Human factors

Having a knowledge of human factors has helped me look at clinical practice in a new light:

• Many human errors can be mitigated by good design of things and systems
• Systemic errors are best tackled by design through forcing functions, automation/computerisation, rather than training/education and policies the ‘Hierarchy of Intervention Effectiveness’.  Yet, clinical practice focusses on the least effective interventions.
• The SHELL model is helpful to understand the complexity of clinical practice:  the interfaces are particularly important.  The use of the term ‘software’ is a bit anachronistic now, as it just means ‘apps’/computer code nowadays, rather than ‘procedures, policies, rules’, etc
• Good practice in Human Factors can be learned, taught and improved
• QI and good managerial practice should complement clinical practice (doctors vs managers).  Managers need to learn human factors, too
• Make it easy to do the right thing and hard to do the wrong thing
• System designers needs subject matter experts to consider all use cases/scenarios
• Where is the point when the excess cost outweighs the benefit?  That is, what is the acceptable level of risk/acceptable level of quality?
• ‘Culture eats strategy for breakfast!’ (attributed to Drucker)
• Medicine expects failure and is doomed to failure – all patients eventually die
• In clinical practice, we don’t really work in proper, functional ‘teams’, but rather professional silos
• Telling people to ‘pull their socks up’ rarely works
• Best results are seen where humans are taken out of the equation entirely, e.g. terminate a risk, such as strong potassium chloride no longer available
• Automated safety measures can have unexpected consequences, e.g. MCAS in the Boeing 737 Max
• Human beings are ‘creative’ and find workarounds
• Rare disasters become forgotten to history

Attitudes of a good anaesthetist

• Puts patient welfare first: shows commitment, compassion and self-sacrifice
• Proactive: pre-empts problems as much as possible, conscientious, not careless or apathetic
• Personal integrity: espoused values match enacted values
• Circumspect: careful, holistic approach to risk, avoids unncessary procedures of little benefit, prudent
• Prioritises well
• Communicates clearly and effectively with patients and colleagues, uses ‘adult to adult’ approach
• Keen to learn: inquisitive, challenges/tests orthodoxy
• Non-discriminatory in terms of race, colour or creed
• Strives for high levels of competency, recognises limits, not reckless, pragmatic
• Shows good leadership
• Well-balanced: calm, maintains self-control, doesn’t panic, values others’ input

Anesthetist Working In Operating Theatre Wearing Protecive Gear checking monitors while sedating patient before surgical procedure in hospital