The Operating Theatre Journal May 2022

Jones (2016, cited in Koleva, 2020) found that by applying the knowledge
of human factors in clinical practice through an understanding of the
impact on human performance of teamwork, equipment, workplace,
duties, culture and organisation has the potential to enhance clinical
performance and ultimately patient safety. Fann et al. (2016, cited in
Koleva, 2020) suggest that breakdowns in communication, situational
awareness and leadership that are vital to teamwork may lead to
disruption and adverse events. This is supported several years later
by Koleva (2020) as their key findings emphasise that communication
failures, situational awareness, fatigue, lack of healthcare
professionals and surgical case load are common contributing factors
to ‘never events’.
As leaders, managers and healthcare professionals responsible for
the safe and effective delivery of healthcare to patients in either a
primary, secondary or tertiary care setting, we all have a duty, and
a responsibility for encouraging behavioural change and challenging
poor practice. An atmosphere of clear and effective communication,
along with a culture of patient safety, will deliver better patient
outcomes and help decrease both morbidity and mortality, as multiple
studies have evidenced this already. For example, Weiser and Haynes
(2018, p. 928) reported a 30% decrease in mortality with the use of
the checklist.
The first question to ask is, what are human factors? The Health and
Safety Executive (1999, p. 2, cited in Flin et al., 2009) defined human
factors as, ‘Human factors refer to environment, organisational and
job factors, and human and individual characteristics which influence
behaviour at work in a way which can affect health and safety. A
simple way to view human factors is to think about three aspects:
the job, the individual and the organisation and how they impact on
people’s health and safety-related behaviour’.
We are affiliated with Martin Bromiley, an airline pilot whose wife,
Elaine Bromiley, died due to an anaesthetic incident in 2007. Her story
is portrayed in a video ‘just a routine operation’. The video shows how
important it is that everyone is comfortable communicating if they
feel something is wrong (Bromiley, 2012). Bromiley (2008, cited in Flin
et al., 2009) was surprised to find that there was little awareness of
the role of human factors for patient safety.
Moray (2000, cited in Flin et al., 2009) developed a model of the
organisational, human and technical components of sociotechnical
systems.
Flin, O’Connor and Crichton (2008, cited in Mercer, Arul and Pugh,
2014, p. 105) defined human factors as, ‘the cognitive social, and
personal resource skills that complement technical skills, and
contribute to safe and efficient task performance’. Catchpole et al.
(2010, cited in Mercer, Arul and Pugh, 2014, p. 105) defined human
factors as a means of, ‘enhancing clinical performance through
an understanding of the effects of teamwork, tasks, equipment,
workspace, culture, organization on human behaviour and abilities,
and application of that knowledge in a clinical setting’. Thiels et al.
(2015, cited in Tagar, Devine and Obisesan, 2019) stated that human
factors are increasingly understood to play a significant role in patient
safety events.
Human factors in healthcare are just as important as Human Factors
in other industries, such as aviation, motor racing, space exploration
and nuclear. An understanding of their potential impact, along with
that of stress and fatigue, could impact on performance, which in
turn, may result in patient harm. Below highlights an example of
potential harm that could be caused by human factors.
Yule et al. (2006) and Klaas et al. (2019, both cited in Ferorelli, 2020,
p. 2) claim that ‘many surgical adverse events originate from failures
in non-technical aspects such as leadership, situation awareness,
decision making and especially communication and teamwork among
operators’.
The key structures that underpin patient safety in human factors are
the organisation, the environment, the team, and the individual.
These are inter-dependent and to date most developments in patient
safety have concentrated very much on the individual. Without the
appropriate organisational, environmental and team structures the
individual remains at risk and vulnerable. (Renton, Chohan and Tagar,
2020).
Before the current literature is reviewed in more detail, be mindful
of the study by Taifoori and Valiee (2015, cited in Koleva, 2020).
The study asked 170 operating room nurses what the main causes of
errors were in the theatres. The responses were; tiredness (92.8%);
incorrect or insufficient information (89.5%); distraction (88.9%);
impaired concentration (88.2%) and lack of staff (88.2%).
Coming Soon – Cambridge University Press
Fundamentals of Operating Department Practice
2nd Edition
• EDITORS:
• Daniel Rodger, London South Bank University
• Kevin Henshaw, Edge Hill University, Birmingham
• Paul Rawling, Edge Hill University, Birmingham
• Scott Miller, St Helens and Knowsley Hospitals NHS Trust
• PUBLICATION PLANNED FOR: August 2022
• AVAILABILITY: Not yet published - available from August 2022
• FORMAT: Paperback
• ISBN: 9781108819800
Why not recommend The OTJ to your librarian
14 THE OPERATING THEATRE JOURNAL www.otjonline.com