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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY December 2013 | Archived Issues

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Human Factors in Surgical Care

The OR360 project seeks to re-engineer teamwork and technology for 21st-century trauma care.

Work Focuses on Human Behaviors in Complex Systems

By Ken Catchpole, PhD
Director, Surgical Safety and Human Factors

Medical accidents are among the top 10 causes of deaths in the United States, with approximately 10 percent of patients experiencing some form of accidental harm. These accidents cost up to $980 billion per year.

Why do medical errors happen? What helps healthcare providers work to the best of their ability? The causes are complex and multifactorial, yet safety interventions frequently ignore this complexity. Human factors — the study of the relationship between humans and the systems they work in, and the practical application of that knowledge — seeks to answer these questions. Human factors grew out of a combination of management science and applied psychological research, and has become a key component of safety and performance improvement in other high-risk industries. It is vastly underrepresented in healthcare, but it is growing fast.

Healthcare systems create errors through a complex mix of factors. The tasks required, the equipment used, the working environment, the team and pressures from the organization all contribute to failure or success in any complex system. Human beings create safety by holding deficient systems together, and rather than signifying "negligence," adverse events are a symptom of deeper system problems. Putting humans at the center of developments in technology and treatments allows us to address the needs of our providers and patients, improving safety and efficiency, reducing costs and enhancing overall well-being.

The delivery of safe and efficient trauma care requires the precise coordination of multiple hospital teams under considerable time pressure. As part of the Cedars-Sinai OR360 initiative, funded by the Department of Defense, our team observed the entire trauma process for more than 150 patients. We found that flow disruptions occur about every six minutes. These disruptions interrupt or slow the work of trauma teams and cause errors.

Our observations enabled us to identify key aspects of process, workplace modification, teamwork, technology and information management that would benefit from re-engineering, resulting in measured improvements for patients and staff.

Sustaining this optimal human performance remains a challenge, so a secure, cross-platform smart app is now in development to hard-wire these improvements. It will act as a shared information resource, displaying basic patient information to enhance teamwork, situation awareness and decision making to avoid preventable mistakes. Ongoing work based on models of error-free, time-pressured performance in aviation and motor racing is set to improve the reliability and safety of handoffs across the medical center.

In the past, the failure to understand why errors and complications happen has limited improvements, but the lessons are now being learned. As part of its approval process, the U.S. Food and Drug Administration now requires a human factors assessment for every new medical device, leading to safer, easier-to-use devices that minimize the opportunities for errors. Simulation capabilities have grown exponentially, offering the ability improve technical skills, teamwork skills, equipment designs and our understanding of accident causation.

Human factors research is helping to expand our ability to improve performance and safety beyond force of will, awareness, more checks or more rules. The growing understanding of how humans perform in clinical systems will benefit every healthcare practitioner and patient at Cedars-Sinai and worldwide.