In Jo Bibby’s recent blog she talked about developments in healthcare and the need to explore the ‘human factors approach’ taken by other industries, but what does a ‘human factors approach’ mean?
I’m not sure that anyone in aviation ever decided to follow a human factors approach; it just slowly developed, mostly out of common sense but backed up with strong evidence.
The strong evidence wasn’t driven by research and control groups and so on, but mostly by the narrative evidence of accident and incident investigation. We found out what was killing people; then did some research; then looked at the impact. Of course as we’ve got more sophisticated we’ve been able to do lots of research, but in the early years it was often a bit like the development of medicine – ‘let’s try this and see what happens’.
Human factors can be defined in many ways, and there is often confusion between human factors and ergonomics. Many people (including myself) use ergonomics to define 'physical design around the user', but correctly human factors and ergonomics are one and the same. Even the institute that leads on human factors uses both terms in its name: The Institute of Ergonomics and Human Factors. Their website provides a definition of what ergonomics/human factors are, but one of my colleagues has summarised it as such:
'Clinical Human Factors are about enhancing clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture and organisation on human behaviour and abilities, and application of that knowledge in clinical settings’. Still not a snappy definition, but it gives some idea of the range of applicability to a human factors approach. I often talk about human factors making it easy to do the right things with reliability of outcome – of course an even easier definition is making healthcare ‘user friendly’.
I visited a hospital in the north east last week where one of the clinicians, Dave, pointed out a simple example of the above. The hospital has two wings, old and new. The drugs cupboards are identical to each other in the new wing, and it’s the same story in the old wing, but of course the ones in the new wing are significantly different to those in the old wing. Dave takes up the story: ‘When I go to get a drug in the new wing I can go straight to what I want; but in the old wing I have to stop, think and search a little; and these few moments not only delay me but also increase my mental workload, albeit momentarily. At a time of high workload that might be one step too far – maybe the wrong drug, maybe the wrong decision, maybe something forgotten.’
Of course, when a clinician makes a mistake it’s easy to blame them for being slack, a poor performer, and then people shake their heads and wonder how they could have made such a stupid mistake. But we all know that we do the same: we go into a room to get something and forget what we’ve gone there for, we lose the car keys, and we send a text to one person meant for another. And when we put on our professional uniform, our human condition doesn’t change.
Making it easy to do the right thing is key to creating an error tolerant work environment. If you are working to produce an error tolerant working environment then you're working on something which ultimately leads to a 'safety culture'. A safer culture needs error tolerance, but developing error tolerance needs a people aiming for a safer culture! Confused? Before you ask which comes first, it probably needs a little bit of both: people at the top aspiring to be safer, and people at the bottom developing ways of doing it. It therefore follows that you need to have good communication up and down the organisation before you can really move forward.
So embracing human factors is about making it easier to do the job, having things where you need them, always, and behaving in a way that makes it easy for people to work with you and speak with you.
It’s about rules that are easy to follow every time, not rules that you have to work around to get the job done.
It’s about telling the truth, admitting mistakes and not worrying about sanction.
It’s about feeling that you can make a safe decision where you can’t achieve safety and productivity at the same time; and knowing that your bosses will back you up, all the way to the top.
And it’s about having at least the bare minimum number of people and tools to get the job done. Now that’s another story!
Martin is a pilot and the founder and current Chair of the Clinical Human Factors Group.