Martin Bromiley 💙
@MartinBromiley
Followers
16,175
Following
1,247
Media
123
Statuses
11,688
OBE. Keynote Speaker. Founder, Clinical Human Factors Group. Bereaved & remarried. Promoting human factors for safer healthcare. Views personal & my own. he/him
Joined January 2012
Don't wanna be here?
Send us removal request.
Explore trending content on Musk Viewer
#DOHKYUNGSOO_POPCORN
• 117884 Tweets
#今月描いた絵を晒そう
• 112258 Tweets
25 YEARS LEGO X GULF
• 80025 Tweets
Gabigol
• 52407 Tweets
Rinku
• 41642 Tweets
参騎出陣
• 37345 Tweets
GENE
• 35849 Tweets
メンディー
• 29931 Tweets
風呂キャンセル界隈
• 28453 Tweets
#T20WorldCup24
• 27034 Tweets
LILI
• 24962 Tweets
#PVL2024
• 24495 Tweets
Dube
• 22166 Tweets
Hardik
• 20789 Tweets
ヴィルトゥオーサ
• 20508 Tweets
メンさん
• 20297 Tweets
ミンギュ
• 18974 Tweets
GABRIEL BARBOSA
• 17583 Tweets
Jadeja
• 17390 Tweets
CokeStudioConcert WithBINI
• 16197 Tweets
Siraj
• 14849 Tweets
Creamline
• 13652 Tweets
ジョシュア
• 13166 Tweets
サザエさん
• 10759 Tweets
大慶くん
• 10065 Tweets
Last Seen Profiles
Pinned Tweet
"He loathed complacency & arrogance & highlighted that disciplined flying presented the greatest challenge & the most satisfaction" - O Zupp
7
22
105
We have produced a 2-page guide to key non-technical behaviours to help clinicians in this emergency. Developed by clinicians, academics and experts in non-technical skills/human factors, please share.
63
1K
2K
It’s been 13 years. Today, my 17yr old Adam was under general anaesthetic for a surgical procedure. Thank you to the whole team who explicitly talked “safety” and demonstrated numerous “safety” processes & behaviours which were clearly part of their normal work 1/3
23
187
791
The
#BawaGarba
case is tragic for all concerned. In a just culture, learning is prioritised and systemic issues are fully explored first, and if appropriate individuals are then held accountable. How that is done sends a powerful message to everyone in the system.
#justculture
14
536
689
F1 - “let’s engineer safety at multiple levels, learn and improve car safety, develop safer track design, modify the regulations”. NHS - “Memo to drivers, please be more careful”
To walk away from that impact and fireball is a truly remarkable testament to safety engineering... wow...
10
10
90
19
158
643
I’ve witnessed excellence over the past 3 days. Thank you
@MKHospital
for the care after my little MI, I’m now at home. I saw consistency of “safety” behaviours, done compassionately for me & every patient around me. 1/6
60
74
638
When you make an error, acknowledge it, make it right & learn from it. When someone else does, remember it could be you. Stay humble & safe
13
467
589
In 2007 I remarried. Two young step children came into a new blended family. Megan qualified as a Nurse last year and is working today. Very proud. To all Nurses my thoughts today are with you
#InternationalNursesDay
12
23
609
Another life saved through the work that myself and
@ClinicalHF
have championed over the last 15 years. Aware of my late wife’s case a junior intervened (by clearly stating what the issue was) when consultant lost situational awareness during an unexpected emergency.
16
105
626
I’ve felt a sense of horror at recent NHS tragedies in the news, whether maternity, the response at Chester when staff tried to speak-up, the awful stories from female surgeons, or the death of Martha Mills, two things come to mind. Culture & the steep authority gradient 1/3
22
168
646
“I wouldn’t have done what they did” is the common refrain; but trying to understand why it made sense at the time is how we learn
13
234
571
On
#WorldPatientSafetyDay
I’m reflecting not on those lost, but on those who’ve now lived as a result of improvements seen in patient safety over the years. Too often harm still happens - but I believe safety has improved since 2005 when my late wife died.
14
164
560
To all my healthcare followers in 2021: may your systems make it easy to get it right; may your leaders & colleagues create psychological safety; and may you find a moment to appreciate how much you’ve done for us all.
10
92
538
I’ll state clearly: inadvertent errors need to be understood & shouldn’t be punished, the science of human factors can help us improve systems to prevent reoccurrence. But we must not tolerate appropriately judged wilful or grossly negligent actions
17
282
489
This is a remarkable book written by people who are amongst my heroes in human factors. It’s aimed at paramedics but if you work in a safety critical role in any industry it’s probably the best introduction to the science and application of HF/E today.
17
149
479
Today is
#WorldPatientSafetyDay
Feeling safe to express yourself in the workplace creates safety for you and your patients. My thoughts with all in healthcare today.
10
291
476
Deeply humbled, and in admiration of all those who received recognition today.
40
83
453
Never be embarrassed by your successes or failures, the latter gives you the humility to cope with the former - but learn from both
6
227
423
I've been so inspired by many healthcare professionals I've worked with, especially those who've had to overcome the darkest moments, and I carry their professionalism in my heart in my own arena. Thank you. Learning, humility, compassion.
6
102
380
Design for safety, making it easier to get it right. Awesome!
The new blue syringes have arrived at
@EastAngliAirAmb
for pre-drawn fentanyl - we have used red for roc for some time now. Always aiming to reduce human error and improve patient care 👏 🚁🚑👍
#HEMS
29
76
612
5
77
391
Found out yesterday of another life saved as a result of the human factors work that
@ClinicalHF
have been doing. Every time I hear another story it makes the hard work worthwhile.
10
36
354
My themes today at World Patient Safety Summit, a need for: 1) system focus thru long term national coordinated safety plans; 2) human factors expertise permanently embedded in national bodies; 3) a learning & just culture, just for all in the system & those harmed by the system
20
190
334
It’s taken me a while to get to this. I sat in ICU for 13 days at the lowest point of my life. This is a beautiful book, it fills me with hope for those at their worst moments whatever the future may hold
@WhistlingDixie4
7
53
337
The bottom line? At potentially my most vulnerable I felt safe, informed, involved & cared for. The staff achieved this safety, consistency and compassion after their worst ever year and that is what’s truly remarkable.
@MKHospital
@OUHospitals
6/6
15
22
342
Understanding, tolerance, bringing out the best in people and bringing them together is the mark of a great leader. The world feels a little lighter right now.
6
38
323
“The professionalism curriculum needs to be revised with a focus on resilient systems rather than resilient doctors. Workplaces would do better by defining resilience as a shared value rather than an individual asset.”
One more time:
Resilience is a system property, not an individual one.
It is about how the system as a whole adapts to changing conditions, not loading it all on the frontline.
What we don’t talk about when we talk about professionalism: Resilience -
7
65
199
5
104
305
Human factors - making it easy to do the right thing
@brittp_27
@HumanFact0rz
@UnityHealthTO
@KariLynWhite
@davepaskarMD
@brodie_nolan
@DrCarolynSnider
@TGrantcharovMD
@emcrit
@UofTTrauma
@SocraticEM
@purdy_eve
How bout those airway carts...👀 we channeled our inner love for M.A.S.H! Bet ya can’t wait to use em!
9
42
123
4
86
293
Deeply humbled to be awarded an OBE, this is for all those who work tirelessly to bring the science of human factors into healthcare.
48
148
286
Amongst talk of extra staff, facilities and new technology, my plea to healthcare leaders, starting with
@MattHancock
is please keep the focus on making healthcare safer, and making it easier to get things right. 1/2
7
113
281
“Ambulance” last night on BBC. Excellent non technical skills demonstrated by paramedics and call handlers. Inc a powerful example of a valuable open mini brief prior to attending a newborn who may have needed CPR. And amongst it all, no egos. Truly humbling.
3
46
252
This tragedy is an awful reminder to healthcare that “safety” is not a campaign or a course. It is & always will be a core part of everyone’s duty. And a safety culture requires constant leadership attention at every level, every day - every behaviour counts.
Exclusive: Largest maternity scandal in NHS history revealed in leaked report describing dozens of mothers and baby deaths
27
234
163
11
119
257
Today my wife had a procedure at the place my late wife had hers. She told Nurses she expected them to speak up if they saw anything wrong
9
127
232
Happy
#WorldAnaesthesiaDay
to everyone involved in anaesthesia. Thank you for all you do. Be slow, humble and safe.
2
27
255
In other news, this is human factors at its best - designed to make it easy to do the right things.
We're open. A brand new trauma bay at
@UnityHealthTO
, with new workflows, new equipment and logistic solutions, new tools to promote teamwork and safety. Purposely designed, extensively tested, revised with end-user feedback. A trauma care environment like no other.
78
226
1K
8
64
239
First of a series of 2 min films looking at aspects of human factors in healthcare. All free to use, good as tasters during training or to promote the topic, thanks
@ClinicalHF
and
@HealthFdn
#clinicalhumanfactorsperspectives
series of short videos with
@MartinBromiley
number 1 - What is the point of clinical human factors?
2
71
95
9
146
240
It’s been 15 years, delighted that it still helps make a difference to another generation!
Just found son number 2 watching the video about Mrs Elaine Bromley’s case as part of his 2nd year medicine course.
Excellent to see this as part of the undergraduate course at Glasgow University.
@MartinBromiley
13
2
186
18
8
227
The awful cost of unsafe systems. Important issues raised, but when Elaine died all I wanted was for it not to happen to others. We must apply the science of safety, human factors & develop a safe, just & learning culture to move forward.
1
85
226
Really pleased that some Royal Colleges are clearly defining what behaviours are acceptable/unacceptable through campaigns like this & training nontechnical skills - role modelling most influential form of leadership
Badly-behaved surgeons are putting patients' lives in danger due to 'culture of bullying', report finds '
15
180
101
16
125
213
Spoke to a manufacturer of medical equipment yesterday. Very impressed with a piece of kit - designed around emergency algorithms and making it easy to use correctly under pressure. Turns out they employ a human factors specialist in the design team.
7
25
218
Happy
#WorldAnaesthesiaDay
In the last 15 years Anaesthetists have helped lead the way on safety and human factors - for which I think they deserve a day for themselves (and also because they’re awesome).
Happy
#WorldAnaesthesiaDay
🥳
Today we're celebrating & showcasing how important anaesthesia is & the vital role anaesthetists play in the care for all patients.
VP
@WHarropG
is kicking off the special celebration with a message to anaesthetists around the globe & the public.
15
365
626
5
45
209
How? Define the behaviours that create and maintain a safety culture and a just culture; role model from the top; develop systems that make it easier for staff to get it right; work in a way that encourages all voices to be heard. 2/2
8
78
210
“Human Factors testing and evaluation criteria should be included as part of the selection methodology used in NHS procurement processes.”
Prof Jim Reason once told me that dealing with equipment issues in healthcare would save far more lives than any other intervention.
Our latest report highlights the high patient risk associated with some medical devices used within the NHS for patient care & treatment. See the report & our recommendations
1
38
49
8
127
201
Massive congratulations to all those involved in this very readable paper. I hear it’s 10,000 full downloads in 6 weeks. That’s what spreading the word about human factors is about. Human factors in anaesthesia: a narrative review - Kelly
9
71
213
Took yesterday to read the
@DOckendenLtd
report. The scale and extent of death & injury is appalling. The behaviours reported are unacceptable. That staff withdrew statements very recently is deeply disturbing. But this is not about one Trust 1/5
4
62
210
It seems to me there are two critical evidence bases right now. The medical evidence base & the evidence base around human behaviour. They are different but both critical. Glad that we seem to be listening to experts from both perspectives.
6
50
203
Inadvertent errors, freely reported, should not attract punishment but learning, however people must be held accountable for correctly identified gross negligence. How that is done sends a powerful message to everyone in society.
#justculture
#BawaGarba
15
120
196
Thank you to everyone for their love, support and messages. I’m taking it easy, feeling ok and still in awe of the care I received from the NHS. With much love and respect.
8
1
205
Specific individual behaviours enhance safety. Other behaviours reduce safety. There’s a good evidence base in other industries. In healthcare how do we encourage & train behaviours? In healthcare disaster after disaster this seems a common issue. It’s not just one hospital.
19
75
197
If you want to train nontechnical skills, identify at an organisational level what behaviours you want and don’t want - not much point talking about things like leadership if you don’t define the good specific behaviours/indicators
#clinicalhumanfactorsperspectives
video shorts series 5
@MartinBromiley
talks about 'What would good Human Factors training look like'
1
18
25
12
99
194
Of course my late wife was also a victim of the exact same issues. Despite the great work on human factors, systems thinking etc, senior leaders in the system have to work together to change a system that encourages the behaviours staff & patients experience now 3/3
10
30
207
Human factors, designed to make it easy to get it right
The jewel in the crown of the
@EdValentine2
GUH ED Resus project - the rare and challenging procedures trolley!
When the 💩 hits the 💨 it needs to be this clear and simple! 👍🏻
@NyeBevanEM
55
69
408
5
25
194
Worth reflecting on how far safety has moved up the healthcare agenda in the last few years when you read this. When my late wife died there was a v small number of folk who got it. Safety is the now the shared aim from frontline to SoS, even if people disagree how to achieve it
It was great to talk to DHSC staff about patient safety this morning. Wise policy advice from officials (including telling me when I am getting things wrong!) is what has made progress possible so thank you to all
41
9
37
8
71
188
“Holding managers and staff to account for their standards of behaviour can radically reduce bullying”. Defining those good (nontechnical) behaviours would be a start, as well assessing people against them. Great piece from
@rogerkline
12
118
176
Today is
#WorldPatientSafetyDay
Feeling safe to express yourself in the workplace creates safety for you and your patients. My thoughts with all in healthcare today.
1
92
181
Other industries have tackled culture and steep authority gradients. It takes time but you have to recognise it is THE problem; and you have to take action to change the system and behaviours. It’s not too difficult, unless you like the status quo 2/3
2
35
188
Lovely to see Patient Safety Congress full of mentions of human factors & some fantastic advocates for the topic. We’re still learning, safety is never done, understanding the human in the system is central to improvement
@ClinicalHF
Good luck
@ShaunLintern
#HSJpatientsafety
5
27
185
Absolutely the right thing to do. As always the devil is in the detail, getting the expertise at a senior level in the orgn and making sure it’s listened to by the leaders is crucial.
NHS hospitals to employ safety experts to tackle thousands of avoidable mistakes
63
94
142
21
33
169
I’m definitely not an expert, but I hope my personal views on the use, mis-use, and over use of checklists in h/c helpful. Plus a little bit on speaking up.
6
108
164
It’s
#ODPday
- You’ve been so welcoming to me over the years. I hope today’s been a good one for you all, you marvellous people.
7
23
165
Self esteem and success have a short shelf life. Self acceptance, learning from failure and doing your best for others are life long companions.
4
99
152
Yesterday was our
@ClinicalHF
seminar on safety and human factors in healthcare asking “why is it so difficult?” A thread 🧵 providing a small number of examples of what our speakers identified as barriers to learning and improvement….1/9
7
70
172
Congratulations to
@AKPritchard2
on her appointment as CEO
@NHSEngland
There are many challenges, but I hope there’s scope in her role to help the NHS move to a just and learning culture, and banish behaviours such as blame and bullying to the past. That really would be wonderful
1
27
170
I can’t recommend this highly enough. Culture, behaviours and processes identified clearly. An achievable gold standard.
@ClinicalHF
3
79
158
This is for everyone who's supported me getting human factors into healthcare 1/3
16
76
150
Perhaps now more than ever - “how can I make it easier for you?”
6
45
159
This is a remarkable free monthly resource. Anonymised incidents reviewed from a human factors perspective.
What you need to know to avoid medication errors can be found in the last
#patientsafety
report that just came out!
Download it here:
6
38
68
8
66
154
For
#WorldPatientSafetyDay
myself &
@PatrickWaterso1
have some thoughts about human factors & maternity.
@PatrickWaterso1
is one of the
@ClinicalHF
Trustees & expert, he’ll be tweeting about systems, here I’ll share reflections about non-technical skills 1/
7
79
157
It’s clear that the health, regulatory and legal system all need to learn from the
#BawaGarba
case if staff, patients and the system are to have confidence in the systems that support learning and accountability.
#justculture
3
78
142
The ever brilliant Thomas Jun with a short video explaining systems thinking during investigations to improve healthcare safety......
5
116
150
“Understanding human factors & ergonomics is a key element of building a better patient safety system”. Multiple refs to human factors, design for safety, training in non tech skills etc. in this from
@CQCProf
Excellent work and a good way to look forward to 2019.
@ClinicalHF
🎙️📰📻 PRESS RELEASE:
@CareQualityComm
calls for a change in
#SafetyCulture
across the NHS to reduce avoidable harm
1
20
27
5
87
149
Wishing all the wonderful ODP’s a happy
#ODPday
and thank you for all you do to create and maintain safety!
8
23
155
Just received news of another life saved. Dr credited understanding of human factors & application of good non technical skills and thanked
@ClinicalHF
4
42
142
This week we launch the free
@ClinicalHF
booklet on design for safety in healthcare, jointly funded by
@HealthFdn
& the 6th Form
@SirHenryFloyd
one of whom was my daughter Victoria. The 6th Form raised £3K to initiate the project - so proud!
9
67
150
Well done
@Kevin_Fong
OBE on your very well deserved honour, delighted for you. Your thoughtful contribution to publicising the science of safety and human factors to healthcare and beyond has been incredibly important. Well done from all
@ClinicalHF
and my family!
7
21
150
Setting standards of behaviour c/o
@MattHancock
“Everyone makes errors. Making mistakes is acceptable. But bad behaviour is not acceptable.
I want to see the highest standards of behaviour that underpin empathetic leadership: integrity, honesty, transparency.” 2/2
Speaking in Birmingham this morning on what we need our NHS leaders to be so we can build the health service of the future
27
34
85
2
77
145
“I always say the same thing to the nominated nurse or doctor on the team; ‘if his oxygen saturations drop below 90% tell me. If I don’t answer, I didn’t hear you, so tell me again’ Thank you
@WhistlingDixie4
for this lovely feedback and all you do.
@EmergMedDr
I should have said - this line in the book became absolutely cemented in my head as something that would be part of my life when I listened to the inspirational
@MartinBromiley
speak at
#SMACC
in Berlin - thank you Martin
0
5
21
3
46
140
This article is awful to read. We need to become obsessive about specific “good” behaviours, identify them, recruit for them, train for them, feedback on them, and not tolerate behaviours that don’t fit the expected norm. Anything else kills careers & patients.
13
54
142
All human factors folk working in healthcare should read this, very carefully! Excellent work by
@MaryDixonWoods
and
@FP_Farhad
Learning from other high risk industries is not straightforward for healthcare, says our new paper. Risk controls need to be evaluated on their own merits in context.
4
93
122
3
90
127
Important recognition of the role of human factors and great to see how many people at the frontline are already aware of the crucial role of human factors
Human factors work is critical in improving patient safety across the NHS - insightful discussions with
@MartinBromiley
and staff
@westernsussex
yesterday who are making huge strides to improve safety culture
31
58
144
3
66
135
My heart goes out to all involved in the
#BawaGarba
case, in the hope that the system can learn not just from the tragic loss of a young life, but also understand how we should deal with the aftermath to ensure learning so others don’t suffer.
#justculture
5
74
128
.
@doctimcook
said it’s 10 yrs since
#NAP4
. I re-read the Foreword. I think anaesthetists have met the challenge I posed, but events have shown that systems thinking & simulation aimed at nontechnical behaviours are even more important. But how’s the rest of medicine doing?
4
53
132
My thoughts, admiration and respect to all healthcare staff around the world. And to those leaders having to make the most difficult decisions. Roosevelt’s “It’s not the critic that counts...” comes to mind. The next Hollywood superheroes blockbuster should be about you.
4
31
131
Well done Scotland, developing a multidisciplinary coordinated national approach to human factors in h/c......we need to learn from this
Yesterday was good day, working hard with friends and colleagues to push forward Human Factors & Ergonomics in Scotland’s NHS and Social Care
@pbnes
@drjeffcott
@CMcIlhenny
@justjools86
@KerJsk
@nikkimaran
@mjmoneypenny
@rallydoc
@RhonaFlin
@Duncansmcnab
2
20
29
0
79
130
Looking forward to chatting with loads of medical & nursing students tonight, inc the significance of these documents & the central role of Human Factors in their future
@CQCProf
@ClinicalHF
@ptsafetyNHS
@aidanfowler1000
1
51
124
Thinking of all the wonderful ODP’s on
#ODPDay
You are often the eyes and ears that have the situational awareness that others may not. Keep being wonderful!
3
24
136
As friends have pointed out, why is it that patients have led the biggest changes in safer practice? We need Royal Colleges, professional bodies, policy makers, managers & clinicians shouting “this is not good enough, we must change.” The evidence is there.
9
24
121
Thank you Kate. The team found themselves in a situation that the system never really helped them develop the skills for. Humility, insight around human factors and good nontechnical skills are the defences that can make the difference.
If you are interested in human factors you need to watch this - it is the story of Elaine Bromley. It’s so powerful - you will cry, you might shout but it will make you better at everything you do. Just A Routine Operation
#HumanFactorsSavesLives
12
113
263
6
42
126
This seems like a big step forward to reduce medication errors, what do ergonomists/human factors experts think?
A drug company that seems to get it. Well done Wockhardt
#humanfactors
@ClinicalHF
@MartinBromiley
@steves2048
6
11
34
17
60
120
The first
@ClinicalHF
12 min podcast, supporting the use of “working under pressure” non-technical skills guidance. An interview with Prof Chris Frerk from the frontline -
8
77
127
Just Culture, a brutally honest, positive example from the NHS and
@sidneydekkercom
......give yourself half an hour......it is worth it
Just Culture: The Movie has been released! It documents the amazing transformation of one organization that went from blame to learning, from hurt to healing. You can watch it at For subtitles in other languages: click on Settings -> Subtitles
10
180
298
4
67
119
It’s worth adding that in my late wife’s case it’s likely that the medic’s behaviour that led the nurses/ODP failing to speak up was normalised over a period of time. The nurses/ODP’s didn’t “see” it as unusual, and blamed themselves for the outcome.
My observation is that disruptive behaviour is so common in h/c that I find it hard to believe that it’s not a learned behaviour in the majority of cases. Role modelling? I suspect the respondents were being generous.
11
33
79
2
52
116
Interesting learning for me - “user error” implies the user at fault, “use error” puts the onus back on the manufacturer to ensure that it’s designed and tested for the user
#saferhealthcarebydesign
5
55
122
Very humbled, just doing what I can. The best thing I've done is surround myself with top people. This is for those who support CHFG.
Congratulations to
@MartinBromiley
in receiving the Henry Hickman medal – hear his work on 2 June
#RSMAnaesthesia
5
23
33
7
34
111
I'm definitely guilty of using the terms blame and accountability interchangeably. But they are very different. We have a blame culture in healthcare, a just culture includes appropriate accountability.
6
72
112
Watching this video brought tears to my eyes. Hearing healthcare staff talk about human factors in such a practical, perceptive way - 15 years of hard work has been worth it. Of course more to do, safety is never “done”, and a massive culture to change
@Fionafionakel
@Kevin_Fong
@MartinBromiley
@doctimcook
And watch this very useful panel discussion with
@Kevin_Fong
@Fionafionakel
@chrisfrerk
& Clinton John sharing their
Experts' Top Tips - Human Factors and Ergonomics
#AirwayMatters
via
@FutureLearn
3
16
29
2
31
118
Staff
@MKHospital
demo’d genuine concern. I saw an HCA raising a concern with a Nurse; a Nurse interrupting a Consultant who didn’t have all the information; a Consultant showing respect & empathy for the knowledge & workload of more junior staff. This all creates safety. 2/6
2
9
118
Designed around the professionals to make it easier to get it right....
5
18
117
Finally
@DOckendenLtd
has done a remarkable job. But it’s the harmed families who have driven safety, who have helped make a difference, who have sacrificed much of their lives to try & help it not happen to others. When will healthcare drive safety & culture change? 5/5
3
15
119
“I told him what he was trying to remove was actually part of the intestine. The surgeon asked if I had more knowledge than him. He said as a surgeon he knew the difference. After opening, he realized he had cut the intestine. (Nurse)”
Investing in non-technical skills may be critical to improving surgical quality in low- and middle-income countries, found Shehnaz Alidina and colleagues:
0
17
33
4
39
118
Training staff in teamworking/human factors/CRM/TRM/non-technical skills can’t work in a vacuum. Behaviours trained must be agreed, explicit, examined, expected, role-modelled, routinely assessed and performance managed across the whole system from day 1 to retirement 3/5
2
20
120