Human Factors Theory

In complex environments such as a hospital setting, humans have the ability to prevent major errors as well as cause them.  Human Factors theory is concerned with the scientific study of interactions among humans and within systems (Norris, 2009).  Etchells, et al. (2006) define human factors as “designing systems to meet the needs, limits and capabilities of the people who work in them” (p. 69). The application of human factors science is necessary to enhance patient safety (Etchells, et al., 2006). A failure to design systems without consideration to human factors can result in inefficient and error-prone processes (Norris, 2009)……  First noticed in the aviation industry, Human Factors Theory holds that technical competence is not enough for high stakes occupations (St. Pierre, et.al, 2008).  Errors and catastrophes are often caused by deficits in non technical skills such as interpersonal communication, teamwork, leadership, supervision and cognitive skills such as situation awareness, planning, decision making and task management (St. Pierre, et al., 2008). Heightened skills in these areas have led human factors to be responsible for miraculous saving of lives in the acute care setting.  The key to managing these is to design systems that limit the ability for human failings while maximizing the potential for human success and innovation during critical situations.

Nurses working in the healthcare environment are taught to be vigilant.  Although the definition of this varies, it is commonly described as the attention to behaviors that provide caring, safe and effective nursing care (Simmons & Graves, 2008).  The concept of attention is the controlling of thinking, perception and action (St. Pierre, et al., 2008).  Vigilance is the ability to maintain this attention for extended periods of time (St. Pierre, et al., 2008).  Nurses have undergone disciplinary action for descriptions of lack of vigilance (Simmons & Graves, 2008).  Human factors studies have shown that there are mental and physical barriers to maintaining a vigilant state due to fatigue (Simmons & Graves, 2008).  Fatigue is described as a disturbance of attention in which achievement potential is reduced (St. Pierre, et al., 2008).  The problem with fatigue is that it is not recognizable until the achievement potential is already reduced. Vigilance is controlled by consciousness (St. Pierre, et al., 2008)  Cognitive psychologist James Reason found slips in performance described as being in “automatic mode” when a task is familiar and repeated frequently (Simmons & Graves, 2008).  A nurse can perform a task correctly numerous times and then “slip” causing an error that is usually only detected by someone else post occurrence (Simmons & Graves, 2008).  J. Reason describes these slips are thus undetectable by the performing clinician (Simmons & Graves, 2008).  Because of the lack of conscious awareness, this error is not mediated by training or vigilance. Perhaps fatigue is a factor in these slips as well as other issues of attention.  Knowledge of this type of human limitation can prompt device makers and system designers to anticipate human failures (Simmons & Graves, 2008).  The expectation of a human to sustain vigilance to provide safety is faulty.