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Chapter 28
Human Factors
Cristina Daccarett
Human factors is a multidisciplinary eld that studies the human body and its cognitive strengths
and limitations to develop tools and devices that enhance performance and increase safety and
user satisfaction. Ergonomics is a eld frequently included when referring to human factors.
Historically, ergonomics referred to the study of factors only related to physical activity, but this
denition has been broadening blending human factors with ergonomics.
Although human factors have been used extensively in industries outside of healthcare, its
use in healthcare settings has been minimal. Despite this, errors from machines, materials, and
methods have signicantly decreased because they are being designed with safety in mind, with
extensive quality testing and based on evidence-based practice. Although focus should still be
placed on human–machine interactions, greater focus needs to be given to the understanding of
how the human brain, behavior, and abilities are impacted by processes and the environment.
Healthcare providers have a sincere commitment to providing the best care possible and to do
no harm. Unfortunately, aspiration, expertise, and competence do not always prevent harm when
the processes designed fail to understand human capabilities. Human factors help mitigate this
by focusing on two main areas, how humans process information and nonpsychological issues. As
part of information processing, the science looks at visual and auditory systems, perception and
cognition, decision making, display processing, and controls. Nonpsychological issues relate to
workspace layout, strength, physiology, and stress.
In healthcare, there are some human factors that have a higher eect in the safety of patient
care. ese include cognition, distractions, physical demands, and the environment.
Contents
Cognition ................................................................................................................................ 244
Distractions ............................................................................................................................. 244
Physical Demands ................................................................................................................... 244
Environment ........................................................................................................................... 244
244 ◾ Cristina Daccarett
Cognition
Cognition is a group of mental processes that give humans the ability to process information and
apply knowledge. It includes memory, attention, decision making, and problem solving. When
processes are designed, limitations need to be considered and tools must be developed to medi-
ate these shortcomings. For instance, instead of asking a provider to remember the ten items that
need to be collected to insert a central line maintaining the sterile eld, develop a checklist with
the items needed. A change to make the process even more human-friendly would be to have the
items located within proximity in the storage area. e ideal process would be to develop a kit that
contains all the needed supplies, limiting the number of items the provider needs to remember to
one item.
Distractions
Despite best eorts, high noise levels and interruptions are becoming inevitable in healthcare
organizations. ese factors are frequent causes for distractions causing providers to divert their
attention to items other than their main area of focus. Unfortunately, there are situations where
the eect of distractions cannot be minimized, such as when a pharmacist performs the nal
check to a medication dispensed. To limit distractions, a visual signal can be developed to alert
others not to disturb the pharmacist during this critical check. An example of this visual signal
includes a color mat for the pharmacist to stand on when performing the nal check.
Physical Demands
Physical demand refers to the stressors that impact human physical capability, technical skill, and
cognitive ability. Frequently, individuals underestimate their limitations, overestimate their capa-
bilities, and have diculty identifying their physical constraints. Failing to recognize the eect
of lack of sleep, performing tasks outside the scope of practice, or taking on too many tasks are
examples of physical demand. Another example is when a provider underestimates their physical
ability to handle a patient. Protocols have been developed to safely lift patients and failing to fol-
low them can cause injuries and musculoskeletal disorders to providers.
Environment
Environment refers to factors associated with the setting such as lighting, sound, and tempera-
ture. When including human factors in healthcare, considerations should be given to ensure that
the conditions facilitate the delivery of safe, eective, and ecient patient care. Unfortunately in
healthcare, improvements to the environment are often constrained by older facilities that were
not designed with ow and human factors in mind. is can be seen, for instance, in inpatient
care units that have signicantly small storage units and a high number of items to store. A very
busy and messy storage area can create errors due to delays in nding the appropriate product, or
accidentally taking the wrong item. To mediate the challenges caused by small storage areas, stor-
age rooms could be organized by placing the commonly used items within reach, including labels
Human Factors ◾ 245
and color bins to identify products and limiting the amount of product stored to what is absolutely
needed to operate for a specic period (a shift, 24 hours, a week, etc.).
Increasing the use of human factors in healthcare will result in signicant improvements to the
quality and the safety of care delivered, and will positively impact patient and employee satisfac-
tion. As processes are being designed and modied, a human factors “expert” can provide great
guidance and highlight opportunities. It is also important to include the knowledge of individuals
who are closely related to the process and are performing the task on a daily basis.
When errors or near misses occur, a root cause analysis can help determine if the cause was
related to human factors, and if that is the case, processes should be redesigned with consider-
ations to prevent them. Keep in mind that it is always preferable to redesign a process, rather than
add an additional inspection step.
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