Human factors
not be optimal. The human factors method can further be used to help revise training programmes. These methods have been used in the health and safety field for many years and they can, and are, applied more widely to critically assess various workplace operations. Following initial learning, the most effective training programmes are those that impart habitual behaviours upon the trainees. This is especially important when carrying out atypical activities that are different from everyday life, such as excluding contamination and seeking to ‘clean’ an object to a far higher level. In taking personnel through a human factors exercise, it is important to understand the forces that can help promote change and the forces that create barriers to change (this can be visualised through force field analysis, as represented in figure 1). Reviewing and seeking to overcome the barriers to change is necessary, if new and effective practices are to be implanted. Some examples of forces that can enable
change are: l Commitment to patient welfare. l Balanced work targets. l Effective communications with feedback loops in action.
l Shared understanding of work objectives. l Ability to raise issues and suggestions. l Personnel feeling valued. l Having time to improve work practices. l Welcoming of new people and acceptance to new ideas
l Improved morale and energy. l Involving teams and giving time to implement changes.
l Asking people what they need to implement changes.
l Empowering people to make their own decisions.
l Leaders able to spend time on the floor with teams.
l Effective education, including contamination control and decontamination principles.
l Clearly defined roles and responsibilities.
In contrast, some forces that can work against change are: l When personnel do not feeling valued. l Where there are insufficient numbers of capable personnel.
l Unreliable equipment. l Unsafe working practices or equipment. l When people have a sense that they are not being listened to.
l Ineffective training. l Work scheduling that is not realistic.
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Driving Force Driving Force Driving Force
Driving Force
Driving Force Driving Force
Decontamination
processes in Sterile Surgical Unit
Restraining Force Restraining Force Restraining Force Restraining Force
Restraining Force Restraining Force
Figure 1: Representation of force field analysis showing driving and restraining forces (alternatively, these can be described as inputs and outputs).
l Insufficient time in the working day to reflect or to consider improvements.
l Regulatory expectations. l Management not aligned to change. l Communication is too top down with ineffective feedback loops.
l Fatigue. l Unclear roles and responsibilities.
These forces can be assessed through task analysis with the end goal of improving procedures. Before undertaking this, the risk factors most likely to be influenced by human activity need to be assessed.
Risk factors Before considering how the human factors approach can deliver improvements, an understanding of the risk factors involved with reprocessing is required. These risk factors, with the human factors paradigm, are sources of variation and uncertainty and consequently areas that can be addressed through a methodological approach with the goal of delivering more consistent practice. Human activity: The activities of personnel can lead to situations where contamination is more likely (including dirty instruments, missing surgical instruments, and broken instruments that end up in the hands of surgeons in the Operating Room). These activities (or ‘active failures’) can occur consciously or unconsciously, and can be attributed to three principal areas5
:
l Action slips or lapses (such as picking up the wrong detergent or an error with equipment disassembly or assembly).
l Mistakes (such as because of lack of knowledge, selecting the wrong item to be processed or picking the incorrect sterilisation cycle).
Documentation: Inaccurate recording can lead to errors, such as delayed processing times and missing decontamination steps. This is a consequence of the design of documentation and the types of data that need to be recorded (some items of equipment, for example, have long and challenging to recall serial numbers).
l Violations or work-arounds (such as not checking when an item needs to be processed by or reducing a step due to time pressures on equipment turnaround).
Many adverse events occur as a consequence
of ‘latent failures’ (things like management decision or organisational processes) that create less than ideal conditions of work (such as excessive workload, inadequate supervision, poor communication, poorly maintained equipment, or a lack of knowledge due to training deficiencies).6
These factors are often
the root causes of the aforementioned three active failures.7
Time: Time is an important variable and the target time for reprocessing equipment is important. The longer an item is left, the more difficult soil becomes to remove (through drying and hardening) and the opportunity for microbial growth increases and their removal becomes more challenging as organisms become embedded in the encrusted debris.
Clutter: The greater the amount of clutter, then the greater the challenge there is around organisation and promoting consistent practice. The presence of clutter also provides opportunities for contamination and the situation of various objects presents challenges for cleaning surfaces, since items may not be removed to facilitate the cleaning process.
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