Human factors and ergonomics as a patient safety practice
Many patient safety incidents are related to lack of attention to human factors and ergonomics (HFE) in the design and implementation
of technologies, processes, workflows, jobs, teams and sociotechnical systems. HFE is now recognised as a key discipline to
help reduce or mitigate medication errors,1 ,2 to improve the design and implementation of health IT,3 and to eliminate hazards that contribute to patient falls.4 According vibram five fingers shoes sale to the International Ergonomics Association,5 'Ergonomics (or human factors)i is the scientific discipline concerned with the understanding of the interactions among humans and other elements of a system,
and the profession that applies theoretical principles, data and methods to design in order to optimise human well being and
overall system performance.' The objective of HFE based system design is to improve wellbeing (eg, clinician and patient satisfaction)
and overall system performance that includes patient safety.6 From an HFE viewpoint, patient safety activities should not only reduce and mitigate medical errors and improve patient safety,
but also improve human wellbeing, such as job satisfaction, motivation and technology acceptance. For instance, patient safety
programmes that increase the workload of already busy clinicians would not be considered well designed from the HFE perspective.
In this paper we described various HFE approaches and contributions to patient safety, and then provide details on a few illustrative
examples of HFE applications in patient safety.
Various HFE approaches to patient safety
A significant focus of HFE in healthcare and patient safety has been the design of usable and safe medical devices and health
IT,9 such as the redesign of code cart medication drawer.10 Health IT can contribute to patient safety by eliminating hazards,11 but can also create new hazards.12 Usability is one HFE design characteristic that can influence health IT's patient safety benefits, or lack thereof.3
Another major focus of HFE in patient safety has been understanding the nature of human error and identifying the mechanisms
of human error involved in patient safety.13 ,14 The Swiss Cheese model of Reason15 describes the alignment of hazards (or 'holes') that can lead to an accident (eg, a patient safety event) and distinguishes
between latent failures and active failures. Vincent and colleagues14 adapted Reason's Swiss Cheese model to patient safety, and described management decisions and latent NFL Jerseys China failures that can influence
error and create conditions that produce safety violations. In turn, these conditions create problems for care delivery and
may lead to unsafe acts (ie, errors and violations), which may then produce an incident if the defences and barriers are not
appropriate. The frameworks of Vincent and colleagues14 and Bogner16 can be used by healthcare organisations to investigate patient safety incidents.
Performance obstacles may endanger patients by making it difficult for clinicians to perform tasks and procedures safely.17 A range of physical (eg, lifting, injecting, charting), cognitive (eg, perceiving, attention, communicating, awareness) andRecently, HFE research in patient safety has focused on system resilience,23 or 'the ability of systems to anticipate and adapt to the potential for surprise and failure'.24 Because not all errors may be prevented, HFE researchers have developed models to understand how errors can be detected,
corrected, Wholesale NFL Jerseys mitigated, and dealt with by operators.25 Strategies for error detection and recovery have been explored among nurses,26 in particular critical care nurses,27 and among pharmacists.28 ,29 Resilience engineering builds on and extends the work done by high reliability organisation (HRO) researchers, in particular
the HRO concept of mindfulness, that is, the ability to prepare for the unexpected and to be vigilant about hazards.30
The first four HFE approaches focus on specific aspects of HFE and patient safety: usability of technology, human error, clinician
performance and resilience. A number of HFE approaches have been proposed to describe more comprehensive systems of patient
care, such as the systems approach proposed by Vincent and colleagues14 ,31 and the SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety proposed by Carayon
and colleagues.32 Vincent and colleagues14 defined seven types of system factors that can influence clinical practice and lead to patient safety incidents, such as
patient factors, task and technology factors, and organisational and management factors. The SEIPS model of work system and