Patient safety and human factors: human factors - work environment
Definition: Workplace hazards are "a set of circumstances or a situation that could harm a person’s interest, such as their health or welfare" (Croskerry et al. 2009), p.409).
For healthcare organizations to become safer for patients, they need to identify risks and hazards embedded in their processes and systems and to learn from safety events (Battles et al. 2006; Legge 2009). Workplace hazards that have been repeatedly highlighted in studies include issues with packaging and labelling of medicines (and this is something that the National Patient Safety Agency (NPSA 2007) has looked into), on-screen displays (NPSA 2010a) and the operability of devices such as infusion pumps (NPSA 2010b).
Complexity is an integral part of the work environment and impacts on work processes, increasing the likelihood of error (Baxter 2010; Plsek and Greenhalgh 2001). Practitioners are often obliged to cope with discontinuities in care by bridging "gaps" in order to make complex systems work (Cook et al 2000). Organisations striving to implement policies and guidelines may, paradoxically, overlook the impact of information overload (Carthey et al. 2011) and worsen the situation. New technologies may alleviate some safety issues but can also introduce novel forms of error (RCN 2009).
An understanding of human factors can help with design considerations of work processes, facilities or devices (NPSA 2009) by ensuring that usability and functionality are considered at the outset (University of Cambridge Engineering Design Centre 2011) . Design can be used to create better conditions for patients and staff (Helen Hamlyn Centre for Design 2012). Standardisation and simplicity can be key organising principles and help people focus on systems not just individual elements (NPSA 2009).
For ideas about how to reduce risks to do with the work environment go to our Action on work environment page.
References
These resources were last accessed on 21 November 2012. Some of them are in PDF format - see how to access PDF files.
Baxter G (2010) White paper: complexity in health care (PDF 481.7KB), Bristol: Large Scale Complex IT Systems (LSCITS).
Battles JB et al (2006) Sensemaking of patient safety risks and hazards, Health Services Research, 41(4 pt 2) August, pp.1555-1575.
Carthey J et al (2011) Breaking the rules: understanding non-compliance with policies and guidelines. British Medical Journal 343:d5283 doi: 10.1136 British Medical Journal Sep 13;343:d5283. doi: 10.1136/bmj.d5283.
Cook RI et al. (2000) Gaps in the continuity of care and progress on patient safety, British Medical Journal 320(7237) 18 March, pp.791-794.
Croskerry P et al (2009) Patient Safety in Emergency Medicine, Philadelphia: Wolters Kluwer and Lippincott Williams & Wilkins.
University of Cambridge Engineering Design Centre (2011) Inclusive design toolkit.
Helen Hamlyn Centre for Design, Royal College of Art (2012) Health and Patient Safety Research Lab pioneering products, Helen Hamlyn Centre for Design website.
Legge A (2009) A review of the top ten health technology hazards and how to minimise the risks, Nursing Times 105(32-33) Aug 18-31, pp.17-19.
NPSA (2007) Design for safety: a guide to the graphic design of medication packaging. London: NPSA
NPSA National Reporting and Learning Service (2009) Lessons from high hazard industries for healthcare, London: NPSA.
NPSA (2010a) Design for safety: guidelines for the safe on-screen display of medication information, London: NPSA.
NPSA (2010b) Design for patient safety: a guide to the design of electronic infusion devices. London: NPSA.
Plsek PE and Greenhalgh T (2001) Complexity science: The challenge of complexity in health care, British Medical Journal 323(7313) 15 September pp.625-628.
RCN (2009) eHealth: making IT SAFER (PDF 282.4KB), London: RCN.