Safety & quality resources: Human factors

Abstract
Background: There is a need for guidance to support human factors/ergonomics (HFE) practitioners to conceive and design HFE interventions that live up to the fundamental principles underpinning the discipline of HFE. The principles are that HFE has a systems focus, is design driven and focuses on both performance and well-being outcomes.

Objectives: The objectives of this scoping review are to: identify studies that meet these principles in order to discover how commonly HFE studies meet the principles for the practice of HFE; the scope and characteristics of studies that meet the principles; and the learning that can be gleaned from these studies.

Eligibility criteria: The principles were operationalised into four criteria that were used to select studies: (1) The intervention acts on more than one aspect or element of the system; (2) a context-relevant needs assessment or systems analysis phase is undertaken to design the intervention; (3) the intervention has an active element that is designed to enhance safety, quality, efficiency, effectiveness or well-being and (4) the intervention is evaluated.

Sources of evidence: The review considered all studies published in peer-reviewed journals between 2010 and July 2024 in which an HFE or related intervention is presented and evaluated. Electronic searches were conducted across five databases plus Google Scholar.

Charting methods: Data extraction was done by consensus using extraction forms and following two stages: (1) data extraction and (2) data interpretation.

Results: A total of 13 intervention studies met the inclusion criteria, suggesting that adherence to core HFE principles is rare. All included studies self-identified as HFE intervention studies. All interventions had a clearly defined scope and most targeted at least four system elements, that is, person, tools, technology, task, process, organisation, environment. The 'people' element was the one most commonly targeted. A wide range of organisational level and patient outcomes were measured, but no employee safety or well-being outcomes were measured in the included studies. In all cases, the intervention team included healthcare providers working with HFE/systems engineering/improvement experts, who often led the project.

Abstract
Integrating advanced technologies like medical devices in healthcare is crucial for addressing critical challenges, but patient safety must remain the top priority. In modern clinical settings, medical devices, such as infusion devices used to administer fluids and drugs, carry risks from use errors, requiring a focus on usability and human factors engineering (HFE). Despite the significance of integrating HFE into technology selection processes, it is often overlooked. A review of five key articles demonstrates how applying HFE principles in procurement strategies can enhance device usability and patient safety. Although designed to reduce medication errors, infusion devices can still cause over-infusion or delays, indicating the need for improved safety features that must be considered in the context of sociotechnical systems. The reviewed studies suggest incorporating HFE in design, purchasing, and implementation to address these issues. The studies highlight various HFE methodologies, showing a wide variation in design, deployment, interpretation, and reporting. This comprehensive examination underscores the importance of standardised evaluations to ensure safer and more effective medical devices, emphasizing the essential role of HFE in advancing patient safety within healthcare settings.

Abstract
This study aims to provide an updated overview of medical error taxonomies by building on a robust review conducted in 2011. It seeks to identify the key characteristics of the most suitable taxonomy for use in high-fidelity simulation-based postgraduate courses in Critical Care. While many taxonomies are available, none seem to be explicitly designed for the unique context of healthcare simulation-based education, in which errors are regarded as essential learning opportunities. Rather than creating a new classification system, this study proposes integrating existing taxonomies to enhance their applicability in simulation training. Through data from surveys of participants and tutors in postgraduate simulation-based courses, this study provides an exploratory analysis of whether a generic or domain-specific taxonomy is more suitable for healthcare education. While a generic classification may cover a broad spectrum of errors, a domain-specific approach could be more relatable and practical for healthcare professionals in a given domain, potentially improving error-reporting rates. Seven strong links were identified in the reviewed classification systems. These correlations allowed the authors to propose various simulation training strategies to address the errors identified in both the classification systems. This approach focuses on error management and fostering a safety culture, aiming to reduce communication-related errors by introducing the principles of Crisis Resource Management, effective communication methods, and overall teamwork improvement. The gathered data contributes to a better understanding and training of the most prevalent medical errors, with significant correlations found between different medical error taxonomies, suggesting that addressing one can positively impact others. The study highlights the importance of simulation-based education in healthcare for error management and analysis.

Abstract in English, French
Objectives: This initiative assessed the integration of the Human Factors Analysis and Classification System, adapted from aviation, into emergency medicine morbidity and mortality rounds. The objective was to determine whether incorporating the Human Factors Analysis and Classification System could lead to a perceived increase in the overall quality of morbidity and mortality presentations through the standardization of classifying cause factors of medical errors.

Methods: This study involved eight emergency medicine residents who applied the adapted Human Factors Analysis and Classification System framework to their morbidity and mortality case presentations over 6 months. Data were collected through surveys completed by presenters and morbidity and mortality audience members. These assessed four main outcomes: relevance, feasibility, quality, and acceptability of the Human Factors Analysis and Classification System framework.

Results: The integration of the Human Factors Analysis and Classification System was positively perceived across all outcome measures. Presenters and audience members rated cause factor identification as important (100%), indicating the relevance of Human Factors Analysis and Classification System in morbidity and mortality rounds. Feasibility assessments showed a mean score of 4.25 out of 5, indicating favorable ease of use. The quality assessment mean score was 3.97 out of 5, indicating perceived improvement in cause factor identification. Presenters (62.5% Strongly Agree, 37.5% Agree) and audience members (73% Yes, 21.62% Undecided, 5.4% No) expressed acceptability and support for continued Human Factors Analysis and Classification System use.

Conclusion: Integrating the Human Factors Analysis and Classification System into morbidity and mortality rounds in the Department of Emergency Medicine was well-received and led to a perceived increase in the quality of cause factor identification. Both presenters and audience members endorsed the use of the Human Factors Analysis and Classification System, suggesting its desirability for sustained integration. The results of this study pave the way for future quality improvement initiatives, including the adaptability of the Human Factors Analysis and Classification System across various medical departments and its potential to enhance cause factor classification in morbidity and mortality rounds.

Abstract
Introduction: Human factors in surgery relate to the environmental, organisational, and human factors that can impact performance in the operating theatre. This study assesses whether various factors such as music, counting backwards, and attempting to do simultaneous tasks impact surgical time and performance.

Methods: Ten orthopaedic surgical staff were asked to guide a metal loop around a metal maze in a 'don't buzz the wire' game. The primary outcomes were the course completion time and the number of times the loop touched the wire. They were asked to do the course four times: one control run, with music, whilst counting backwards from a hundred in increments of three, and whilst simultaneously verbalising the steps of a dynamic hip screw (DHS) fixation.

Results: The average time to complete the course for the control was 33.8 seconds. This was similar to when music was played (33.4 seconds) but increased when counting backwards (38.7 seconds) and verbalising the steps of a DHS (69.8 seconds, p = 0.0039). The average number of touches for the control was 4.3. Similar findings were obtained when counting backwards (four touches), but the number of touches decreased when music was played (2.2 touches). The average number of touches increased to 10.6 when verbalising the steps of a DHS (p = 0.0078).

Conclusion: Human factors can affect surgical performance, and an awareness of this is vital to take necessary steps to minimise the impact this has on behaviour and performance in the operating theatre.

Abstract
Purpose of review: To explore the collaboration between human factors (HFs) experts and clinicians in order to improve perioperative patient safety.

Recent findings: Recent recommendations to integrate human factors into anesthesia in the United Kingdom emphasizes the value of applying disciplines outside of medicine to optimize the patient experience.

Summary: Human factors engineering is underutilized worldwide. Patient safety would benefit from collaboration with HF experts to design resilient systems. Healthcare organizations must consider HF to develop and implement user-centered solutions to improve safety for patients and professionals.

Abstract
Human factors is an evidence-based scientific discipline used in safety critical industries to improve safety and worker well-being. The implementation of human factors strategies in anaesthesia has the potential to reduce the reliance on exceptional personal and team performance to provide safe and high-quality patient care. To encourage the adoption of human factors science in anaesthesia, the Difficult Airway Society and the Association of Anaesthetists established a Working Party, including anaesthetists and operating theatre team members with human factors expertise and/or interest, plus a human factors scientist, an industrial psychologist and an experimental psychologist/implementation scientist. A three-stage Delphi process was used to formulate a set of 12 recommendations: these are described using a 'hierarchy of controls' model and classified into design, barriers, mitigations and education and training strategies. Although most anaesthetic knowledge of human factors concerns non-technical skills, such as teamwork and communication, human factors is a broad-based scientific discipline with many other additional aspects that are just as important. Indeed, the human factors strategies most likely to have the greatest impact are those related to the design of safe working environments, equipment and systems. While our recommendations are primarily provided for anaesthetists and the teams they work with, there are likely to be lessons for others working in healthcare beyond the speciality of anaesthesia.

Keywords: anaesthesia; education and training; ergonomics; human factors; human performance; non-technical skills; patient safety; simulation; theatre team; worker well-being.

Abstract
Healthcare relies on high levels of human performance, as described by the 'human as the hero' concept. However, human performance varies and is recognised to fall in high-pressure situations, meaning that it is not a reliable method of ensuring safety. Other safety-critical industries embed human factors principles into all aspects of their organisations to improve safety and reduce reliance on exceptional human performance; there is potential to do the same in anaesthesia. Human factors is a broad-based scientific discipline which aims to make it as easy as possible for workers to do things correctly. The human factors strategies most likely to be effective are those which 'design out' the chance of an error or adverse event occurring. When errors or adverse events do happen, barriers are in place to trap them and reduce the risk of progression to patient and/or worker harm. If errors or adverse events are not trapped by these barriers, mitigations are in place to minimise the consequences. Non-technical skills form an important part of human factors barriers and mitigation strategies and include: situation awareness; decision-making; task management; and team working. Human factors principles are not a substitute for proper investment and appropriate staffing levels. Although applying human factors science has the potential to save money in the long term, its proper implementation may require investment before reward can be reaped. This narrative review describes what is known about human factors in anaesthesia to date.