By Dr Dave Murray, Consultant Anaesthetist of James Cook University Hospital for the 8th Smart Health Community of Practice (CoP) Forum: Human Factors in the Digitalisation of Healthcare

1. An Introduction to Human
Factors and Ergonomics (HFE)
Dr Dave Murray
Consultant Anaesthetist
HEE NE Human Factors Lead
dave.murray1@nhs.net

2. Do healthcare workers actually need to know
anything about HFE?
Yes (obviously…but actually different in other industries)
• Dispel some myths
• Make it more explicit as to what HF “is”
• HF Video
• HF Framework
• Explore learning about HF within Serious Incidents

4. GMC generic professional capabilities
Domain 6: Capabilities in patient safety and quality
improvement
HEE Commission on Education and Training for
Patient Safety Recommendations
Raise safety concerns appropriately through clinical governance
systems
Rec 1: Ensuring learning from patient safety data and good
practice
Understand basic Human Factors principles and
practice at individual, team, organisational and system levels
Rec 2: Developing a common language
Understand the importance of non-technical skills and crisis
resource management
Rec 3: Evaluation of education and training for patient safety
Demonstrate effective multidisciplinary, interprofessional
teamworking
Rec 4: Engaging patients and public in design and delivery of
patient safety training
Understand risk and its management or mitigation Rec 7: Mandatory training
Understanding fixation error, unconscious and cognitive biases Rec 8: Patient Safety Training for Leaders
Reflect on their personal behaviour and practice
Rec 10: Increased opportunities for inter-professional
learning
Effectively pre-brief, debrief and learn from their own
performance and that of others
Rec 11: Principles of Human Factors and Professionalism
embedded into training
Make changes to their practice in response to learning
opportunities
Rec 12: Management of risks

5. Rec 2: Developing a common language
Trust Self Assessment Reports
• “Simulation and Human factor courses for patient safety incidents involving
teams.”
• “Simulation activities are closely aligned to patient safety objectives. This includes
the integration of the concept of human factors and how these may influence
clinical outcomes.”
• “…simulation suite to enable speciality and inter-professional clinical training to
take place as well as human factors.”

6. Rec 2: Developing a common language
HFE
CRM/NTS

7. Hi Dave…
“Just to let you know that the obstetric training team have just
successfully undertaken a Train the Trainer course on Human Factors.
The course lasted a week and was delivered by a company called…..”

8. “The company called…”
“Crew Resource Management training, also known as Human Factors
training develops effective communication skills and a cohesive
environment among team members…”

9. “The course was excellent….very hard work, loads of homework and
continuous assessment on our facilitation skills etc.
However, we are now able to become trainers in Human factors, as the
company have granted us the license to use all their training material.
We are planning to deliver training for all staff groups within the
maternity service ”

10. “The course was excellent….very hard work, loads of homework and
continuous assessment on our facilitation skills etc.
However, we are now able to become trainers in Human factors, as the
company have granted us the license to use all their training material.
We are planning to deliver training for all staff groups within the
maternity service ”

11. Rec 2: Developing a common language
HFE CRM/NTS

12. Rec 2: Developing a common language
HFE CRM/NTS

13. Understand basic Human Factors principles
and practice

14. I’ve told you what it isn’t…
…so what is HF?
It makes it easier to do the right thing, and harder to do the wrong thing.
Human Factors, also called Ergonomics, brings together a variety of different
scientific disciplines (e.g. psychology, anatomy, biomechanics, engineering) that
provide an explanation of how humans function.
“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.”
Dr Ken Catchpole.

15. I’ve told you what it isn’t…
…so what is HF?
It makes it easier to do the right thing, and harder to do the wrong thing.
Human Factors, also called Ergonomics, brings together a variety of different
scientific disciplines (e.g. psychology, anatomy, biomechanics, engineering) that
provide an explanation of how humans function.
“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.”
Dr Ken Catchpole.

16. I’ve told you what it isn’t…
…so what is HF?
It makes it easier to do the right thing, and harder to do the wrong thing.
Human Factors, also called Ergonomics, brings together a variety of different
scientific disciplines (e.g. psychology, anatomy, biomechanics, engineering) that
provide an explanation of how humans function.
“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.”
Dr Ken Catchpole

17. HEENE Human Factors Faculty
• Build a knowledgeable and effective HF faculty
• Work with Postgraduate schools of medicine to develop and deliver
training for trainee doctors
• Developing training for all healthcare staff, from awareness through
to Masters level courses and qualifications
• Variety of conferences and CPD events and informal meetings
The Result… increased staff able awareness with safer systems to
deliver better quality care

19. An Introduction to Human Factors
https://vimeo.com/250281561
https://youtu.be/aGZz3w5Hy8Y

20. Review SIs using (Educational) Framework
Did the task features make the incident more likely?
• Eg Unfamiliar / Difficult / Monotonous task
Did the ward environment hinder your work in any way?
• Eg Poor layout /Excessive noise
Did local policies & protocols help or hinder?
• Eg Protocol too complicated / Contradictory policies exist

21. Awareness Practitioner Facilitator Expert
People –individual &
teamwork
• Fatigue, hunger, and strategies to mitigate against these.
• Cognitive basis of performance, fixation error, cognitive biases.
• Cognitive aids, “read-back”
• Able to recognise times of high cognitive workload
Environment -
physical aspects of a
workspace
• Impact of eg heat, light, noise, room layout, and strategies to
mitigate against error.
• Sets up their own work space to enhance performance.
Equipment &
technology
• Errors inherent in design of equipment.
• Labelling and packaging.
• Can identify examples of good and poor equipment design
Tasks & processes
• Role of Standard Operating Procedures in aiding reliability.
• Impact of shortcuts and work-arounds in performing a task.
Organisation
• Role of underlying culture
• Assist in developing a learning organisation through incident
reporting and dissemination.
Ergonomics and
research methods
• Different investigative techniques may be used to understand,
design and create a better working environment.
• Importance of person and systems in patient safety.

22. Example within the “Environment” domain:
Awareness (of basic principles of HFE & can recognise how these apply in
performing their own role).
• Demonstrates awareness of how human performance is affected by the physical
environment such as heat, light, noise, layout.
Practitioner (integrated HFE principles into their everyday role):
• Sets up own workspace to optimise performance of a task, taking account of
environmental conditions. Has strategies to use in noisy environments.
Facilitator / Expert (higher level of knowledge of HFE, professional
qualifications, able to apply this at operational and strategic level)
• Can lead redesign of stockrooms & ward layouts.
• Able to develop organisational guidance for commissioning of new wards that adhere to
HFE principles.

23. Example within the “Environment” domain:
Awareness (of basic principles of HFE & can recognise how these apply in
performing their own role).
• Demonstrates awareness of how human performance is affected by the physical
environment such as heat, light, noise, layout.
Practitioner (integrated HFE principles into their everyday role)
• Sets up own workspace to optimise performance of a task, taking account of
environmental conditions. Has strategies to use in noisy environments.
Facilitator / Expert (higher level of knowledge of HFE, professional
qualifications, able to apply this at operational and strategic level)
• Can lead redesign of stockrooms & ward layouts.
• Able to develop organisational guidance for commissioning of new wards that adhere to
HFE principles.

24. Example within the “Environment” domain:
Awareness (of basic principles of HFE & can recognise how these apply in
performing their own role).
• Demonstrates awareness of how human performance is affected by the physical
environment such as heat, light, noise, layout.
Practitioner (integrated HFE principles into their everyday role)
• Sets up own workspace to optimise performance of a task, taking account of
environmental conditions. Has strategies to use in noisy environments.
Facilitator / Expert (higher level of knowledge of HFE, professional
qualifications, able to apply this at operational and strategic level)
• Can lead redesign of stockrooms & ward layouts.
• Able to develop organisational guidance for commissioning of new wards that adhere to
HFE principles.

25. http://www.cassiemcdaniel.com/blog/hierarchy-of-effectiveness-process/
Safe effective systems to
deliver healthcare

26. http://www.cassiemcdaniel.com/blog/hierarchy-of-effectiveness-process/
Safe effective systems to
deliver healthcare

27. Summary
• Healthcare workers need to know about HF to ensure a safe system
• It is not CRM/NTS
• Reflecting on SIs using a framework
• Ensure sufficient faculty to provide training
• Video is freely available
https://vimeo.com/250281561
https://youtu.be/aGZz3w5Hy8Y
dave.murray1@nhs.net