Human factors: designing systems for safety, quality and efficiency

Human factors is a well-established approach that was originally pioneered by the aviation industry as a way of avoiding errors through improved teamwork and communication. 

A few years ago, my team at the Health and Safety Executive in Ireland (HSE) decided to explore this area in more depth to see how it could be applied to improve safety, quality, and efficiency in health care settings.

Providing our patients with safe, high quality care is something that the HSE is deeply committed to. Every person in our organisation, whether they are in direct contact with patients or not, plays a role in this. 

Under the leadership of Dr Orla Healy, our National Clinical Director for Quality and Patient Safety, and Patrick Lynch, National Director for Quality Assurance and Verification Division, we decided to design an approach and develop a resource that was grounded in the principles of human factors as a way of improving the safety culture for both staff and patients.

Working with Dr Paul O’Connor, Senior Lecturer in Primary Care and Human Factors at the National University of Ireland Galway, our aim with this project was to create a resource that could be used by anyone in any health care setting.

We wanted people to be able to grasp the principles of human factors and be empowered to apply these to their own work environment.

This collaboration has led to the publication of An Introduction to Human Factors for Healthcare Workers, a guide that is available for free on our website.

Human factors is a discipline that considers a wide range of theories, measures, and approaches; and draws from a range of fields including psychology, anatomy, physiology, social sciences, engineering, design and organisational management.

Human factors takes three key elements into account: the job, the individual doing the job, and the organisation.

In this guide, we have divided our approach into two halves. The first half provides an overview of the research and evidence base that underpins human factors. We felt this was important to include because while ​‘human factors’ is a term that may be familiar to some, most of us do not have formal training in this area.

The second half of the guide offers a flavour of this approach. In chapter four of the guide, we outline a model of situation awareness to show how it supports good decision making, and we include a case study to show what can happen when situation awareness is lost.

We all know that in high-workload, time-limited situations, the full spectrum of a health care professional’s technical, social and cognitive skills are tested. Our approach is designed to be applicable to any and all circumstances, as a way of reaching a fuller understanding of the reality of human factors in health care settings.

One of the most powerful ways in which this guide can be used is in reframing how adverse incidents are reviewed.

As Dr O’Connor explains, this guide was developed in order to move the focus from the behaviours of individual health care workers and consider how the health care system supports (or hinders) them from doing their job.

The Human Factors approach, known as a system approach, makes a distinction between latent and active errors. It includes a four-point approach to reduce the risk of an adverse incident:

1. be more aware of error-provoking conditions in the work place and take action to resolve them
2. avoid blaming individuals when errors occur but seek to understand the underlying causal factors within the system that contributed to the error
3. adopt a learning approach by becoming involved in incident review and analysis of adverse events
4. consider learning from what has gone well, and reflecting on cases with positive outcomes in order to identify the causal factors of good performance.

This approach considers both human-to-human and human-to-technical factors with the aim of cultivating a working environment that encourages openness and disclosure as part of the work culture.

For me, the ultimate success of this project was watching how it has created an encouraging, open and welcoming culture where my colleagues feel that they can come to me and ask me for guidance. This has been one of the most rewarding outcomes of this work.

This guide offers any health care professional or organisation a practical place to begin understanding the power and insight of human factors and how to use them to improve safety, quality and efficiency for patients and staff.

My hope is that this guide will make human factors  accessible to all health care staff in their everyday work.