Spreading human factors expertise in healthcare: untangling the knots in people and systems

Frequently espoused by well meaning clinicians and aviators, rather than academically qualified HF professionals, it has led to misunderstandings about the range of approaches, knowledge, science and techniques that can be applied from the field of HF to address patient safety and quality of care problems. [...]in healthcare, CRM was among the first, and has been by far the most dominant HF paradigm. 5 Table 1 Aviation examples 29 Healthcare examples 30 Equipment design A cockpit is designed to minimise perceptual and control errors, 31 security systems have been developed to reduce operator fatigue and boredom and enhance training opportunities 32 Equipment predisposes to control 33 and perceptual errors, 34 often poorly maintained, with significant gaps in engineering for safety 35 Task design Design based on a thorough understanding of what is needed to get an aircraft safely from A to B 36 Lack of standardisation, 37 professional autonomy, differences between practice settings, and differing prioritisations of competing goals gave rise to widespread variation in individual behaviours and institutional protocols, 38 making task definition a challenge Communications and teamwork Structured communications are embedded within tasks that are well defined, trained and practiced 39 Safety communications 40 and tasks 41 are highly variable and tasks can be intermittently performed 41 Selection and training Specific scientific approach, 42 including simulation and recurrent training 30 Training follows the apprentice model, with little attention to rigorously establishing which skills are essential or even for evaluating the degree to which these skills have been successfully acquired 43 Incident reporting systems Encouraged reporting behaviours. 44 'Black box' flight recorders allow the detailed independent reconstruction of accidents 45 Usually ineffective, 46 with reconstruction of incidents rarely possible, 47 and 'black boxes' culturally difficult to employ.\n 29 From gate keepers of knowledge to trusted colleagues The speed with which HF ideas have spread in healthcare reflects recognition of the tremendous need for the application of HF expertise.