This is part three, human factors engineering. Human factors engineering is a science that's interested in how people do their work, particularly thinking about the ways in which the human can function in ways to do their work better or in our view, to have fewer problems with patient safety. This is a rich lens to understand how safety events occur. It's a manner of approaching patient safety that comes from the concept of the high reliability organization. Some HROs that you can think of might include aviation, nuclear power, perhaps the prototype is a nuclear powered aircraft carrier where there are weapons, airplanes, navigation, the health of the people who work on the ship. All these things have to come together and the ship has to work at all times, regardless of the weather or if other adverse events occur. The ship has to keep going and that's our understanding for patient care in the hospitals and systems that we work in. So human factors is a study of all those factors that come together when we're talking about the humans and their role in the system. The experts in human factors work to try to design systems, processes, or instruments that work best for humans. And one should emphasize that that includes processes and teamwork. It's only recently that in healthcare we've understood the need to pay attention to human factors and doing too little attention to human factors probably has been a source of ongoing errors. All of us should understand the concept here that humans are fallible or that humans simply have limitations in the way in which they can work. Where does it come up? Well, one is in terms of ordering medications, providing handoffs, movement of patients. There's avoidable and dangerous confusion everywhere and we have to understand that we have limitations in our ability to navigate through that. And so the human factors design principles include an interest in designing things in the workplace to minimize error, to think about the concept that all healthcare is complex and to think that the same should be applied to healthcare as is in other high-reliability organizations. When you think about an instrument, for example, this slide shows that our interaction with the instrument from our using it to our getting information from it travels through several different domains. One is our psychomotor work where our hands press buttons, say, on an instrument. And those buttons have to work right. The machine may provide an output which we will sense in terms of our sight or sounds. All of these things need to come together and those who study human factors help us to understand the different pieces that lead to good functioning in a system. So in healthcare, things that might need good human factors engineering attention include look-alike or sound-alike medications, equipment, the layout of a unit, abbreviations, names, or the design of equipment. Again, from the standpoint of human factors, errors are the inevitable downside of having a brain. And so the failures that we are involved with often have to do with our own physical or mental limitations. And a good system is one that protects patients from those probable outcomes of our functioning. Errors are more likely to occur when we are unfamiliar with a task, when we're inexperienced, when there's a shortage of time, when you've done inadequate amounts of checking, when there are poor procedures that have been planned for you, when there's a poor interface between the human and the equipment, or where there are situations that allow for distractions. In terms of you, the individual, we remember that our limited memory capacity and our perceptual capacities are limited by fatigue, stress, hunger, illness, distraction, language or cultural factors, and hazardous attitudes. While in terms of fatigue, we should not ignore the importance of the deficits that come from fatigue. This has been so important that, as those of you who know any residents know, the work hour rules have come about in an effort to prevent patients from the harm that could come from fatigue. And this is important not just for residents and fellows, but for all staff in a clinical practice. Errors by transport, lab personnel, or the registration all can be detrimental. Here is one attempt to reduce distraction. In this situation, the person preparing medications for administration puts on a vest. This way, those of us who read the vest do not interrupt this nurse, and she, in this case, is more likely to not be distracted and less likely to make an error. One good mnemonic to remember is halt. If you're hungry, late, angry, or tired, halt. Take a moment to think about if you're going to provide safe care. Another self-care checklist would be I am safe. If you're under the influence of an illness, medication, stress, alcohol, fatigue, or emotions, stop and think about whether or not you can provide safe care. In general, it's important to apply human factors thinking in the moment and in the long term, especially if you're a part of a team or of your own team leading your own practice or that of others. Apply and accept human factors principles to what you do. Design processes that can help include making things visible, reviewing and simplifying processes, making standard processes and procedures, and the use and acceptance of checklists, which are an example of the basic methods that can be useful in preventing errors. One should avoid reliance on memory or simply on vigilance and use institutions or resources to help you. Here in this slide, we can see a picture of a flight book, which we should see analogously to use of resources like textbooks, textbooks on an iPad, or on a device at all times during our practice. One should not disparage the use of resources in the care of one's patients. Another topic, as I mentioned before in terms of hazardous attitudes, has to do with professionalism. The lack of professionalism can impede or make worse the contribution of human factors to adverse events. The lack of professionalism by just one member of the medical staff or by the team imperils patient safety by raising the risk of adverse events from either violations or errors. This can include disruptive or inappropriate behaviors that are seen in poor communication and poor teamwork, where members of the team are ignored or safety measures are ignored. In fact, the Joint Commission now pays attention to professionalism as a core principle in good hospital practice. In summary, human factors tell us that errors are common and they are inevitable. There are situations where errors are more likely to occur, and you can do things to prevent yourself from being in that situation. And in the long term, in designing your practice or in designing the system in which you work, it's important to pay attention to human factors principles and to apply it wherever you are. For more UN videos visit www.un.org

human factors engineering

patient safety

systems design

minimizing errors

healthcare complexities