Career advice

Human factor skills: how harnessing them helps nurses improve patient outcomes

Take control of challenging situations by understanding human factors in your team

Picture: iStock

Human factors play a part in our lives from when we wake up to when we go to bed. We use human factor skills every day, both in our work and personal lives. But what exactly are they and why is it important to understand their role in healthcare?

Human factors are, says the Health and Safety Executive, ‘environmental, organisational and job factors, and human and individual characteristics, which influence behaviour at work in a way which can affect health and safety.’ 

Human factors apply in the workplace and outside it too

As a trainer in human factor skills, I understand they can be difficult to apply to healthcare. But many of the things that make up human factors – such as teamwork, leadership, communication and workplace stress – will already be familiar to you in your work.

Human factor skills, which also include spatial and situational awareness, can be applied outside work too.

‘It was difficult to hear anyone behind the mask, there were alarms going off, I did not know who anyone was – everyone looked the same. I needed to regain control’

Take the rush-hour crush at the train station, for example, when it seems like the whole country wants to get to your destination. It is busy and packed, but have you noticed how no one touches each other? This is down to spatial awareness.

When finding a place to stand on the train, unconsciously you are applying situational awareness by using non-verbal cues, such as nods and eye contact, to get to your spot so you can get home.

Consider how human factors influence patient outcomes

If you apply this to healthcare, such as a cardiac arrest situation, a number of human factor skills need to be used to optimise the outcome for the patient.

There needs to be a leader and followers. This makes up the team, which needs to communicate with a flattened hierarchy to ensure conversation flows both ways, and situational awareness ensures the safety of everyone in the room.

We also use human factors skills in more everyday tasks, such as moving a patient. This still needs a leader, a team, effective communication and situational awareness.

Using human factor skills in nursing

  • Anyone can ask for a time out to establish people’s roles and who can do what. It doesn’t have to be the most senior member of the team, so don’t be afraid to do this
  • Extrinsic pressures are those around the task that can distract from it, like unnecessary alarms. Removing these pressures can reduce the stress from the situation
  • We need clear information when we are feeling stressed, so use clear and concise language. Tools like SBAR – Situation, Background, Assessment, Recommendation – are great for getting the message across
  • Good followers and leaders share the same qualities – effective communication, teamwork and situational awareness. You don’t have to be the team leader to successfully apply good human factors skills
  • Remember that it’s okay not to be okay. Self-care isn’t optional right now - we need time out, time to relax and recharge our batteries. Sharing our experiences through debriefing can also help us to stay focused


Tools for coping with changes imposed on clinical practice by the pandemic

The COVID-19 pandemic has meant significant changes to clinical practice. Working in a busy COVID-19 intensive care unit (ICU), with larger than usual patient numbers and nurses who don’t normally work in critical care, has brought every aspect of human factors into focus.

During a recent shift in ICU, a patient started to bleed from their tracheostomy. This was stressful for everyone involved, and even with my knowledge of human factor skills, I found it challenging.

All the right people were there, but they were wearing masks and long gowns with goggles. It was difficult to hear anyone behind the mask, there were alarms going off everywhere, I did not know who anyone was or who had what skills, and everyone looked the same.

A way of taking control when facing challenges

I needed to regain control, so after assessing the patient to make sure they were safe, I stepped back and put on my gloves and apron. This reduced my stress levels and gave me time to think of a plan away from the immediate environment.

Silencing the alarms and ensuring nothing was needed urgently removed some of the external – or extrinsic – stresses, such as noise and distraction.

I then asked someone to watch the monitor while we made a plan and asked for a time out so everyone could introduce themselves and tell me their job. This enabled us to make a plan and ensure everyone had a role in the procedure.

We allowed one person to talk, and anyone who had concerns could raise their hand to speak.  

What I learned in the process

  • Allowing one person to speak at a time while wearing a mask enhanced everyone’s concentration
  • Raising an arm to talk enabled clearer communication
  • Using the time out allowed for situational awareness to be built – everyone had a task and fed back to the leader, allowing the plan to evolve

Time outs take the stress out of a situation

Time outs are an easy human factor skill that can be used to reduce the stress and anxiety of any situation. They only take ten seconds but are a valuable way of gaining situational awareness and can be done by any member of the team.

Human factors are integral to our working lives. Understanding how they affect our actions is vital if we are to deliver the best care for our patients, support our colleagues and look after ourselves.

Stephen Cutler is a senior staff nurse in ICU at Guy’s and St Thomas’ NHS Foundation Trust, and a senior lecturer at the trust’s Nightingale Academy. He is on a year’s secondment to London South Bank University where he uses simulation to teach human factor skills to nursing students