What are clinical human factors?
Towards the bottom of this page you will find a fascinating comment stream of debate, discussions and suggestions around the thorny issue of trying to define clinical human factors. We’ve condensed them here into some shorter definitions:
Tim Cook, Consultant Anaesthetist, Royal United Hospital, Bath:
“Clinical human factors are all the non-technical factors that impact on patient care in medicine. Human factors have enormous breadth including human behaviour, interactions between professionals, design of equipment, systems and environment. The impact of human factors is enormous. Awareness of and attention to the negative aspects of clinical human factors improves patient care.”
Peter Buckle, President Elect of the Institute of Ergonomics and Human Factors (UK):
In August 2000, the International Ergonomics Association Council adopted an official definition of ergonomics or human factors):
“Ergonomics (or human factors) is 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 optimize human well-being and overall system performance.” (expanded upon at much greater length at the bottom of this page)
Ken Catchpole, Human Factors Practitioner & Senior Post-Doctoral Scientist, University of Oxford:
I like the idea of “enhancing clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture, organisation on human behaviour and abilities, and application of that knowledge in clinical settings.”
Graham Plant, Consultant Interventional Radiologist (X-ray Surgery) at the Basingstoke & North Hampshire Hospital Foundation Trust:
I find that definitions are remembered better if they start with a snappy “summary”.
“The things that enhance or reduce human performance.”
OR
“The things that enhance or reduce human performance, and differentiate us from logical, completely predictable machines.”
Chris Seal, Airline and Military Pilot and Human Factors Consultant:
I like Graham Plant’s suggestion or, even simpler, the partial quote from Alexander Pope: “To err is human.” As a result, every system, process, machine, tool or act that a human devises, uses or does is prone to error and failure. The study of and the learning from this simple truth is the basis of Human Factors.
Beverley Norris, Human Factors Lead, NPSA:
“Human Factors is using what we know about people to design safe, effective and efficient systems.”
Denis Wilkins, Retired Surgeon and member of CORESS:
I like Martin’s definition:
“Human factors are all the things that make us different from logical, completely predictable machines. In simple terms they are all those things that enhance or reduce human performance in the workplace.”
In August 2000, the International Ergonomics Association Council adopted an official definition of ergonomics or human factors) as shown below:
The Discipline of Ergonomics/Human Factors
Ergonomics (or human factors) is 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 optimize human well-being and overall system performance.
An ergonomist is an individual whose knowledge and skills concern the analysis of human-system interaction and the design of the system in order to optimize human well-being and overall system performance.
An IEA-recognized Certified Ergonomist is a professional ergonomist whose practice and training have met the quality criteria set by an IEA-endorsed certifying body.
Domains of specialization
Derived from the Greek ergon (work) and nomos (laws) to denote the science of work, ergonomics is a systems-oriented discipline which now extends across all aspects of human activity. Practicing ergonomists must have a broad understanding of the full scope of the discipline. That is, ergonomics promotes a holistic approach in which considerations of physical, cognitive, social, organizational, environmental and other relevant factors are taken into account. Ergonomists often work in particular economic sectors or application domains. Application domains are not mutually exclusive and they evolve constantly; new ones are created and old ones take on new perspectives.
There exist domains of specialization within the discipline, which represent deeper competencies in specific human attributes or characteristics of human interaction.
Domains of specialization within the discipline of ergonomics are broadly the following;
Physical ergonomics is concerned with human anatomical, anthropometric, physiological and biomechanical characteristics as they relate to physical activity. (Relevant topics include working postures, materials handling, repetitive movements, work related musculoskeletal disorders, workplace layout, safety and health.)
Cognitive ergonomics is concerned with mental processes, such as perception, memory, reasoning, and motor response, as they affect interactions among humans and other elements of a system. (Relevant topics include mental workload, decision-making, skilled performance, human-computer interaction, human reliability, work stress and training as these may relate to human-system design.)
Organizational ergonomics is concerned with the optimization of sociotechnical systems, including their organizational structures, policies, and processes.
(Relevant topics include communication, crew resource management, work design, design of working times, teamwork, participatory design, community ergonomics, cooperative work, new work paradigms, virtual organizations, telework, and quality management.)
This was a worldwide agreed definition and I feel the CHFG might do well to adopt it too,
Regards,
Peter Buckle
President Elect of the Institute of Ergonomics and Human Factors (UK).
Previously I suggested that definitions may be helped by starting with a snappy, short definition e.g. “The things that enhance or reduce human performance.”, it is also clear that this may be the “hook” but it is the next 10 words, and the ten after that etc, (to purloin a quote from Jed Bartlet in “West Wing”) that are important. Also it is clear that different groups may need different definitions depending on their own knowledge and the context.
My comment was primarily aimed at helping mould a definition on the CHFG website which would be read , at least in part, by people who have had little exposure to HF, but are interested in the topic.
Reflecting on the discussion and the contributions of Chris Searle, I still feel that the snappy hook can be useful in some contexts and I wondered if the phrase
“To err is human; factors that make this more or less likely are called Human Factors”
might be of use.
Have fun!
Graham Plant
Consultant interventional Radiologist at Basingstoke
I presume the long definition with sub-categories if for in -depth conversations.
It wont work for short conversations.
I think it is important to define clinical human factors rather than human factos as that bis what this pressure group is about.
In our ‘sound-bite’ society we need a shorter two line definition that encapsulates where CHFG comes from. I’m not sure the sentense in bold do that. For me it is a bit anodyne (sorry!).
I obviously don’t have the answers but I wonder if a definition like
‘Clinical human factors are all the non-technical factors that impact on patient care in medicine. Human factors have enormous breadth including human behaviour, interactions betweem professionals, design of equipment, systems and environment. The impact of human factors is enormous. Awareness of and attention to the negative aspects of clinical human factors improves patient care.’
might have utility.
9and that’s still too long!!)
all the best
tim
Hi
Good start as a definition, I find that definitions are remembered better if they start with a snappy “summary”.
“The things that enhance or reduce human performance.”
OR
“The things that enhance or reduce human performance,and differentiate us from logical, completely predictable machines.”
Happy Xmas!
Peter offers an excellent definition; indeed the proper one, but Tim is right in needing something snappy for people to understand, with direct clinical meaning. BUT his emphasis on non-technical is misleading – HF can impact on techincal knowledge, training and performance too. I would also feel extremely uncomfortable about “attending to negative aspects” of anything, which sounds remedial; and would encourge the practice that I have observed of using “the human factor” as a surrogate for blame.
From the professional side, there is a huge lack of accredited HF practitioners, which has meant that ‘proper’ HF, as defined by Peter, has not been the clinical experience of HF; which has mostly been through training delivered by well meaning but unqualified enthusiasts. This has lead to a very skewed and limited view of HF among clinicians (and subsequent a range of other positive and negative effects). Indeed, this “human factors training” is not in fact training in any practical human factors skills that an accredited professional would recognise at all. Thus, there is a divide between the science and practice of human factors in a clinical setting (which has broad and deep implications and needs) versus human factors “training” which is usually (though without any “standard” it’s diffiuclt to know) about making clinicans aware of how their performance is affected by the world around them (which is narrow but easy to understand).
The concession that we as professionals need to make is that, even though HF has been misrepresented through unacredited and unregulated repackaging from aviation 1) it gets the core ideas across to the people involved (even if it is of limited benefit) and 2) it’s definitely the thin end of the wedge for getting in wider systemic considerations. The fact that Tim understands the importance of design etc. (and has conducted some excellent equipment evaluations) is a reflection of this; and I’ve definitely worked noticed a sequence of changes in enthusiastic clinicans from “what is HF?” to “HF is about teamwork/what pilots do” to “HF is about systemic influences on human performance”. The NHS Institute’s publication illustrates some of these differences quite well in terms of who might need to know what.
The argument may need to circulate for some time, but we’d be missing a trick not to include the semantics that have arrived from aviators; but utterly hobbling future development if we don’t listen to the accredited professionals.
I like the idea of “enhancing clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture, organisation on human behavior and abilites, and application of that knowledge in clinical settings”.
Happy New Year to all.
I too prefer the simpler approach and, therefore, I like Graham Plant’s fisrt suggestion above.
Even simpler, the partial quote from Alexander Pope: “To err is human.”
As a result, every system, process, machine, tool or act that a human devises, uses or does is prone to error and failure. The study of and the learning from this simple truth is the basis of ‘Human Factors’.
The only thing I would add to the group’s 4 categories above is ‘GOOD TRAINING’ because it is through good training that we develop our successors’ awareness of the possible pitfalls – some of which we have made ourselves. Yes, we should encourage perfection in all that we do but it is also vital that we all should appreciate that the human condition is a most fallible one, especially when it is inexperienced or over-confident. Good training, however, allows development of the ethos and culture of ‘honest analysis’ of our situation, our processes, our resources, our abilities (and those of others) while assessing the least risky solution. Without good training we are blind to all the possibilities. Furthermore, it is so very important to select the right trainers!
I am, of course, going to lean towards Ken and Peter’s views. I too think we need something short and meaningful, but human factors has a long and complex definition because it is a very broad subject with many areas of specialisation. Those human factors professionals with expertise in HCI will know only a little about CRM and vice versa; so too the human reliability experts or those with knowledge of safety culture. Very few of us can profess to have expertise in all areas of HF, but the common feature is that HF professionals are trained to be systems focussed. For instance, no HF professional would recommend training as a safety solution without also considering the equipment, work design, environmental and organisational influences. And one of the things that defines HF as a discipline is the set of tools that allow us to evaluate those. The important issue for me is that all of these specialisations have a vital contributions to make to patient safety and we haven’t even begun to explore many of these yet. I wouldn’t therefore want to curtail the opportunities for progressing human factors in healthcare by using a limited definition. I agree wholeheartedly with Ken’s views on the misrepresentation of HF…when I came into healthcare 5 years ago I barely recognised what was being promoted as HF. There has been a lot of progress since then, but we still have a long way to go and it would be good to capitalise on the increasing awareness of HF to start to introduce and promote the broad range of HF knowledge and tools. That’s why I would resist the definitions that focus on ‘human factors’ as ‘stuff about people that lead us to making errors’ or which promote training. It needs to reflect that it is scientific discipline with a grounding in safety science, not just a set of principles. I suppose after this long ramble I should offer an attempt at a definition… one I use when trying to simplify HF is ‘HF is using what we know about people to design safe, effective and efficient systems’. (Note ‘human factors’ as singular…a discipline!). Very pleased to see this debate.
The LMQ HF model has been well received in several industries for many years now.
It was developed to address the lack of interest in the subject by key decision makers who needed sonething simple and understandable, but which also reflected its critical importance.
The importance of having a ‘snappy’ working definition should not be underestimated. Let me explain. As an advocate for the cause, I look for opportunities where I can, to help at a practical level with the introduction of better awareness of HF into the surgical community. As John Hunter the founder of the Royal College of Surgeons, once famously said “Stop thinking and do the experiment!”. One of the opportunities which I have spotted is through the Training the Trainer courses of the Royal College of Surgeons which I happen to teach a few times a year. It is a highly successful course, taught throughout the UK and also abroad and runnning now for the past 15 years. The purpose of the 2- day coursecourse as a whole is to improve teaching and training skills by providing additional insights into the various aspects of teaching and learning: ie the psychology of learning, approaches to teaching,assessment, etc, etc. For the two most recent courses my Fellow Faculty (don’t you just love alliteration!) and I thought that it might be interesting to run a session on HF. We started with the Elaine video – that most powerful of ‘hooks’ – and used this to start a discussion on HF. It is clear from the interaction that the major block is understanding the scope of HF. This is where an easily assimilable definition of the concept is so important in helping us non-experts get our heads round the concept. I have started moves to try and have the session adopted officially as part of the course and believe that this will be an important practical move in opening eyes and stimulating an interest in HF among the next generation (who, by the way, are thse who attend the course). I like the definition Martin has put up. I can see how this can then be expanded by leading into Peter Buckle’s more comprehensive listing. Very interesting discussion.