Introduction
Most healthcare professionals can remember a time where they left a shift thinking that the near miss they just encountered had nothing to do with anyone’s clinical knowledge. If you remember such a scenario, then you’ve already had an encounter with human factors. The textbooks may tell you that human factors refer to the interactions between doctors as humans and the rest of the system they work in. But the way we see this everyday includes those ward rounds that never get finished without repeated interruptions or the resident doctor who spots a mistake but doesn’t feel able to speak up to the consultant.
None of this is about clinical acumen or drug doses. It is about people and the system they work in, which is now consistently cited as the largest contributor to avoidable harm in the NHS. Trusts are now waking up to this fact in their pursuit of keeping patients safe and supporting their teams. Candidates are now increasingly turning up to job interviews and being asked about their interactions with human factors and error.
So this guide is all about explaining what human factors mean (in a clinical context), why you are seeing the phrase pop up so regularly and how you can start building the skills needed.
What Are Human Factors in Healthcare?
Often with human factors, it is best to begin with what it isn’t. It isn’t a euphemism for “human error” in the sense of blaming people. Rather, the discipline aims to ask “what about the system that humans operate in that makes the mistake easy to make?”. It would be unfair to simply label your tired registrar who misreads the drug chart at three in the morning careless. They are operating in an environment shaped by repeated interruptions, precarious staffing levels and huge cognitive load. Human factors give you a neat way of looking at all that.
The Clinical Human Factors Group defines it as the organisational, individual, environmental, and job related characteristics that influence behaviour in ways that can affect safety.
Sometimes you might hear the term, non-technical skills used interchangeably with human factors. It describes the specific behavioural skills a clinician may need to navigate day to day life, such as situational awareness, decision-making and communication.
The Anatomy of Human Factors
So far we have listed what some of these human factors may look like and their importance to your practice. If you are convinced of their importance then the next place to go is in understanding the components of human factors and where they are seen in practice.
Imagine for a moment that the Surgical registrar’s afternoon clinic is running incredibly late, with a queue of patients filling up the waiting room. You have a stack of results and notes to check before each patient. Do you compromise on thoroughness in the interest of speed? This kind of environment is typical in the NHS and is exactly the type where important findings get missed. Not through carelessness, but because our attention is finite and is being pulled in multiple directions at once. What the surgical registrar does next is all about situational awareness and that is the first element we will cover in our overview of human factors. This is all about perceiving what’s happening around you and having an ability to anticipate what could happen next.
Situational awareness will only get you so far without the next skill which is decision-making under pressure. Once the surgical registrar has noticed the queue building and the results piling up, they still have to decide what to do about it; either see everyone at the usual pace and risk running hours over, ask a colleague to help, or triage and see the most urgent cases first. None of these decisions are objectively correct, and that is the point. Structured approaches exist because they can take some of the pressure off in moments of judgement. Simple frameworks such as “gather information, generate options, decide and review” stops our surgical registrar from either freezing or acting on the first decision that comes to mind.
Communication and team work is perhaps one of the more conspicuous examples of human factors given the huge push for practices such as SBAR handovers and WHO surgical checklists. These tools don’t exist because someone thought paperwork and documentation is missing from your day, but because communication that is unstructured is where information gets lost. Verbal handovers where the number of patients totals double figures, the notes are half written and a bleep goes off mid sentence is a perfect set up for something to slip through the cracks.
Finally lets cover managing fatigue and workload. This is the area most healthcare professionals are often most reluctant to admit applies to them. Yet the evidence doesn’t care about egos. Cognitive performance after a run of night shifts drops in ways that are comparable working over the drink-drive limit. You don’t need to be exhausted to be affected, even moderate sleep deprivation slows decision making and narrows attention. When we do human factors training we don’t tell clinicians to just ‘be more resilient’, we recognise fatigue is a predictable risk factor and build in safeguards for it, such as asking a colleague to double check a drug calculation at 4am or handing over a task rather than pushing through it alone.
Practical Tools You Can Start Using Right Now
Structured courses can help you use tools consistently and confidently, but you can start by applying human factors thinking at home or at work. Here are a few starting points:
Notice your own state: Take a minute in the middle of your shift to notice how you are doing. Are you fatigued, hungry or stressed? It sounds like a simple question, but you’d be surprised how rarely we stop to notice the signs our body is giving us. Naming how you are feeling is a legitimate safety behaviour to yourself and your team.
Treat near-misses as data: some specialities adopt a better culture than others when it comes to ‘near misses’. Some specialties, such as radiology have built in sessions where residents reflect on difficult cases and near misses. You can just as easily do this with your own practice. A near miss is a free lesson about where your personal system could do with improvement.
Build in a brief and debrief: Before a busy shift or a complex procedure, taking two minutes as a team to agree roles or flag concerns can set expectations. Afterwards, a short debrief of what went well and what didn’t turns the experience into learning.
Use closed-loop communication: Chances are you have heard this one before. When instructions are handed over, ask the recipient to repeat it back or confirm they have heard it. It takes seconds and closes one of the most common shortcomings in clinical communication.
You can achieve a reasonable amount from reflecting and really trying to practice the tools above. But if you are serious about implementing the tools necessary to improve your practice then structured human factors training has real advantages. It can give you realistic scenarios and protected time to practice these skills, and importantly some CPD credits and a formal certificate you can point to in a portfolio or interview to evidence your learning.
If you are looking for something specifically built around real NHS scenarios run by NHS clinicians with a background in education and professional development training, then Medset’s Human Factors in Healthcare course is a CPD accredited, one day online course covering human error, situational awareness in healthcare, decision-making, team work and crisis management.
Whichever route you take, we recommend looking for a few things: CPD accreditation, teaching led by clinicians who understand NHS working conditions rather than a generic corporate safety course, and a format that’s genuinely engaging rather than a tedious webinar.
Frequently Asked Questions
Do you honestly think human factors knowledge will help me at speciality interviews?
Very often, the answer is yes. It is hard to come by any specialty interview these days that does not include a patient safety or teamworking scenario. If you are a candidate who can confidently talk about systems thinking, situational awareness and structured communication, assessors will score you highly. This is especially the case if you can point to a formal human factors for healthcare professionals course that you have undertaken. Remember to always check the current person specification and interview format for your specific speciality before your interview, as they change year on year.
Is human factors training mandatory for doctors in the UK?
The short answer is no. There is no blanket mandate to have a formal certificate to say you have partaken in a human factors course for doctors. However, the principles of human factors are embedded in GMC training standards. You will no doubt hear them mentioned in your trust inductions and mandatory training programmes, and increasingly in speciality curricula. Many doctors therefore complete dedicated human factors training as part of their portfolio or for leadership roles.
Who should do human factors training? Is it just for doctors?
Absolutely not. Human factors apply to anyone who is directly or indirectly involved in patient care. This includes nurses, midwives, physician associates, advanced clinical practitioners, allied health professionals and managers with a patient safety remit.
How would you recommend I go about learning about human factors before I do a full course?
Start by applying a couple of the tools in this guide on your shift. Communicate in a closed loop fashion, have a two-minute team debrief before something complex and take a couple minute break on your shift to notice the signals your body is giving you. Once you have done that, a structured course can get you there faster and more consistently by giving you realistic scenarios and protected time to practice.
