Harnessing human factors in healthcare

Discussing a fresh approach to patient safety.

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The 2013 concordat from the National Quality Board advocates that human factors and ergonomic thinking should be integrated into healthcare by frontline providers, helping to create a positive and just culture. Traditional aviation-style human factors training within healthcare has tended to focus on non-technical skills and crew resource management. However, over emphasis on an individual’s cognitive and social skills can position the responsibility for patient safety directly with healthcare professionals’ actions, and does not consider the complex elements of the current healthcare system.

The Chartered Institute of Ergonomics and Human Factors (CIEHF) 2018 white paper for health and social care highlights the need to think about human factors from a broader systems approach. Inter-related activities or entities, united in a common purpose (including the clinical environment, equipment utilised, relevant systems and processes, alongside human or departmental interactions) should all be considered to enable healthcare professionals to work safely.

It is also vital to consider the emerging paradigm of Safety II, a concept that acknowledges the complexity of modern healthcare (Hollengal). The current Safety I ideology, that patient safety incidents can be deconstructed in a simplistic, bi-modal, “cause-and effect” linear way is outdated, yet we persist in doing just that with timelines and root cause analysis. These current methods are reactive and have not resulted in a significant reduction in patient safety incidents over the past 20 years.

Safety II shifts our attention from safety incidents to looking at “ordinary work”, in other words, paying attention to what really happens day to day (Varieties of Work; Steven Shorrock). This proactive approach can help us anticipate potential systems issues, enabling staff working within the system to work safely.

However, the success of this approach to safety is reliant on all levels of government, judiciary and management finding a consensus. Staff will not speak up about “ordinary work” until they feel safe and empowered to do so, near misses will go unrecorded and valuable safety messages lost. Safety II views people in the system as the most valuable, resilient resource, not a problem to be fixed and constrained. It is time to engage with frontline staff and pay attention to “ordinary work”, with an aim to work safely every day.  

“Learning from Serious Incidents within Acute NHS Trusts ” (CQC, 2016) recommends human factors should be utilised to find future solutions following serious incidents. Being Human in Healthcare believes an understanding of human factors, Safety II and systems thinking can help healthcare leaders and frontline staff achieve this goal together. Set up in 2018 by Dr Jen Blair, a consultant anaesthetist, and Jess Wadsworth, a senior nurse educator, their vision is to bridge the gap between human factor theory and the realities of an emergent and complex modern healthcare system. Engaged directly in “ordinary work” within healthcare and clinical education themselves, Being Human in Healthcare is an expert translator who ensures its training resonates with healthcare professionals, enabling them to work safely every day.