The nature and reality of working safely
Mark Johnston
Training and Research Officer
(Patient Safety)
NHS Education for Scotland
mark.johnston@nes.scot.nhs.uk
0131 656 3258
@markjohnston71
Quality Education for a Healthier Scotland
Multidisciplinary
Ergonomics and Human Factors
Multidisciplinary
• Known as Human Factors in the United States,
everywhere else Ergonomics; they mean the same
thing!
• Ergonomics from the Greek – Ergo “Work” and
Nomics “Laws of”
Therefore the discipline is concerned with the laws that govern
human work.
• Uses methods to evaluate human work in order to
optimise well-being and performance of individuals
and organisations
Quality Education for a Healthier Scotland
You’re amazing!
Multidisciplinary
Quality Education for a Healthier Scotland
Multidisciplinary
Quality Education for a Healthier Scotland
Factors impacting on an individual that
contribute to error
•
•
•
•
•
•
Multidisciplinary
Stress
Fatigue
Illness
Hunger/Thirst
Hazardous attitudes
Language and cultural factors
These are NOT Human Factors, these are the
consequences of not adopting Human Factors.

Quality Education for a Healthier Scotland
Human Factors
A common language
Multidisciplinary
“…the scientific discipline concerned with the understanding of interactions
among humans and other elements of a system, and the profession that
applies theory, principles, data and methods to design in order to optimise
human well-being and overall system performance.”
International Ergonomics Association
Physical
Cognitive
Human
Organisation
Quality Education for a Healthier Scotland
Domains of Ergonomics and Human Factors
Multidisciplinary
Physical ergonomics - human anatomy,
anthropometry, physiological and biomechanical
characteristics as they relate to physical activity.
Cognitive ergonomics - mental processes, such as
perception, memory, reasoning, and motor response,
as they affect interactions among humans and other
elements of a system.
Organisational ergonomics - sociotechnical systems,
organizational structures, policies, and processes.
Quality Education for a Healthier Scotland
Summary
Multidisciplinary
Key points
• Ergonomics and Human Factors mean the same
thing
• The Twin aims are enhanced well-being and
performance of individuals and organisations
• These aims are interdependent
• It is a scientific discipline; 4yr degree course +
practice + specialisation
Quality Education for a Healthier Scotland
Why do errors happen?
Multidisciplinary
Bad people?
Errors occur due to
system design and how
those designs influence
behaviour
Quality Education for a Healthier Scotland
Even experts err
Multidisciplinary
Quality Education for a Healthier Scotland
The dilemma of “human error”
Multidisciplinary
If 1 event out of 100,000 goes wrong, humans are
assumed to be responsible in 80%-90% of cases
It follows that
If 99,999 out of 100,000 events go right then humans
are responsible in 80%-90% of cases
Which outcome results in investigation?
Quality Education for a Healthier Scotland
Multidisciplinary
Inaction, Breach, Violation, Loss of Situation Awareness
– all are just substitute terms for ‘Human Error’
• Human Error is not the cause
• Human Error is a symptom
Quality Education for a Healthier Scotland
Captain Hindsight
https://www.youtube.com/watch?v=opfXmYlTotc
Quality Education for a Healthier Scotland
Multidisciplinary
Why don’t we (usually) bump into
each other?
Quality Education for a Healthier Scotland
Multidisciplinary
Our response...
Safety 1 –
focuses on what went wrong and tries to
control by introducing further restriction
(pre work view - little or nothing goes
wrong, contradicted by hindsight)
Safety 2 –
facilitating the performance
adjustments that are necessary for
everyday work to succeed.
People not systems are intrinsically safe!
Quality Education for a Healthier Scotland
Multidisciplinary
So….handwashing. How is that going
for you?
Multidisciplinary
What for you is the front line
reality of trying to implement
those guidelines and best
practice? Safety 1
Would a safety 2 approach
help?
Quality Education for a Healthier Scotland
Tips for Safety 2
Multidisciplinary
• Look at what goes right, as well as what goes wrong
• Things do not go well because people simply follow the
procedures. Things go well because people make sensible
adjustments according to the demands of the situation. Find out
what these adjustments are and try to learn from them
• Work is Vs work as imagined (do people follow the rule all the
time?)
• A small improvement of everyday performance may count more
than a large improvement of exceptional performance
• Allow time to reflect, to learn, and to communicate (Be mutually
accountable)
Adapted from Van Stralen
Quality Education for a Healthier Scotland
It goes right more than it goes wrong
Multidisciplinary
• Celebrate that
• Be curious as to why
• Change Culture? Choose your attitude.
Quality Education for a Healthier Scotland
The nature and reality of working safely
Mark Johnston
Training and Research Officer
(Patient Safety)
NHS Education for Scotland
mark.johnston@nes.scot.nhs.uk
0131 656 3258
@markjohnston71
Quality Education for a Healthier Scotland
Multidisciplinary