Awareness of the importance of attitudinal, interpersonal, cultural, and other non-technical factors in the achievement of safe outcomes in health care is growing. Interest in the applications of human factors approaches to medical care is high. The aviation industry has dramatically improved its safety record over the past 20 years through the design and implementation of a training program widely known in as "Crew Resource Management" (CRM). CRM is based on identifying and dealing with human limitations through skills such as teamwork, communication and situational awareness. There is a growing body of evidence to suggest that the application of CRM skills to healthcare may measurably improve patient safety.

This paper demonstrates the successful adaptation of human factors and CRM skills from the aviation industry to the healthcare industry. The paper discusses the

  • "burning platform" (1999 IOM Report) that readied our organization to reach outside of health care. and the subsequent partnership with aviation through the University of Texas.

  • step by step process of designing and implementing human factors interventions across a large integrated healthcare delivery system (including tools).

  • key factors needed for successful implementation.

  • current human factors projects within our organization.

  • some post implementation results and updates

  • weaving of human factors/CRM into the fabric of the organization.

  • research necessary for wider acceptance of human factors approaches in health care.

Medicine - A High-Consequence Industry

Human error is inevitable. A 1999 IOM report estimated 98,000 patient deaths a year as a result of medical error. We know why error occurs-human beings have limitations. We are bounded by limited memory, constraints in the ability to process multiple demands, stress exacerbated fixation on task, and human physiological and psychosocial needs for sleep, nutrition, safety, esteem and belonging. These limitations are magnified by poor group dynamics, cultural differences, unrealistic attitudes, experience, and other issues such as staffing and work environment.

Human Limitations (available in full paper).

The delivery of medical care involves the integration of many people in many roles within a complex and ever-changing environment. The players within the healthcare delivery team come from a wide diversity of experiential, cultural, gender, training and role expectations. Layer in great power distances that result from a hierarchical culture. Finally, add a rapidly changing technological and innovative environment which challenges care providers to adapt to the new equipment and procedures. The result is a highly fluid and complex care environment that sets us up for error. Complicating the matter even more is the culture of silence in which healthcare operates. Error has historically been viewed as a direct reflection on competence. The belief was good doctors, nurses, technicians don't make mistakes. If we could learn one thing from aviation, it is everyone is fallible; the best pilots have committed error with tragic results. In 1978, United Airlines flight 173 was flown into the ground as the crew fixated on a landing gear light. The plane ran out of fuel.

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