The healthcare system is complex, opaque and prone to accidents. This provides exciting challenges and opportunities for the human factors and ergonomics (HF/E) practitioner. The current challenges faced by the healthcare HF/E practitioner are primarily of legitimacy. The needs, benefits and value of the HF approach are frequently unrecognised, and the business case can be challenging to justify without explicit regulation. Furthermore, those familiar with some HF/E practices may have a limited understanding of the breadth and depth of the discipline. Communication and collaboration with clinicians and other stakeholders are therefore prerequisites for success. To understand this complex environment and work, direct observation, listening and knowledge elicitation from clinicians and managers is vital. Since the role of HF/E is not necessarily understood (Russ et al., 2013), it is also important to explain in simple terms what your role is and how you can help the delivery of front-line care. In a hospital environment, this tends to involve assisting with field investigations, incident analysis and delivering interventions or training. In each of these areas, the HF/E practitioner can help clinicians to think in new ways about the relationship between humans and other aspects of the system.
“Uncertainty about the goals, processes, risks and workload means that it is not always possible to conduct clinical work methodically or as planned.”
“With regards to working across the system levels, from organisation to team to individuals, it is important to get the commitment and permission from those senior in the organisation, and also to encourage the middle management level to be part of driving change. Ultimately, nothing will work without the support of those at the front-line, so sense-checking any proposed changes with them, before investing time and energy, is critical.”
“There are many problems with the current RCA process. The notion of one ‘root cause’ is the first since each part of each multi-causal chain of events has its precursors (Hollnagel, 2014). However, the use of RCA is at least attempting to track upstream from the event to the contributory factors.”
“Learning how to convince people that there may be other ways to think about improvement is a skill that needs constant practice. Fortunately, there is a growing cadre of engaged and enthused clinicians with experience of HF/E approaches who will be supportive.”
“Success is most likely to be achieved by collaborating with a broad range of clinicians, administrators, safety and quality professionals, advocating for an HF/E view of the world that will be new to many of your colleagues.”
Reflection by Deborah Goodwin
The chapter on HF/E in Healthcare had me smiling from the opening sentence: “The healthcare system is complex, opaque and prone to accidents”. How refreshing and reassuring to hear that other HF/E healthcare practitioners have similar perceptions and experiences to my own! The multiple and interwoven influences on a ‘simple’ ergonomics program are remarkable; from competing priorities and at times, seemingly contradictory goals, to limited resources and public opinion. To navigate this successfully requires a delicate balance of following direction while simultaneously championing the role HF/E has for better outcomes.
The information shared leans toward the involvement of an HF/E practitioner from a patient safety and care delivery perspective. While there have been teams to work on this in the organizations I have worked with, my primary focus has been the application of HF/E for worker safety and injury prevention. Interestingly, the challenges for both patient and worker safety are similar; equipment design, bureaucracy, policy, learning from adverse events, training development and delivery, skepticism and so on. Indeed two sides of the exact same coin.
I applaud the authors for their explanation and commitment to the importance of communication, learning about the clinicians’ work and challenges, and building collaboration and cooperation. While I learned this in theory in school, for me, truly understanding and consistently practicing this came from experience. Honestly, I got it wrong a few times to be able to realize the infinite value of getting it right!
I have come to recognize what a privilege it is to go into others’ work environments, meet experts in so many disciplines that literally save lives, and have them share their ideas, motivations and concerns with me. It makes me happy and yields professional satisfaction to learn all these amazing things, and to be able to offer HF/E knowledge that can make things work better and more safely.
One of the best things I was told in the first few months of my career was that I asked good questions. This chapter describes why that is important, and I encourage everyone to keep asking the questions. Questions stimulate conversation, identify root causes, address misunderstandings, yield new ideas, built respect and relationships, prioritize actions, and ultimately allow HF/E to integrate into this complex and opaque system of healthcare we love.