Career advice

Why human factors is about more than communication and teamwork

How human factors can improve nurses’ workplaces and create safer, streamlined services

How human factors and ergonomics can improve nurses workplaces and create safer, streamlined services that take account of the realities of working in healthcare

In the UK, human factors and ergonomics are interchangeable terms. Both look at the way humans interact with each other and the systems and processes in which we live and work.

How human factors and ergonomics in healthcare can be used in complex systems

Human factors and ergonomics (HFE) in healthcare is predominantly linked to non-clinical skills, such as communication, teamwork and situational stress management. Although these are important aspects of HFE and are key to understanding how we respond to emergencies and high stress situations, this is a just a small aspect of applying HFE in practice.

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How human factors and ergonomics can improve nurses’ workplaces and create safer, streamlined services that take account of the realities of working in healthcare

Picture: iStock

In the UK, human factors and ergonomics are interchangeable terms. Both look at the way humans interact with each other and the systems and processes in which we live and work.

How human factors and ergonomics in healthcare can be used in complex systems

Human factors and ergonomics (HFE) in healthcare is predominantly linked to non-clinical skills, such as communication, teamwork and situational stress management. Although these are important aspects of HFE and are key to understanding how we respond to emergencies and high stress situations, this is a just a small aspect of applying HFE in practice.

I was drawn to HFE through my work as a simulation facilitator. The term ‘human factors’ is used a lot in the simulation world, looking mostly at the way teams work or how people react to a situation.

But if we are already working in a poorly functioning system that is full of latent threats, good communication or situational awareness will only go so far in reducing risk.

We work in complex systems that have not been designed with HFE in mind. The base system may be many years old and has been developed, adapted, with parts removed and parts added to improve safety.

‘When you place people in such a complex environment, it is amazing we don’t see more errors’

For example, patients in the NHS can go through several different processes to get to the right person because ‘that is the system’. But when the system has been changed so much it looks completely different to the original design, this can leave patients having to navigate complex systems that don’t make sense to them, or even to us as practitioners.

The complexity grows when you add in issues such as staffing levels; local, national and international guidance that can sometimes contradict and confuse; and cultural, political and economic factors.

So with this complexity, how can improving communication or team working alone help?

It is easy to consider people who make errors as being to blame, with ‘human error’ often reported as a cause when things go wrong. But when you place people in such a complex environment, it is amazing we don’t see more errors.

Engagement with the people in the system is at the heart of HFE. This has been demonstrated in aviation whereby talking to pilots about how they flew planes led to improvements in design. This showed that ‘pilot error’ was, in fact, due to aircraft design.

In healthcare, engagement with people in the system is fundamental to improving patient care and our understanding of why particular actions happen.

The SHELL model

A simple model that provides a good overview of HFE is the SHELL model. Originally designed as an aviation tool, it has been adapted over time for use in healthcare and other safety-critical industries.

  • Software The policies, laws, guidelines and standard procedures that dictate or guide us to undertake our roles
  • Hardware Any tool that is used to do your job, from a pen to more complicated clinical equipment
  • Environment This is the physical environment, but also includes the economic, political and cultural environment you are working in
  • Liveware – others Teamwork, communication, leadership, followership and the norms of teams
  • Liveware – you The individual; knowledge, attitudes, beliefs and culture but also psychological and physical well-being

The final L is what links all the elements. If you have considered all of these factors and worked to reduce potential clashes, your systems will interact well.

Using HFE when setting up a COVID-19 vaccination centre

I am currently leading a COVID-19 vaccination service. When designing the service, we used HFE methods to test the processes we wanted to use. After carrying out a task analysis of the work of an occupational health nurse to understand the intricacies of the process of administering a vaccine, we simulated the proposed process to see what it looked like and identify potential failures in the system.

‘We need to accept that people from outside healthcare can help us to improve what we do’

This showed that although an experienced vaccinator would be able to vaccinate a large number of people, the area being proposed was too small and the process had too many potential risks.

Using this information, we identified an environment that enabled us to deliver the planned process safely – a process that has only had minor changes since we started in December last year.

How to apply the SHELL model in practice

Use policies and procedures as they are meant – as a prompt to help you do your work. If they are too long or confusing, speak to the author about adapting or rewriting them so they are easier to use in practice.

Do you understand the technology you are required to use, and do you have easy access to it? Have you been trained how to use it? If not, how can you access training?

Look at your environment. If it is cluttered, work out why. Identify what is used regularly, what needs to be close at hand, and what can be moved out of your immediate working area. Think about why the area is laid out how it is and if it doesn’t make sense, work with your colleagues to change it.

What is your team culture like? Do you have shared goals and objectives? A supportive team culture can lead to improved patient outcomes, so talk to your colleagues if you think changes need to be made.

Think about you as an individual. Do you have the same goals and objectives as your team? How is your health and well-being? Taking care of your physical and mental health is vital for yourself and your patients.

Accepting advice from human factors and ergonomics professionals

HFE practitioners come from a variety of backgrounds, but it is a profession in its own right. HFE professionals work with the people in the system to help improve existing systems, and if their advice is sought early enough, they can contribute to the design of systems and processes to ensure these are safe.

One of the biggest barriers to these experts being able to help is the assumption that only healthcare professionals can know and understand what happens in healthcare.

We can learn a huge amount from industries such as aviation, but the notion held by some that ‘pilots don’t operate on people’ can prevent us from accepting help from HFE experts in this industry. Putting their experience in context is key.

How healthcare can learn from other disciplines

We need to adopt a collaborative approach and accept that people from outside healthcare can help us to improve what we do. As there are only a handful of qualified HFE experts employed in the NHS, we need to look to HFE experts from outside healthcare to help train us.

A human factors approach is key to improving patient safety – and the safety and well-being of staff, which is not always considered when we talk about HFE.

Learning about the fundamentals of HFE will enable health professionals to identify possible problems and signpost issues to the experts. Understanding how to apply the principles of HFE also now forms part of the Nursing and Midwifery Council’s standards of proficiency for registered nurses.

Non-technical skills are important, but HFE covers a lot more than communication and teamwork.


Find out more

The Chartered Institute of Ergonomics and Human Factors


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