In this tutorial, the concept of 'human factors' will be mentioned frequently. Human factors is a discipline which is the meeting of psychology, engineering and the study of ergonomics. Within different contexts, different specialities become more important. Following airline accident investigations, the airline industry has seen massive safety improvements subsequent to the integration of a human factors approach into the design of equipment, processes, regulation and crew resource management training. In healthcare, this revolution was launched by Martin Bromiley and the Clinical Human Factors Group. In the maternity sector, through reports from NHS Resolution, the RCOG and reviews of maternity services such as Morecambe Bay, Shrewsbury and Telford and Cym Taf, we are beginning to see that the breadth and scope of human factors issues are wider than the airline industry experienced. The comparability of aviation and healthcare is considered in the table below.
| Domain | Aviation | Healthcare |
|---|
| History | | - Hundreds of thousands of years
|
|---|
| Key raw material | - Aircraft usally less than 30 years old, frequently serviced
| - Humans can live to 100 years or more, check-ups every 1–2 years or less frequently
|
|---|
| Activities | - Pilots operate one/two types of aircraft for 1–10 hours with same crew on board
| - Healthcare professionals deal with a wide range of equipment, presentations and diseases.
- Duration of stay can be days or years with frequent staff changes
|
|---|
| Equipment | - Degree of standardisation across aircraft
- Most procedures are automated with multiple back-up systems in place
- Information (weather conditions) readily available
| - Little standardisation or design across medical equipment
- Automation of procedures and back-up systems are variable; healthcare is 'hands-on'
|
|---|
| Service users | - Healthy passengers with little knowledge of crew or aircraft
- Crew and passengers have limited personal interaction and do not provide personal support during crises
| - Patients are sick, vunerable and/or injured
- Patients are often equipped with knowledge on their condition, hospital or doctor
- Staff will get to know the patient (and their families) well and provide support during crises
|
|---|
| Service delivery | - Homogenous
- Same crew on board a flight
- Pilots are not acquainted with passengers or provide support during crises
- 'Comfort' rather than safety correlated with ability to pay
- Few subspecialities of pilots or crew
| - Heterogenous with number of subspecialities involved
- Health professionals build rapport with their patients
- Care is personal with patients involved in treatement decisions
- Quality of care related to ability to pay, especially in developing countries
- Many subspecialties in healthcare
|
|---|
| Safeguards | - Many safeguards in place with a high degree of automatisation and computerised support
- Strictly enforcable rules to exclude adverse effects of fatigue or alcohol on pilot's performance
| - Limited safeguards, hands-on work and a relative lack of automatisation and computerised support
- Lack of strictly enforceable rules to exclude adverse effects of fatigue. Rules about alcohol are seldom made explicit or enforced
|
|---|
| Safety | - Equal for everyone on a plane
- Fatalities can be over 100 at a time including the crew
- Setting of target is relatively infrequent and rarely conflicts with passenger safety
| - Can correlate with ability to pay, especially in developing countries
- Fatalities generally involve one person. Staff fatalities directly associated with patient care are very rare
- Targets may often be present and may on occasion conflict with patient safety
|
|---|
| Adverse events | - Major adverse events are always investigated by a national body and featured in the media
- Pilot immunity often part of reporting culture
- Adverse event investigation reports always published
| - Major adverse events are usually only investigated locally, occasionally subject to wider investigation and occasionally featured in media
- Immunity is not part of reporting culture and discipline procedures are wide ranging
- Adverse event investigation reports are seldom published.
|
|---|
Reproduced from Kapur et al (2016).
This module will guide you in your thinking around your human factors journey. You will have to make difficult and potentially significant changes to your behaviours and to challenge those around you to change, if we are to see genuine improvements.
