Patient safety and human factors: action on work environment

The work environment is the scene of any interaction between patient and health care worker. It is also the site of interactions with technology and equipment. Those interactions can be analysed using methods adapted from industry before or after an adverse event or failure occurred (Flin 2009).

This can be done in different ways. Perhaps the best known is Root Cause Analysis (RCA) which has been widely promoted in health care (National Patient Safety Agency 2004). However this technique is retrospective and analyses single events (Card et al 2012a). Prospective hazard analysis (PHA) techniques were developed in the sixties to widen the scope of these tools but it was only in the nineties that they were applied to healthcare (Card et al. 2012b).
 
Further approaches to identifying and analysing problems are also available such as 5 whys analysis, fishbone diagrams, problem tree analysis and the Seven-S Model (see Hewitt-Taylor 2012).

These methods can be used separately or in combination to make sense of the risks and hazards that are a threat to patient safety.

Tools and interventions

Two important techniques that are used to identify risks are the root cause analysis (used after an adverse event), and the Structured What If Technique (for anticipating adverse events).

Root cause analysis

Root cause analysis (RCA) is designed to explore the contributing factors to adverse clinical events. The process is based on a sequence of questions.

The process is described fully on the National Patient Safety Agency website (NPSA n.d.). A summary of the findings of a research study exploring the nursing contribution to RCA and the benefits and challenges involved is described by Mengis and Nicolini (2010).

Structured What-If Technique (SWIFT)

SWIFT is a systems-based risk identification technique that employs a workshop-based approach with participants addressing pre-developed guidewords or headings to examine risks and hazards at a system level (Card AJ et al 2012b). Because of this, the success of the technique is dependent on a representative group being available with the right insight into the systems in question. However it looks to be capable of playing a useful role in health care as part of a prospective hazard analysis with participants finding it a credible and easy to use technique when facilitated properly.

References

These resources were last accessed on 25 March 2013. Some of them are in PDF format - see how to access PDF files.

Card AJ et al. (2012a) Successful risk assessment may not always lead to successful risk control: A systematic literature review of risk control after root cause analysis, Journal of Healthcare Risk Management, 31(3), pp.6-12.

Card AJ et al. (2012b) Beyond FMEA: The Structured What If Technique (SWIFT), Journal of Healthcare Risk Management, 31(4) pp.23-29.

Hewitt-Taylor J (2012) Identifying, analysing and solving problems in practice, Nursing Standard 26(40) 6 June, pp.35-41.

Mengis J and Nicolini D (2010) Root Cause Analysis in clinical adverse events, Nursing Management16(9) February, pp.16-20.

NPSA (n.d.) Root Cause Analysis (RCA) investigation, NPSA website.

NPSA (2004) Root Cause Analysis (RCA) toolkit, London: NPSA  

Go to: Human factors - work environment.

See also information about other human factors and interventions.