Human factors in healthcare is a multidisciplinary science focused on optimizing the relationship between people and the complex systems they operate within. This field applies knowledge about human capabilities and limitations to the design of medical equipment, technology, and work processes. The underlying premise is that most healthcare errors are not the result of individual incompetence but rather symptoms of flawed system design that makes it easy for practitioners to make mistakes. This approach seeks to improve safety and efficiency for patients and providers alike.
Defining Human Factors Engineering in Healthcare
Human Factors Engineering (HFE), often called ergonomics, is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system. Its goal is to optimize human performance and well-being while enhancing the overall effectiveness of the system. HFE applies theory, principles, and data to design in a way that minimizes the potential for error and maximizes ease of use.
The field gained prominence in high-reliability organizations such as aviation and nuclear power, where small errors can have catastrophic consequences. Healthcare adopted these principles, recognizing that its complex, high-stakes environment shares many characteristics with these industries. This marked a fundamental shift away from a traditional culture of “blaming the person” for an error and toward a systems approach.
Instead of punishing a clinician for a mistake, HFE professionals analyze the entire work system to identify latent errors. Latent errors are organizational or design flaws that lie dormant until they contribute to an accident. This perspective acknowledges that humans are fallible and that systems must be designed to anticipate and mitigate human limitation. The focus moves from trying to perfect human behavior to intentionally designing a safer environment where the correct action is the easiest action to take.
The Interacting Components of Human Factors
Human factors analysis breaks down the healthcare system into interacting components, often utilizing a framework like the Systems Engineering Initiative for Patient Safety (SEIPS) model. Understanding these components reveals where design flaws can undermine professional effort. These components include the people involved, the tools and technology they use, and the physical and organizational environment.
The Human Element
The human element encompasses the physical, cognitive, and social factors that define a healthcare worker’s performance. Cognitive factors, such as attention, memory, and decision-making, are susceptible to overload in fast-paced clinical settings. Excessive cognitive load from poorly organized information can hinder a provider’s ability to make accurate, timely decisions.
Physical factors like fatigue, stress, and high workload directly impact a person’s ability to perform tasks reliably. Working long shifts can impair judgment and lead to simple slips and lapses. Team dynamics are also a component, as communication failures or breakdowns in hierarchy often contribute to over 60% of reported sentinel events.
Tools and Technology
This component examines how well medical devices, equipment, and information systems are designed for their users. Poor design forces clinicians to develop “workarounds” to complete a task, which introduces risk. For example, a non-intuitive Electronic Health Record (EHR) interface requiring excessive clicks or complex navigation leads to frustration and potential data entry errors.
Confusing alarm systems on patient monitors are a common technological flaw, frequently leading to alarm fatigue where clinicians ignore alerts. Using different brands of the same medical device, such as defibrillators or intravenous line connectors, across a single hospital can create confusion and increase the likelihood of a use error. Human factors studies test these tools under real-world conditions to identify potential problems.
The Environment and Organization
The environment includes the physical space, such as the layout of the operating room or the lighting and noise levels in a patient unit. A noisy, cluttered workspace can distract providers, making it difficult to concentrate on complex tasks. Poorly placed supplies or an inefficient room layout can also waste time in time-sensitive situations, impacting patient outcomes.
Organizational factors involve the workflow processes, staffing levels, and the overall culture of safety within the institution. High staffing ratios and rushed patient handoffs increase the opportunity for miscommunication and missed information. The organizational culture determines whether an error is viewed as a learning opportunity to improve the system or an individual failure to be punished, which affects the willingness of staff to report adverse events.
Applying Human Factors Principles to System Redesign
The application of human factors principles seeks to engineer safer processes by redesigning the system to prevent errors, rather than training people to be more careful. One strategy is standardization, which involves making equipment and processes uniform across all clinical settings. Standardizing the appearance and functionality of high-risk medical devices, such as infusion pumps, reduces the mental effort required from a clinician moving between units.
Another principle is simplification, which reduces the number of steps required to complete a task. Optimizing a medication ordering process in an EHR to eliminate unnecessary screens or data fields can reduce the likelihood of a prescribing error and lower the cognitive workload. Simplifying complex procedures into mandatory, sequential steps is the basis for the widely adopted surgical safety checklists.
Redesign often leverages constraints, which means designing the physical environment or technology interface so it is impossible or difficult to make a wrong choice. A classic example is the design of non-interchangeable filling ports on anesthesia vaporizers, which physically prevents a clinician from filling the machine with the wrong volatile agent. Pre-loaded swab applicators for skin preparation were introduced to prevent the accidental injection of cleaning solutions, a mistake that occurred when the disinfectant was stored in a syringe-withdrawable format.
These redesign efforts are tested using usability methods, simulating real-world conditions to ensure the changes improve safety and efficiency without creating new, unintended problems. Applying HFE principles to redesign complex drug-drug interaction alerts in an EHR has been shown to increase efficiency and reduce prescribing errors in simulation studies. By focusing on the intentional design of the work system, human factors moves healthcare toward a proactive, preventative approach to patient safety.