Human factors have seen a surge of interest in healthcare as a method to combat the unacceptably high levels of healthcare error and harm. Healthcare is very unpredictable in nature; patients have a variety of problems, or may develop new ones, there may be emergency events where healthcare staff are required to respond quickly and effectively, making potentially life-and-death decisions where an incorrect act, or an omission, can have significant consequences.
The interest in human factors stems partly from several high-profile cases, including that of Elaine Bromiley, who lost her life from a rare yet manageable airway problem. This case championed by her husband, Martin, led to the formation of the Clinical Human Factors Group (www.chfg.org), who have campaigned for change in the NHS and have a variety of resources including Elaine’s story.
A recent report by the Commission on Education and Training for Patient Safety commissioned by NHS Health Education England cited that there is a need for a common language for human factors and the need for it to be embedded across education and training (HEE, 2016). This call for a common language arises from the confusion about the definition and the extent of human factors.
Definition of Human Factors and Ergonomics (HFE)
Dr Ken Catchpole describes human factors as ‘enhancing clinical performance through an understanding of the effect of teamwork, tasks, equipment, workspace, culture and organisation, on human behaviour and abilities, and application of that knowledge in clinical settings’.
One of the most important things to emphasise is that humans do and always will make errors, and while effective training can reduce this, there will always be human errors – partly because of the way the human brain functions and the limitations of the human body. We know humans are more likely to make mistakes in certain situations, for instance when we are hungry, angry, late or tired (HALT). We are also predisposed to making errors by the way we think and interact with the world around us. To an extent this cognitive vulnerability is one that can be exploited because it is predictable; however, awareness alone will not prevent these as they are subconscious and can only be captured by robust systems.
The current view of errors is that they cannot only originate in the clinical team through knowledge errors, slips and lapses and violations, but also at an organisational level through poor policies, procedures, management, etc. (Reason, 1990). Unfortunately, there is still a misconception held by a lot of people that human factors awareness just needs team training – this is only part of the issue, and really human factor awareness needs to be embedded across the system so that processes, tasks and equipment are designed to take into account how the human can and will act.
Part of the confusion stems from the myriad terms that are often incorrectly used interchangeably. To add to this confusion, there are potentially divergent views on what human factors are at an academic level, with a difference in opinion between ergonomists and behavioural psychologists. The term ergonomics, while focusing on the human–machine interaction, can also be used interchangeably with the term human factors.
Now consider that we don’t just work on our own but in teams, and often multiprofessional teams or even teams across departmental or organisational boundaries. Historically we haven’t trained for this team-working component, but have had to find our way through trial and error – but without any measurement or feedback on performance, this development is very variable. Professor Eduardo Salas, who has explored team-working, says that the risk is that we concentrate on the clinical processes and not the team-working and produce a ‘team of experts and not the expert team’ (Salas et al., 1997). The focus of developing an effective team and the processes required is often referred to as team resource management (TRM) or crew resource management (CRM). These team training programmes originate from the aeronautical industry and encompass a range of non-technical skills (NTS), which will be further discussed later in this part of the book – this is more the domain of the psychologists.
The ergonomic interpretation of human factors is completely system-focused and ergonomists use their expertise to analyse and design systems that complement the strengths and abilities of people. The aim is to make systems which are safe and work with the people. They try to design out error by analysing and redesigning the process, at all times ensuring that humans will be able to work with, rather than in spite of, the systems.
However, the two views can be seen as a spectrum of human factors and one view does support the other to improve patient safety and staff performance.
As an example of the breadth of Human Factors and Ergonomics, Table 6.1 is based on part of a human factors engineering model and looks at some elements that could affect Obstetrics.
Table 6.1 Elements of human factors and ergonomics adapted from the SEIPS 2.0 model (Holden et al., 2013).
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