I, I do thank you very much for, for coming and joining us tonight. Really interested to know what resonated.

If you've got any thoughts or questions, anything, at all, obviously, I'd love to hear from you now, or if you'd like to get in touch with me, Dan at vetleds.co.uk, to talk about anything else at all, then, as I said, I'd love to hear from you, so thank you very much.

That was great, Dan, thank you so much. Just you're so passionate talking about it all. You got me all all enthralled.

I was completely there with you running through it. It's great. I'll just give everyone a few minutes just to pop any questions that they may have into the Q&A box, but I just, you know, you're saying what, what resonated with.

With us, and certainly for, for myself, I mean there were so many points and I think what's really interesting is, where you just summarised it then where a lot of these kind of tips they work on, All kind of all levels, so it's where where we're dealing with the pandemic and the new challenges and, you know, that are being posed to the industry at the moment, but also on a very clinical level, you know, I think particularly I kind of, I love that stop 5 and you know, the kind of debriefing thing and I just think that that's exactly what. We all need to do, you know, it's kind of debriefing going, right, OK, we're in this challenging situation at the moment with, with the industry as it is, you know, everybody's kind of struggling, everyone's overworked, you know, but taking that, that time to just sit back and go, right, let's let's just look at this and, and give a calm perspective, and it's, you're right, it's exactly the same thing that we need to do after a difficult procedure and we probably. Used to do it maybe when we were in practise and you had that those 5 minutes, particularly if you had students, I think we encourage students to do it, don't we reflect on, you know, how that surgery went or what could you have done better and and to grow them that way and then maybe when once we qualify and we feel like we've established, we don't actually ask ourselves these questions enough, maybe.

Yeah, absolutely. I think it's, it, it does. It just, I think there's a sense of, like, with that sort of, it's not, not conscious like there now, but I think it's, it's just, it's, once, once there's a sense that we're not training anymore, it's just not, it's no longer normal.

It's, it's, you know, and, and normalising is, is a big thing. And, . It's not, you know, it, it, like, all the different professions are gonna go through different journeys in terms of how you get, you know, how you can help these things to become normal.

And, you know, looking at aviation as an example. I, you know, I remember even in the time, the sort of 10 or so years that I was doing it, it became a lot more normal. In different airlines I work for, for those conversations to start happening.

And once they are, it, it's, it's just seamless, because at the end of the day, you just naturally, even on days when you previously thought you didn't have time, you inevitably actually do find 2 minutes just to say, how was that? Anything, any thoughts about anything, you know, I could have done, or we could have done, anything we did really well. And it just happens seamlessly, and you're so much better for it.

So it's really interesting. Yeah, it's, it's the importance of giving yourself that, that 5 minutes and obviously, you know, if you're a practise manager, I think it's getting your team to to have that 5 minutes as well and encouraging that and, and especially, you know, on the emotion side, I think, I mean, vets particularly are kind of perceived, aren't they, as as almost like superhuman, you know, people or the public don't really realise that we are, we're humans too, and you know, we, we do kind of feel it, and I think certainly recently there does seem to have been this uprising in . Maybe antisocial behaviour sometimes between clients and and the veterinary staff, whether it's front of house or you know, the vets themselves directly.

And we, we're just expected to kind of shrug it off and it not to affect us, but realistically we are only human and, and I think maybe accepting that and acknowledging that emotion. Response and then giving yourself the time to actually go, that's OK, that's, that's how I feel about that. And now I'm gonna, you know, with that clarification, kind of move on and not let it affect the rest of your day, you know, but it's owning it, isn't it?

Owning that emotion and and accepting that you, you are, although you're a vet and you're wonderful, you are only human. Yeah. And it's almost become.

It's a cliche thing to say, but it, it, it, it only happens through, you know, all these things are, are a practise. And, it only happens through, through doing it, because otherwise, yeah, it's, it's just, again, it comes back to sort of normalising that emotional response. And, .

Yeah, I think it's just that, that middle ground between we, we inherently want to either to pretend it's not there, or we stew and we stew. And actually, it's kind of going, well, that is how I, as you say, it's a great expression. That is how I feel right now.

Yeah. And what next? And it's, it's easy to say, but genuinely, when we, when we make a con as so much of this is about taking, making a conscious intentional change, you know, whether it's about having the briefings, having the debriefings.

People in senior positions, you know, we talked about hierarchies and sort of authority gradients, you know, simple things, but at the beginning of every day, at the beginning of every procedure, just actually making that comment. You know, if anything doesn't look, it doesn't look right, if you've got anything at all, you know, speak up, you know, and ask any questions. Explicitly saying that every day, even if it doesn't seem.

Because you only said it, you know, you said it a week ago or whatever, it's, it's actually making that conscious effort to go to to realise that it will make a difference saying it every day, even though it sometimes, doesn't appear necessary in the same way that actually taking that second to go. How do I feel? And what might that be about for me right now?

What needs might be not being met for me right now, because it sounds quite obvious, but we just, we get, we get conditioned away from doing it because we're so functioned, and we're so conditioned to do and apply technical skills and achieve outcomes and we get into our tunnel. So, so, yeah, really resonate with what you're saying there. Yeah.

And I think, you know, as a leader as well, you know, it's what you said about you have to ask the questions, you know, before you leave. And I think that that's a key one, for me, and like you said, giving other people the opportunity to actually take 5, to think about actually how do I feel today, how has today gone? So actually saying as a.

Whether it's a practise manager or a leader of any team, you know, how, how are you doing? How, you know, how, like you said, that, that is there anything I could have done to have helped you today? That's, I mean, that's a beautifully phrased question.

And I just think if, if we all kind of took one thing, if, if we just took that and actually asked our team members that at the end of each day, you know, what could I have done to make your day a little bit easier and how do you feel? And give them that, that time to actually have their voice and to take stock of any kind of emotional onslaught that they've had that day and, you know, process it, isn't it, process it and verbalise it, and then own it and then you can start the next day with a, with a clean slate. .

Absolutely, I think, yeah, I think that's really, yeah, that, that sort of, I would say summarises much of it very well indeed. I was listening, I was listening. I told you I was enthralled.

It's been wonderful. And I think interesting hearing, it's always interesting hearing a kind of reflection on something. It's, yeah.

Yeah, well, there, there were so many, honestly, I, I could probably go on, go on nights, but there's, there's no direct questions that have come through from everyone else, so I think it's just, it's just me chewing your ear off, Dan. I think you've answered everybody else's questions or they're all sitting at sitting at home asking themselves, oh, you know, how am I feeling today, and maybe assessing things themselves and taking stock of, of what we've said, so, . I think, well, what we'll probably do is call it a night and let everybody go away and have have their little bit of thinking time and do a little mental debrief.

But I just want to say to everybody that's joined tonight, obviously thanks for giving us your time. I do hope you find this session as valuable as I have, you know, and, and everybody feels more prepared to adapt to whatever challenges you may face and the team may face tomorrow. Please do spend a couple of minutes to do the survey that pops up at the end just so we know what you want to hear about next, so we make sure that we're servicing you guys as well.

Thanks, once again, to, Kyle, who you guys probably won't won't have seen, but he's running behind the scenes, making sure everything runs smoothly, so we're very, very grateful to that. And obviously thanks massively to Dan for covering such an interesting topic and helping us all to adapt and thrive in this crazy new world that we're we're suddenly finding ourselves in. But I hope you have all had a great evening.

And we'll see you all again soon, hopefully you as well, Dan, and another webinar. Thank you very much. And yeah, if anyone wants to get in touch, please do contact us at BetE for anything non-clinical human factors, whatever, whatever it's about.

Yes, thank you very much, Jackie and and Kyle. Take care everybody, bye.