Human factors


useful contextual information. Actual data will also provide the necessary information for how long each task takes to complete. This is important for procedures and for scheduling. With scheduling, errors are more likely to occur when surgical processing departments are operating at almost maximum capacity. Under such circumstances, operations will inevitably migrate towards the marginal boundary of safety, therefore putting the system at greater risk for accidents.9


On completion, the map needs to be tested


in the ‘real world’. It is important that any paper exercise is followed by a walkthrough of the process to determine if it is truly representative before the procedure is officially released. To take a more concrete example, one type of


error with surgical processing departments is packaging errors:10 l Packing incomplete such as incomplete packing materials, broken packaging tape etc.


l Instrument missing: the number of instruments in the package is less than required by the procedure.


l Instrument malfunctions due to missing screws.


l Instrument accessories missing. l Damaged instruments. l Instruments of the wrong specification. l Wrong packaging tag applied. l Selecting the wrong packaging material. l Mixing-up the required quantities of different instruments.


Each of these can lead to failures of sterilisation and hence patient risk. However, human factors approaches can aid error minimisation, such as through improved tagging systems and colour coding.


Using human factors to deliver effective training Following the above work systems analysis, training effectiveness can be improved by including more learning, education and discussion to reduce the erosion of learning value, especially when undertaken on a group basis.11


by speeding up training for new hires, this introduces the risk of poor practices being conducted.


Using human factors to improve ergonomics Examining the work area and the position of items and the motions and activities which personnel have to engage with is a useful exercise. Poorly designed areas and ones where ergonomics have not been examined can contribute to such errors as poor design, time pressure, unacceptable workload, reduced competence, poor morale, distraction due to noise levels and weak communication systems. The outcome of workspace analysis can


lead to ergonomic interventions that improve healthcare workers’ quality of working life, such as leading to improvements in musculoskeletal symptoms,13


Addressing each of these contributes to error reduction and, consequently, a lowering of contamination rates. When adopting this type of approach into the workplace, it is good practice to review after a reasonable period of time has elapsed (such as after three months). This ensures that practices are working, that fundamentals are being retained by personnel, and to gather overall feedback on procedures and the training programme.


References 1 Dept of Health (2016) Health Technical Memorandum 01-01: Management and decontamination of surgical instruments (medical devices) used in acute care


and which reduce errors by making


tasks easier to conduct and more efficiently. This latter approach can involve decreasing clutter,14 placing objects where they are actually needed, paying attention to stock levels and so on.


An important part of the training process is personnel engagement and involvement. One study into participation of healthcare workers in training schemes, as well as inputting into workspace design, showed that work satisfaction increased and errors reduced as a result of a multifaceted human factors intervention programme.12 It is important that accelerated training


programmes are only used where there are appropriate controls (this can arise where areas are short staffed). The danger is that


42 www.clinicalservicesjournal.com I August 2023


Conclusion This article has considered the work of surgical processing departments from the perspective of human factors. This is from the perspective that processes need to be designed with people in mind, both from the position that people are a source of variation and uncertainty (which must be understood in order to reduce error) and that involving people in areas like the workspace, procedures and training makes each one of these job aspects more effective. Human factors analysis of surgical processing departments can help personnel and managers to consider: l Policies and procedures. l Training and education. l The physical environment. l People and roles. l Technology and workspace.


2 Part A: Management and provision. Available at: https://www.gov.uk/government/publications/ management-and-decontamination-ofsurgical- instruments-used-in-acute-care


3 Shorrock, S.T. and Hughes, G. (2001) Let’s get real: How to assess human error in practice, IBC Human Error Techniques Seminar


4 International Ergonomics Association (IEA). The discipline of ergonomics. Human Factors. 2000;1: 01 Available at: http://www.iea.cc/ ergonomics/


5 Mao X, Jia P, Zhang L, Zhao P, Chen Y, Zhang M (2015) An Evaluation of the Effects of Human Factors and Ergonomics on Health Care and Patient Safety Practices: A Systematic Review. PLoS ONE 10(6): e0129948


6 Reason J. (2000) Human error: Models and management. BMJ. 320(7237):768–770


7 Vincent C, Taylor-Adams S, Chapman EJ, Hewett D, Prior S, Strange P, et al. (2000) How to investigate and analyse clinical incidents: Clinical risk unit and association of litigation and risk management protocol. BMJ. 320:777–781


8 Reason J. (1990) Human Error. Cambridge: Cambridge University Press; 1990


9 Kirwan, B. (2017) A guide to practical human reliability assessment, Taylor and Francis, USA


CSJ


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