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Okay. Thank Thank you very much. Pretty. Um, So we we kind of need to move swiftly on, uh, but I'm excited. Proud to announce that we will be having, uh, a podcast effectively filmed live here with us from the author, Hub team, Pete based and cash actor who need no further introduction. To be honest, uh, and they will be broadcasting their infamous podcast from live from our stage here at Bo to Congress. 2020. Thank you very much. Thanks, Oliver. Thanks. Um hi, guys. Uh, no pressure. 11 minutes to lunch. Uh, everyone's felt You guys want to stand up 30 seconds. Just please liven up a little bit for us. Although it's it's gonna be hard work. Um, has most importantly, has anyone seen Sue Deacon High? See, we've We've been a little bit concerned. Come in, please. OK, great. Everyone have a seat. Gets it. Pete, were you making notes on the how to retire with dignity talk? See, uh, great. I'll get your mic microphone. So this is a new thing for us. As you know, we do this in a studio. There's a little bit of editing. Not as much as not really? Not much. It's mainly just taking out anything libelous that Pete says. And major swearing any See bombs, Pete? Not today, please. Okay. Nothing. Because this is all being recorded, as is Pete. So if this goes out, were canceled. Um, do you wanna swap sides? Is that okay? I think you should be in the middle. All right. In the middle, then you these microphones on. Great. I'm scared. Oh, no, don't worry. Don't do. Is your mic okay? I think so. Awesome. Okay, listen, I feel kind of naked of that, like, lacquer to start. Can someone clap their hands or something? Thank you. We normally have Fabio doing that. So hello. And welcome to our first ever live addition of the author podcast. Uh, we've been invited the boat to Congress that people who are listening at home, which is the British Orthopedic Trainees Association. They must be desperate. Uh, we're a long way from our Paris in East London, but I'm particularly delighted that our first ever live event is here in the glorious city of Liverpool, God's own home to Juergen Klopp's mighty Reds. Come on. Listen, we're grateful for the invite. Well, like thank Botha for awarding us the best podcast. Remember last year? Yeah. The best podcast hosted by too badly aging men. Uh, it's quite a niche concept. Isn't it years ago as well? Yeah, but we really appreciate we came in. We came in person to collect our cash prize. It's a cash prize. Right. Okay, well, we'll talk about it later. It's not, You know, it's not easy being a soft tissue knee surgeon in London. So, Pete, what are we talking about today? So, normally, when cash asked me what we're doing today, I it takes me about five goes to get it right, and we have to edit, edit, edit until until I get it right. Uh, but today it's easy, cause we've got Sue Deacon with us, and we are having a discussion with it. What we're actually gonna talk about I don't really know. I don't think she does either. So we'll see how it goes anyway. Sue Deakin. For those who don't know her, she's a consultant. I've got my notes here. She's a consult Ortho pod at Bury Saint Edmunds. If you want to know where bury ST Edmunds is, if you think of East Anglia that, like pregnant bulge of East Anglia. Um, and you imagine you're the foetus with your head, like down and your ass up. And she's very is there is about where your head of pancreas might be. It's kind of halfway between between Cambridge and Norwich and Colchester and Sydney asses kind of bang in the middle and crystal clear. There you go. She's so especially interest is Pedes and foot and Ankle. 20 years at the coalface and still on the on call rater. That means that that is that is impressive if you follow on Twitter, which I do things that crop up regularly are human factors patient safety, women in surgery, recurring themes. Human factors lead for her trust. Trustee of the clinical Human Factors Group Charity dedicated to improving patient safe safety. She's an amateur singer. Probably not that amateur You more Lady Gaga or Beyonce, which is? Oh, it varies. 19 sixties to 2000 twenties. Okay, All right. So mixed bag. I'm in a band. Yeah, bad band with a bad Do you play an instrument or you just vocals tambourine and sing in Great. Are you the lead vocalist? Yeah, awesome. Awesome. She has promised to sing to us later. Yeah, I haven't stood on the stage in Davos and sang Valerie for 50 quid. So both are pretty generous. We'll get a point glass out. Amateur singer, mother of two grown up kids, Vice President's a O U K and Ireland. So as vice president mean, you're going to be Presidente. Yeah, that's coming in. I have to fess up to something which is a bit awkward, is I don't know what I don't know What the specifics. I don't know what happened to him, but obviously something happened to cash on an ao course, something bad. And he's every time you bring up a oh, Cash has got nothing but negative vibes. He's got dark thoughts about a Oh, I've never really got to the bottom of it. What's all about? I had some bad experiences. It leads one night out that I don't want to talk about. I'm still paying off the air. Davos advances from 10 years ago. Um, but you're not gonna catch me up. I'm not gonna say anything bad about our butts. German shot, Footloose truth and this frog and oh, I took I took hours of work. I'm reading the room. I'm seeing a few a oh, people here, so I'm not gonna slagging them off. Otherwise, it's a bit like saying that I think Mother Teresa's are all for human being or global warming is a good thing. Um, I will say that I think oh does wonderful work and that they should charge even more money and even more remote places for things that they do. Um, but you're moving on quickly. Thing that made me so the thing that made me say which is nothing to do with with With With UK is is that when they took the skiing skiing element out of the Davos course, that really that really ruined it for me. I did my basics, endeavors and all. I I'd learned to ski and learned how to put a screw in all at the same time, and I was absolutely knackered when 19 nineties. Sometimes that was they were big nights, but it's not cheap in devil's, um, so So listen, one of the things that you're passionate about known for, is human factors. It's one of those terms that a lot of us here about, and it means different things to different people. To me basically means don't be a dick. Um, what is emotional intelligence? That's that as well. Yeah, OK, don't show me up now, but what is human factors and why does it matter? Okay, well, I first became interested in human factors, and it is a very difficult thing to describe, and a lot of people think it's just about don't be a dick, but it's also not just how you manage yourself. It's how teams work, but actually, and it's not just nontechnical skills, it's also about the systems and processes the environment. The kit we used, the way it's designed, Uh, the HR processes the way a new building, a new hospital, might be built, Um, and designed around us. So another term for it is also ergonomics. Um, and I first became interested in because I had a horrible never event in 2011 when I operated on the wrong leg and I needed to make sense of how that happened. So sharing with us, I get palpitations. Even talk about the story is this is quite it's quite brave, for someone can stay to talk about this, so I wanted to help other people learn. So that's how I became interested. I've operated on the right leg and I still don't talk about those. Tell us so I've been a consultant for what, eight or nine years? And actually the problem? Well, basically, I had a girl, 19 year old, very intelligent girl just coming out of uni. She had bilateral ankle instability, and when I saw in the clinic, problem actually started in the clinic. So in 2011, I had a massive foot and ankle clinic mixed in with a few kids and few trauma cases, which is not that far off from what my clinics look like now. And we all know what it's like running up and down the fracture clinic, bobbing I/O, being interrupted all the time. It was an overloaded clinic number one. There were too many patient's in it. I was interrupted on frequent occasions, and actually the patient hadn't decided which of her ankles was affecting her the most. So she said to me, I'm not sure which one. It will depend which one's playing up the most. At the time. We'll do one at a time. So in those days, there were no electronic prescriptions for surgery. So on the piece of paper, I didn't say which side, and it wasn't a mandatory field, So that was the first thing that went wrong. So that was the system problem as well as me being distracted, overloaded, etcetera. I actually made a conscious decision not to do that. The next thing that happened on the day of surgery me and my lovely registrar, I don't think he's here. And that is probably busy working. Uh, went right now And it was about the time that who checklists came in. Remember, some of you may remember that, and, um, we did everything. We walked to the patient. We did the huge checklist of a massive, uh, checklist. Uh, we marked the correct leg. We consented her for the correct side. And I show a day that day we had a lovely operating list with three nice cases on. In fact, she was easiest of the cases. Um and, um, somehow I managed to stabilize the incorrect ankle and didn't find out until I got home. Picked up a glass of wine and the matron from the ward rang me and said The patient's woken up. I'd already seen her in recovery when she was still a bit dozy and she said, How come you operated on the other leg? Of course I dropped the glass of wine. What's going through your mind when you hear that? Well, I just remember I didn't even know, she said. Do you know you've had a never event today? No, I didn't even know which patient it was. Dropped the glass of wine on the page on the patio, Lovely Summer's Day went straight back in and went to the patient's room. The matron was really supportive. We went in. She was there with her parents because she was a young girl and she said, And the first thing I didn't understand what had happened, but the first thing, of course, was were really, really sorry about this. We're going to try and find out how this has happened, and the mom said to me, Why didn't you check the mark that was on the leg just before he did the operation? And then I looked at her leg and I realized that the nurse on the ward and put the Ted stocking over the leg of the leg that we put the mark on. So he put the mark here pointing down towards the ankle like we're supposed to do. And the busy nurse on the ward had asked the patient to put the Ted stocking on herself, who assumed that she had to put it on the leg that she was going to have operated on. She didn't know any different. And then what we discovered afterwards was that not only that, but because we're having a lovely day. I had a nice senior registrar with me. He'd gone in to do the time, uh, checking in the anesthetic room with the anesthetist and I said, Okay, that's great. If you do that, I'll start scrubbing and then I'll get everything set up so we can do the case together. What he did was in that room. Nobody checked the mark again, even though it was on the checklist, because he done the mark himself. He knew it was there, and the niece test actually put the block in the wrong leg because they had a popliteal block as well. I was scrubbing up, the nurse said, I'll prep and drape the leg. Great. So I walked in beautifully prepared leg. And then at the time out, which we always do after prep and drape, there wasn't a question on the Hugh checklist to check the mark again. Now, I don't know about you. When I turn left at a junction I always indicate left, don't you? Yeah. Always. Yeah. Always, never, ever forget. Oh, and everybody. All my friends afterwards said, Well, I I always check the mark. Why didn't you check the mark again? Well, I thought I did, but there wasn't a question on the checklist. Anyway, it's not so bad. The good news is her ankles beautifully stabilized. Um, and she came back for the other side. She did sue the trust for time off work and quite rightly so. And, yeah, it was something that I needed to get my head around and learn from and help others. So them from doing the same, there was a trainee involved as well because the trainee put the mark on the correct leg. Yes, in front of me, together, we did it. So they must be feeling pretty bad about this as well. How did. How did the the two of you kind of work it out? Well, remember we were both The whole team were devastated. The nurses, the an east test. Remember? We went into a chat with the in east test because he came in as well. It was like, Oh, my gosh, we're going to get suspended. What's going to happen to us? What we do? Um, and the registrar didn't find out till the next day because it was in the evening. We found out and we had a chat. He was also very upset. At that time, we didn't really know the full story because there was a whole investigation. And, you know, it was like we we all supported each other. Everybody. We got together, we chatted. We were all interviewed separately to find out what had happened. Uh, I'd like to think that I supported the trainee as well as I could, and all I could say to you is just just say the truth. Be just say if you ask questions, just answer, then, um he was obviously we all felt Oh, my gosh. What if this had been the wrong kidney? The only kidney that was working the only lung. Or did you have to call the MD you or anything like that? I don't think I did. No. Actually, the trust out with it. Reasonably. Well, I assume they for that one. They just pay up, don't they? They don't. It doesn't go to Courtney for the suing? Uh, no, that that was straight. I didn't even find out two years later that she sued but senior in the clinic every time afterwards, waiting for her to have the other side done. I was quite stressful. I tried to keep her informed of what had happened with the investigation and the improvements that we made to the system to try and prevent it from happening. So human factors is absolutely key because what you're describing there is literally the classical Swiss cheese where it's gone wrong on a dozen different levels. Yeah. Yeah. I mean, there are lots of people involved. There are lots of processes and systems. Things like the way the white board in the room hadn't been put. Whether it was right or left, the nurse hadn't checked the consent form so many different things that added up and was it that that really got you into human factors, and it was that make sense of it. And I was like, What do I do? How do I do? And then our hospital said, Are we going to put CCTV in theaters so we can prevent never events? Okay, I know I became the divisional director of surgery for our trust, so they didn't sack me. Uh, not yet. Um, and And what did we do? Oh, yeah. I had to put an options paper in for better alternatives to put in CCTV in theater. Uh, and I did a lot of research, and I came up with producing a human Factors faculty of people that could train other people around human factors. And that included the execs. We needed to educate them, too, as well as all different people within the hospital. You know, the facilities department equipment department, porters, cleaners, receptionist, surgeons, nurses. So we call it human factors. But a lot of it is systemic factors, isn't it? We know that I mean what's happening now with the NHS supply chain and must not been able to get our kit on time and turning up into theater in the morning worrying about whether you've got the ankle replacement in my case kit available and the nursing staff who are skilled enough to use it. Um, and that's that's that's not that's not all in my control, but it stresses me out. It's real challenges, and I should be thinking about how to do the Ankara place. Well, this 12 smart nails left in the country, and I use six of them. On Monday, I felt guilty. Glad I'm off this week. I don't understand what CCTV is going to do because you'll just have some guys sitting there on his phone eating a pizza, falling asleep. I don't quite get how it's going to prevent a never event. Well, that's kind of what I said. But, you know, it's amazing how non clinical people don't get that. Sometimes I'm just I'm just thinking that I know I know of people who would have tried to pin that on the trainee. It would. It wouldn't have been difficult, would it for the for the consultant, for you to have framed it in a way that that that left the trainee hanging. You see how Pete's mind works. You know, I always have a full guy, but I just I just know that's that's that. That would be a thing in some place, in in in some places. It didn't occur to me in the slightest. I mean, it was the patient's my responsibility, and that's what we all know. That and I was too busy blaming myself. Anybody else? Yeah. Even if it is a training, the fact that the buck always stops with us. Yeah, that's one thing to bear in mind. Yeah. Sue, can we talk about I do do some operations on the white part of the body, by the way. And have you ever worked with me? I'm obsessed about theater checklists. Yeah, and design them and all counts are wonderful trainers. You've been training of the year in your region. Pete's been Tati at, uh, voter, haven't you? Yeah. Once upon a time, I've got participation medal somewhere. Uh uh, So you to also something else you talk about is work hygiene? Yeah, Well, I think it's part of human factors, Really. What is work? Hygiene? Okay, so it's when you get a contract for a job or you're a registrar on your rotation. I hear I see all of this being discussed on social media all the time. So it's when you get your rotor in advance, hopefully or don't get it in advance. It's when you rock up at the HR department and you ask for your badge and they say, No, you can't have it now You've got to come back in an hour That can really affect your day. Um, it's whether your badge actually works on the Children's ward, so or on it. Getting into theater on your first date. Whether you've got your password log in on your computer, I'm sure you could quote examples of where that hasn't worked. Getting paid, getting paid on time, making sure people know all that stuff. Work, hygiene. It's human factors is how to make your life easier. Get on with the job and look after your patient's. But all that stuff we have virtually no control over is we feel we have very little control over it because they are. These things are external to our sphere influence, aren't they? Yeah, exactly. It can feel like that, and that's why people like me and many others, and there's lots of people been talking about this already yesterday, I think can try and influence those other areas of our work. HR, you know, H R processes. They could be improved. Maybe. Maybe. Yeah. The one they would say is we as consultants are quite fortunate because you're in one place, and once you set up, you got your locker, your boots, your theater stuff. You're there for years. Is the trainees that really feel it? I mean, I I know. It's like moving every six months. It's an absolute disaster. Start this process all over again. Yeah. Car parking got up. Uh, that kind of links in neatly to, uh I mean, we we we we can't go on forever because it's 10 minutes past lunchtime, So we'll do one more question. Five more minutes. Okay. Okay. Um, Debbie was talking about Put up a ton of graphs earlier on, uh, just showing how the NHS is is in a bit of a kerfuffle at the moment. And we, you know, it's things are bad. Um, and, uh, we got consultants who are moaning about their pensions about their their job plans. People are going part time sooner than they might otherwise have done. I think there's a lot of negativity coming from the seniors down to the juniors, maybe more than there was in the past. And we know there's a lot of bad press from the NHS people, a lot of doom and gloom from being thrown around. How do we keep this group of people engaged up for it and not cynical and not wanting to leave orthopedics when there's a lot of negativity around? Well, it's understandable. There is a lot of there are a lot of challenges around. But, uh, the one thing an older, wiser person once told me was that no matter what everybody else does to you, they can't take away that relationship you have with your patient's. And the reason why we do this job is to try and make people better, and we're not able to make as many people better as we used to. At the moment, there's still hope that we will in the future, with elective herbs and other things, but no one can take that away, and that's what we go to work for every day. Certainly why I go to work every day and and every. I don't and I still love medicine and orthopedics and surgery. Um, and I hope you all do, too, because people don't leave the NHS because of the medicine or the lack of it do. It's what we love. It's why we do it. But we only leave because of the environments that we work in and the difficulties that are beyond our control. And that's why we need leaders like Deborah and people from the royal colleges and everybody to try and make things easier for us to do that, which is what we love every day. Um, apart from this week's a month, I love it so much even better when you're not there. Yeah, awesome. Well, we've had a much shorter than we had planned because of reasons. Um, we can have a couple minutes. Are there any questions for for Sue, for Pete, For us to do the author hard to do with human factors. Do with work, life, speaking up anything. Is there anything people like to ask? Or are you that? Hey, you've got some. Okay. Hello. I've got my own iPad. I've got my own iPad. We need more. I thank you for your honesty. Did you have any support from your hospital trust in the form of pastoral care or counseling to process the emotional burden afterwards? That's a really good question. Actually. I had lots of mates at work. I didn't have anything formal. Nobody really reached out to me. Other than my friend's, uh, there were quite a few people who did the opposite. Actually, you said, Well, I would never do that. You're a bit stupid, aren't you? But most people very supportive of the people I'm talking about. Yeah, but actually, what that has done is it's led us to produce a peer support program. I'm now appear supporter for other people who have been through a big incident or a complaint or about to go to Coroner's Court's or they've got something scary coming up or have had something bad happen to them. So, no, I think there are more, more hospitals and trust that are doing that. So I've been trained by a psychologist now that had support, and I'm currently supporting a an in East test who's going through a disciplinary process. It's hard work, but actually I really would have appreciated that when that happened? Yeah. Not to me. With me, you've had loads of never events. Do you want to discuss? Discuss any of them here generally. Just blame them on the people around We move on. Yeah. No, no. Let's pretend that we'll edit that bit out. Um, Rich, did you have a question? Yeah. Highway. Sorry. Hold on. Wishes and Mike coming. Thank you. Um, I think it's very important that human fact this is now so widely known about, but we're now getting to the other problem, which is we've got checklists upon checklist upon checklist upon checklist and we're talking about new sustainably sustainability checklist. Um, but people are now getting to the point where efficiency is now dropping due to the number of checks that we have to do. But also the fact that checklists are now being ignored big as well. Somebody else has checked that somebody else has checked that. So how are you thinking about that? And how are you looking at that? So we can change it Because obviously every time a new checklist is put in, we should actually be looking at the whole process and changing the whole process as opposed to just go or just add another layer, We'll just add another. Yeah, Yeah, I understand the checklist. Fatigue? Yeah, there is a thing called checklist fatigue. I agree with you there. And I think that's the key is to make checklist full of meaningful things that are important and not just adding layers just because something happened. Um, but there are definitely some things that we do need to check because we are only human, and we do forget we have to be reminded sometimes. So I am a checklist fan. Maybe because I've suffered as a result of a not so good one. Um, but they have to be designed well enough to take that into account that checklist fatigue can happen. Um, but we do know that it makes safety better. Um, you may think it makes efficiency worse, but if you've got not checked that you've got the kit and you haven't checked that You've got sterile kit and you haven't checked certain things. Then it will make the list less efficient. And we know that we didn't used to do team briefs. We were worried it would take too much time up in the morning. now. I couldn't contemplate do an operating list without a team brief, could you? Has anybody lived before team briefs? Exists? People in this room, I can't believe we used to run around telling everybody individually. Yeah. Um, and now we wouldn't even dream of starting elective list without team brief. Okay, well, embrace them. We'll finish up there. Pete. Who's our next guest? I have no idea. Mark Jankowski? Yes, Mark. We'll see. Yankowski. Yeah, we recorded that a while ago. But he's, uh he's a big cheese J B. J s formally JBs American, but he's now, uh, the chief the editors in chief of that. So, uh, he's our next podcast. We find out about the beef between J. B. J s and B J J and how it's like nineties East Coast, West coast, how the divorce went down. Yeah. Who got the payout? Thank you so much, everyone. Cheers, guys. Thank you. So I just want to say absolutely amazing work from you guys. Thank you for so much, Pete cash for coming and blessing us with one of your podcasts.