Human Factors in Healthcare

Surgeon adjusting glove in operating room.

Despite their best intentions, people make mistakes. They misunderstand and mishear. They enter the wrong information into digital records and overlook vital data when making decisions. They may feel tired and distracted. They have limits as to how long they can focus on one thing.  

In organizations, these human behaviors and limitations make up human factors. They are as expected as the sun rising in the east. They have also become the focus of a field of science.

Rather than trying to eliminate human factors (which is impossible) the science of human factors involves designing systems that anticipate errors that are likely to occur. This is especially important in healthcare where human factors (and errors) can mean the difference between life and death.

What are Human Factors?

The study of human factors includes what has been learned from experience in similar situations, as well as the latest scientific research. The goal is to design workplaces that incorporate this knowledge of human behavior, abilities and limitations. It both acknowledges the reality of human imperfections while building systems that better help organizations deal with them.

Taking human factors into consideration, organizations create workplaces that optimize the performance and reliability of processes and systems while also maximizing workplace health, safety and well-being. An example of the importance of this in healthcare comes from the National Health Service in the United Kingdom, where an estimated 150 preventable deaths occur each week.

The work and study of human factors are generally divided into three main areas:

Human Factors and Ergonomics

Ergonomics looks at every aspect of a task or process where human error can impact outcomes. It draws on a number of disciplines, including psychology, sociology, engineering, biomechanics, industrial design, physiology, anthropometry, interaction design, visual design, user experience and user interface design, as explained by the Human Factors and Ergonomics Society.

Similarly, the International Ergonomics Association defines human factor ergonomics as  a “scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data, and methods to design in order to optimize human well-being and overall system performance.”

A practical example of human factors ergonomics can be found in aviation, a field not unlike healthcare where human error can lead to catastrophic injury or death. In the design of airplane cockpits, instruments are placed in a way that aligns with how human beings perceive, think and act, making the instrument panel intuitive for the pilot.

Human Factors Analysis

Human factors analysis focuses on ensuring designers factor in human behavior when creating workplaces. The idea is not to make human beings adapt to a bad system. Rather, systems should adapt to how humans use it. 

A variety of factors go into assessing through human factors analysis, according to a report from Sandia National Laboratories. They include assessing whether the system supports optimal human performance, or if it actually hinders it. Systems also should not subject humans to extreme physical or mental stress or a too-high workload. Ideally, the system should provide personal satisfaction to users.

There are typically three areas to focus on when analyzing a system or process in the context of human factors:

  • Work factors: looking at issues such as constant disturbances and interruptions, missing or unclear instructions, noisy or unpleasant work conditions and a high workload.
  • People factors: assessing knowledge and skill levels among employees and which employees become bored, distracted, tired and disheartened.
  • Organization factors: these can include poor planning that leads to high pressure situations, a lack of safety systems, inadequate responses to previous incidents, and poor communication between management and employees.

Within healthcare, artificial intelligence and predictive analytics are increasingly being utilized in human factors analysis and risk assessment to prevent medical mistakes and emergencies before they happen—from helping surgical teams eliminate mistakes to helping doctors make more accurate diagnoses. 

Human Factors Engineering

Human factors engineering (HFE) focuses on the special tools, machines and systems used in a process. The goal is to create tools, machines and systems that consider both the capabilities and limitations of human beings, and therefore, should be safe, comfortable and effective for human use. This area sometimes is referred to as “usability engineering” and focuses on user-centered design.

For healthcare, human factors engineering can provide a “framework for efficient and constructive thinking which includes methods and tools to help healthcare teams perform patient safety analyses, such as root cause analyses…to analyze more fully events and ‘close calls’ that involve, for example, medical devices, software, and work areas,” writes John Gosbee in the research article, “Human Factors Engineering and Patient Safety.” 

As Gosbee explains, in putting human factors at the forefront, “we can use HFE to see why their decisions and actions make sense. The more we can think of why we would do or think the same way if we were in their situation, the more likely we are to arrive at productive and long-lasting interventions and redesigns.”

What are Human Factors in Healthcare?

As Gosbee’s research shows, healthcare systems are not always designed to account for the typical ways people interact with their work environment. These human factors come together to impact the quality of care and can unfortunately lead to mistakes, impacting patient outcomes. 

Many factors (human and technical) play a role in errors in healthcare. As noted by the Armstrong Institute for Patient Safety and Quality at Johns Hopkins University, these factors can include poorly designed medical devices, uncoordinated care processes and fragmented health systems.

The institute pointed out that simply asking people to “try harder” or “be more careful” does not solve the issues around human limitations or equipment designed without consideration of human behavior. Rather, healthcare providers must consider real human factors, such as limited attention spans, how tiredness impacts performance, forgetfulness, and the ability to only focus on one thing at a time.

Human factors in healthcare also consider not only how clinicians interact with a work system, but also how it impacts patients and their families. The processes that need changing can range from a different design for a medical device to improved communication from leadership.

When it comes to applying human factors in healthcare, the idea is to design work systems and processes that make it easier to do the right thing and harder to do the wrong thing. 

Applications of Human Factors in Healthcare

In Gosbee’s research article, “Human Factors Engineering and Patient Safety” he shares a detailed look at how the ill-conceived design of a patient monitor almost resulted in the death of a patient during transport. Only the attention to detail of two of the people involved ended up saving the patient’s life.

The patient’s condition was rapidly deteriorating during transport from one area of a hospital to another. However, a monitor showed the patient’s vital signs were fine. What the transport team did not know – but figured out in the nick of time – was that the monitor was in “demo mode,” showing perfectly fine vital signs but not the patient’s actual vital signs.

The researchers noted that many healthcare operations would, in reviewing this incident, discipline the transport team or the person who left the monitor in demo mode. However, a better solution would be changing the design of the monitor. The fact it was in demo mode was only signified by a small “d.” A larger letter, or an audio alert, could reduce the number of such instances to zero.

That’s just one example of many—from years of human factor analysis leading to safer cardiac surgery theaters to how shifting hospital insulin storage from a central location to a patient’s room can eliminate transport steps and, thereby, reduce the likelihood of medication mistakes.

The Armstrong Institute for Patient Safety and Quality at Johns Hopkins University has found that conducting and applying human factors analysis in healthcare tools, technologies and systems can help to:   

  • Minimize clinician error
  • Improve clinician performance
  • Increase delivery of evidence-based medicine
  • Enhance patient- and family-centeredness of care
  • Improve patient-provider communication
  • Reduce inefficiencies and non-value adding tasks
  • Reduce burnout and improve clinicians’ job satisfaction

A focus on human factors in healthcare can make it easier for people to work within complicated healthcare technology and provider systems, and most importantly, it can lead to a higher quality of patient care. Those with expertise in human factors engineering, analysis or ergonomics and design can be invaluable to a healthcare organization and can look forward to a wealth of career opportunities. 

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