From Discovery to Design: The Evolution of Human Factors in Healthcare

I n some respects, the use of human factors engineering (HFE) methods in healthcare has been transformative.However, as measurable progress has been limited in patient safety, these challenges continue.Where is HFE headed to address these challenges?We look at the progress and difficulties HFE faces in today's complex healthcare environment. Human factors in Safety ResearchApplications of HFE in system design can be traced back to the mid-1900s.Post-World War II, many engineers were preoccupied with the safety of transportation systems.As a result, human factors became prominent in domains such as aviation and the military.Applying HFE principles in these domains gave rise to fundamental conceptual frameworks to understand the relationships between humans and complex technology.For example, in the aviation industry, human factors specialists studied a series of elements influencing flight deck design, contributing to a culture shift that promoted the importance of safety in such complex socio-technical systems.From the mid-1970s to mid-1980s, much of the HFE attention focused on process control systems.Industrial events such as the Three Mile Island nuclear incident and the Bhopal industrial disaster reminded us that despite the successful HFE integration in some domains, the process control industry had partially failed to implement HFE methodologies.A series of inquiries followed these incidents, resulting in several regulatory documents outlining how HFE must systematically be incorporated in system design (Meister 1999). Human factors and HealthcareApplications of HFE principles to the domain of healthcare are relatively new.Although some references to human factors in healthcare date back to the 1980s and early 1990s (Leape 2004), it was the work of James Reason in 1995 that contributed to increasing the scope of HFE practices to healthcare systems.Reason reviewed HFE contributions to the domain of healthcare and introduced the concepts of active and latent failures.The former are errors committed by users of the systems (e.g., a doctor administers the wrong medication).The latter are errors created at the organizational level of the design (e.g., inadequate procedures, incomplete training, poor labelling choices etc.) and may lie dormant for several days, months or even years until triggered by a collection of local factors.Among other things, Reason's work emphasized the importance of considering team and organizational factors in the design of safety critical systems as well as avoiding the culture of "blaming the users" and embracing a culture of understanding the root causes of adverse events (Reason 1995).One of the early empirical demonstrations of the significant impact of using HFE design techniques on medical systems was shown in a redesign of the user interface of a commercially available patient-controlled analgesia (PCA) pump (Lin et al. 1998).The authors conducted an evaluation comparing their redesign to the original design.The results showed a significant decrease in programming time, a lower mental workload and fewer errors.These findings clearly demonstrated the applicability From Discovery to Design: The Evolution of Human Factors in Healthcare