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Human Factors
For Interns
Background
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Safety research shows that human factors are the major causal factor of
accidents in high-risk organisations such as aviation. Healthcare is also not immune to
the effects of human error. For example, a review of anaesthetic incidents reveals that
approximately 80% of sentinel events caused by anaesthetists were due to human.
Breakdowns in communication, poor teamworking, lack of leadership, and poor
decision making have all been shown to be common contributors to sentinel events in
healthcare.
Over the last three decades industries such as aviation have increasingly focused
on providing human factors and systems oriented training to operational personnel
with the purpose of improving safety and team performance. More recently,
particularly in the U.S., human factors training course are being delivered to
healthcare professionals. Generally based on aviation models, these courses have been
found to have a positive effect on the knowledge, attitudes, and behaviour of
participants. Moreover, in certain cases they have even been shown to reduce
mortality rates.
What is Human Factors?
The U.S. National Academy of Science defines human factors as primarily
being concerned with “the performance of one or more persons in a task-oriented
environment interacting with equipment, people, or both.” It is multi-disciplinary with
the goal of enhancing the effectiveness and efficiency with which work and other
activities are carried out. It is also important to indicate that human factors takes a
systems approach and considers the influence of how factors such as organisational
culture or practices impact the performance of those ‘at the sharp end.’
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Why Do Interns Need to Know About Human Factors?
There are an estimated 1,775 deaths through medical error per year in Ireland
(extrapolated from U.K. figures). Between 2003 and 2008 the Irish government spent
approximately €74 million settling claims against health agencies. Therefore, there is
a clear need to change the culture in the Irish healthcare system. A crucial venue for
changing the culture must be through the education of future healthcare leaders.
The report of the Commission on Patient Safety and Quality entitled ‘Building a
Culture of Patient Safety’ and published in 2008 stated that “all bodies responsible
for the training and continuing development of healthcare professionals should
review their curricula to ensure that patient safety and quality, including technical
and human factors, is incorporated into the modules.” (p.101). Further, the Medical
Council had also recognised the central roll human factors such as effective
communication and team working play in safety and quality of patient care.
Course Goals
The purpose of the Human Factors for Interns (HUFFI) training is to provide
interns with an understanding of how human factors relate to safety and quality of
patient care. The aim is to educate the interns in the identification of threats and
errors, as well as how to mitigate them. The goal is for the training to be both
interactive as well as to have a practical focus.
The structure of the training will be based upon the threat and error model
developed by Helmreich and colleagues at the University of Texas (see Figure 1).
This model was developed for aviation, but has been adapted to a healthcare
environment. The model takes a systems approach to patient safety and considers the
latent and immediate threats, strategies to manage these threats, and processes to
manage error.
The training will also make extensive use of case studies. These case studies
will include film clips scenarios of Consultant’s discussing incidents that occurred
when they were interns, as well as written scenarios. The use of the scenarios is an
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integral part of the training, and will provide the interns with experience in applying
the threat and error model to actual situations.
Figure 1. Model of threat and error.
Latent threats
National culture, organisational culture, professional culture, scheduling, vague policies
Immediate threats
Environmental
factors
Organisational
factors
Individual
(physica l) factors
Team factors
Patient factors
Threat management strategies and counter measures
Error management
Error
Error detection
& response
Induced patient
state
Management of
patient state
Inconsequential
Adverse
outcome
Further error
Learning Objectives
On completion of the training the student will:
•
be able to define human factors;
•
be able to describe why human factors are important for safety and quality of
patient care;
•
describe the threat and error model; and
•
apply the threat and error model to the identification and mitigation of the
human factors issues in healthcare scenarios.
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Course Content
•
What is human factors and why are they relevant to me? (20 mins)
•
The threat and error model (30 mins)
•
A worked example of the application of the threat an error to a real
healthcare examples (20 mins)
•
In groups of two or three, the students will apply the threat and error module
to understand a series of case studies (40 mins)
•
Class discussion of (30 mins)
Method of Instruction
The course will be delivered to small groups of 8 to 12 interns. In the future we
believe that a blended course of instruction could be used to deliver the training in a
classroom in conjunction with an internet learning environment. In the internet
learning environment, students could use the threat and error model to analyse a
particular health care scenario. This analysis would be posted via the internet to the
site. Other students would then be required to comment on the posts of their
classmates.
Contact Point For Further Information
Dr. Paul O’Connor, National University of Ireland, Galway.
Email: paul.oconnor@nuigalway.ie
Phone: +353 91 492897
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