Human factors and ergonomics in surgical safety: That was then, this is now

It is now over a decade since we began to examine, in a co-ordinated and committed fashion, the incidence and causes of inadvertent injury in healthcare; and thus to understand how changing healthcare systems may be essential for the future delivery of low cost, highly reliable care. That timeframe can be roughly divided into three epochs. There are some chronological overlaps, given that publications often appear some time after the study, with different areas and different countries developing at different rates. Nevertheless, there has been clear progress in the understanding of safety in healthcare, with widening acknowledgement that improvement should be an unceasing challenge. In this paper, we describe those epochs, illustrated with the concurrent development of our research, and then seek to identify the future challenges for Ergonomists and Human Factors (HF) practitioners.