Patient Safety: A Primer - Article #2 - Patient Safety Factors

How do key human and environmental factors contribute to patient safety?
A key strategy to support learning about patient safety is to reflect on basic concepts and how these can be applied in daily practice. This article is the second in a series of articles highlighting a key patient safety topic.

“Human factors” is “the study of all the factors that make it easier to do the work in the right way.”[1] This includes the relationship between human beings and the systems in which they work. Managing the relationship between individuals, the job, environmental factors, and the conditions of work is necessary in order to optimize patient safety.[2] Three concepts are outlined here for consideration in understanding this relationship. These include: the systems approach, human factors engineering, and situational awareness.

The systems approach focuses on the conditions under which individuals work rather than focusing on the characteristics of individuals involved in patient incidents (i.e. blaming). Priority is given to building defenses to avert errors, and putting systems in place to mitigate the effects of mishaps. In a systems approach, systems are preoccupied with trying to prevent patient incidents and assessing the possibility of failures through both prospective and retrospective analysis. Tools for both types of analysis are available. For example, Failure Modes and Effects Analysis (FMEA) is a prospective tool that organizations can use to help identify “the ways a process or design might fail, why it might fail, the effects of that failure, and how it can be made safer”[3]. Retrospective analysis examines the conditions that existed when something went wrong, and identifies potential solutions to address system weaknesses. The Canadian Incident Analysis Framework offers guidance on the analysis, management and learning process from patient safety incidents that have occurred in any healthcare setting.[4]

Human factors engineering focuses on the design of systems, devices, software, and tools to fit human capabilities and limitations. This area of science considers factors that can affect an individual’s performance (e.g. lighting, sounds, work interruptions, use of technology, teamwork factors). Human factors engineering applies these factors when designing systems to better support individuals in their daily practice. Examples of how factors can influence performance include[5]:

• Packaging of two or more products that look alike, resulting in difficulty choosing the correct package/drug, particularly in times of stress
• Relying on memory to recall a large numbers of tasks - humans can only remember 7-8 items, steps or tasks
• Unclear roles and responsibilities within the healthcare team, resulting in poor team communication

Although organizations can employ a variety of actions in efforts to consider human factors and improve the safety of systems, the influence on improving patient safety varies depending on the type of action. A combination of actions is necessary for improvement. For example, education is an important action. In addition, check lists (stronger action) or removal of unnecessary steps in a process and standardization of processes (strongest actions) may be required to strengthen improvement in particular areas.

Another important concept in human factors is called “situational awareness”. This refers to being aware of what is happening around you.[6] It requires that healthcare providers be aware of:

• what is going on
• the meaning of the information received
• making a conclusion

Situational awareness is important to patient safety because it allows the practitioner to be continuously scanning for what information is around them in the clinical encounter. It means that they are alert, thinking critically, communicating effectively, and anticipating what might need to be done.

How do YOU see these concepts applied in practice?

Learn to be Safe!

For more information on patient safety, go to the Manitoba Institute for Patient Safety website at www.mips.ca or safetoask.ca.

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[1] World Health Organization (2011).  WHO patient safety curriculumguide: multi professional edition.  Available at: http://whglibdoc.who.int/publications

[2] Frank JR, Brien S, (Editors) on behalf of The Safety Competencies Steering Committee.  The Safety Competencies:  enhancing patient safety across the health professions.  Ottawa, ON: Canadian Patient Safety Institute; 2008.  Available at: http://www.patientsafetyinstitute.ca/English/toolsResources/safetyCompetencies/Documents/Safety%20Competencies.pdf

[3] Accreditation Canada (2015).  Required Organizational Practices.  Available at: http://www.accreditation.ca/

[4] Canadian Patient Safety Institute (2012). Canadian Incident Analysis Framework.  Available at: http://www.patientsafetyinstitute.ca

[5] Carthey, Jane and Clarke, Julia (2010).  Implementing Human Factors in Healthcare.  Available at: http://www.patientsafetyfirst.nhs.uk

[6]  Singh H, Petersen LA, Thomas EJ.  Understanding diagnostic errors in medicine: a lesson from aviation.  Quality & Safety in Health Care. 2006 Oct;15 (3):159-164.  Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464840/?tool=pubmed