Thursday, March 21, 2013

Human factors in medicine

I just watched the latest BBC Horizon programme. It was about the need for developing human factors training and practice in medicine. It drew on the civil aviation industry, and also fire fighting and Formula 1.

My wife could tell you that the need for human factors training within medicine is something that I've been banging on about for years. It's been apparent that whilst there are many very good and well-intentioned practitioners of all sorts within the NHS, there are also too many occasions when issues arise that really boil down to human factors end up having a negative clinical outcome. This is something that has been a focus of training and safety within aviation since Kegworth, and over and over again, when I hear descriptions of events that have taken place in hospitals, I can think of ways in which human factors training could have helped.

Aspects drawn from aviation in this episode included the use of checklists (although checklists themselves are an innovation, the idea of following "protocols" and procedures are already widely established within medical practice), a strong focus on situational awareness, mention of the need to understand the impact of authority gradients, and the impact of too much stress.

It's easy to add other aspects of human factors issues from aviation (now generally called CRM - crew resource management). For example, fatigue, error chains (mentioned passim without explanation) and communication. One of the major contributors to improvements in the human factors environment within aviation has been CHIRP - the Confidential Human Factors Incident Reporting Programme - which has been extended to Air Traffic Control, cabin crew, aviation engineers and also the maritime industry. Again, for years, I've been saying that if the NHS were to take human factors seriously, such a publication would greatly benefit.

Dr Kevin Fong, the presenter, makes a very good and articulate case for the development of human factors within medical practice. If Sir David Nicholson, the Chief Executive of the NHS, is keen to see substantial improvements in clinical outcomes, I'm pretty convinced that this is one of the places that he should be looking.

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