Human factors and ergonomics in the operating room

Defining human factors and ergonomics

Human Factors/Ergonomics is the application of psychology and physiology for the purpose of designing products, processes, and systems with the purpose of increasing safety and comfort for the human that interacts within the product, process, or system and is divided into physical, cognitive, and organizational ergonomics. While “ergonomics” is the term commonly used throughout the rest of the world, North America differentiates the terms “human factors” and “ergonomics” to cover the cognitive/organizational and physical ergonomics. The term “human factors” tends to include cognitive and organizational ergonomics while “ergonomics” refers to physical ergonomics. Cognitive ergonomics includes the psychosocial attributes of the work system including workload, reliability, stress, communication, etc. Organizational ergonomics includes the optimization of the work system within the organization's mandatory structures, policies, and processes. Physical ergonomics is concerned with the biomechanical attributes within a work system and the effects of that work system on the human body.

Because much of this book focuses on cognitive and organizational ergonomics (human factors) as it applies to safety in the operating room (OR), this chapter will focus on the physical and biomechanical ergonomics, with only small sections on human factors to compliment the other chapters.

Ergonomics is concerned with the optimization of performance. Optimization occurs through examination of the biomechanical and physiological capabilities of the worker, their limitations, and the development of an environment or work system that supports performance while decreasing injury as much as possible. The goal of ergonomics is to achieve the optimal compatibility between human, system, and environment. ^,

The goal of ergonomics suggests that rather than forcing an employee to conform to a limited or compromising work environment, that the employee either be selected for a job which is tailored to his/her individual skills and abilities or the work environment be tailored to the employee's physical abilities. Simply said, the goal is to “fit the task to the individual, not the individual to the task.” In this way ergonomics places emphasis on the work system, the job design, and the adaption ability of the worker. Ergonomics carefully balances employee safety and employee capability, while advancing the company's productivity. Understanding this principle, healthcare has transitioned from the triple aim including population health, patient experience, and cost to a quadruple aim which adds staff satisfaction, wellness, and/or safety as one of the four aims. In this manner, the healthcare industry commits to protecting their staff mentally, physically, and emotionally by creating systems and environments that support well-being.

Human factors and ergonomics in healthcare

Many high-risk industries, such as aviation and nuclear power, have relied upon human factors principles to reduce human error and react quickly to errors within the system to prevent failure. With the publishing of the Institute of Medicine's report, To Err is Human: Building a Safer Health System, it was demonstrated that preventable errors within healthcare were no the result of poor performance but were instead insidious systematic failures that had gone unaddressed. Since the publication, the healthcare industry and human factors field have begun integrating. Some well recognized areas of application of human factors principles include improving the human and computer interface within electronic health records, usability designing and testing for medical equipment, implementation of checklists and memory aids, analysis of task saturation and over loading on providers, process analysis to improve efficiency and decrease risk, improved communication, and root cause analysis investigation, team skills and training, team and organizational culture change, and more.

Addition of a human factors practitioner within the hospital's quality and safety department can provide the facility with a new lens to improve patient care, patient satisfaction, and providers' safety and well-being. Practitioners and researchers in the field have varied backgrounds and education levels ranging from the certificate level through doctorate degree. All healthcare workers can benefit from having a basic understanding of how human factors influences their daily tasks and as such, some nursing and residency programs have begun including human factors as part of the curriculum. ^, However, having an embedded human factors practitioner or team within a hospital provides the opportunity to build trust, promotes the use of multidisciplinary teams, creates transparency, and supports continuous outcomes measurement and planning.

The effects of poor physical ergonomics