Wednesday, 30 April 2014

Book of the month: Human Factors in the Healthcare Setting (Fortune, Davis, Hanson, Phillips (eds))

About the associate editors

Peter-Marc Fortune is a consultant paediatric intensivist, chair and editor of the Advanced Life Support Group (ALSG) Paediatric and Neonatal Safe Transport and Retrieval Course (PaNSTaR) & ALSG Human Factors Group. Mike Davis is the lead educator at ALSG. Jacky Hanson is a consultant in emergency medicine, and Barbara Phillips is a consultant in paediatric emergency medicine and director of ALSG.

About the contributors

The contributors include three of the associate editors (not Barbara Phillips) and Simon Carley (Emergency Medicine, Manchester), Trevor Dale (Co-Founder and Managing Director, Atrainability), Sue Norwood (Training & Development Manager at Global Air Training) and John Rutherford (Anaesthesia, Dumfries).

Who should read this book?

This book is intended for clinical instructors on the ALSG courses and at 95 pages it can be read in a day.

In summary

The book is split into 11 chapters, so the time-poor could jump straight into the chapter of interest:
  • Introduction to human factors in medicine
  • Human cognition and error
  • Situation awareness
  • Leadership and team working
  • Personality and behaviour
  • Communication and assertiveness
  • Decision making
  • Fatigue and stress
  • Key elements in communication: briefing and debriefing
  • Organisational culture
  • Guidelines, checklists and protocols
Most chapters follow a structure of: Introduction & Aims, Background Concepts, Practical strategy & application, Summary.

What's good about this book

This book provides an overview of human factors and its relevance to healthcare. The important players (Flin, Reason, Gaba, Vincent, Salas, St Pierre, Helmreich) and important literature (To Err is Human, An Organisation with a memory, Crisis Management in Acute Care Settings) are referred to.
The book provides the reader with some of the HF vocabulary which will allow her to talk and think about the issues with others. Because of the wide readership this book will enjoy, the fact that these terms will be adopted into clinical language must be a good thing.

What's bad about this book

The book feels slightly cobbled together perhaps because of the number of authors and the lack of a concluding chapter (there is instead an anthology of cases from the editors' own experiences). It also starts off badly in the preface with the following described as the aims:
  • an understanding of the contribution of training in human factors on patient safety
  • an awareness of how this might impact on practice in a variety of settings
The first bullet tells us that we will understand how training in human factors contributes to patient safety, the second bullet point is unclear in terms of what "this" refers to… Is it the understanding? The training? Or patient safety?

"HF is a scientific
The preface then continues by contrasting Ben Goldacre's view of science/evidence-based medicine, with human factors 'science' and goes on to say that "human factors are not science" which will come as a surprise to human factors scientists.

Chapter 1 goes on to tell us that: 
"Medical error, in this book, will be reworded as clinical error - meaning any error that has occurred in the clinical treatment of a patient." 
But then in the same paragraph tells us:
 "An error is any mistake that has occurred: they are specifically defined as clinical (technical) or human (non-technical)."
So clinical error is both a technical error and medical error?

Additionally, although the book does provide a multitude of stats, these can at times be confusing, e.g.:
"It has been found that almost 50% of errors can be due to a cognitive failure…This has led to death or permanent disability in 25% of cases (Wilson et al. 1999)" (and the volume number in the reference is wrong)
What Wilson's analysis of the Quality in Australian Health Care study showed was that 16.6% of hospital admissions were associated with an iatrogenic patient injury, in 57% of these cognitive failure had a role and in these 24.5% led to permanent disability or death. So in 1995, about 2% of people who were admitted to hospital suffered permanent disability or died due, in part, to cognitive failure.

The book also mentions systematic errors such as the post-completion error. The example provided is leaving your card in the cashpoint machine after withdrawing cash. This is a particularly poor example as cash machines have been specifically designed with this error in mind and therefore do not give you your cash until you have withdrawn your card. A better example would have been the "original on the photocopier plate" error.

Lastly and perhaps most worryingly, the book states that "some people are born leaders" (p.28). I am sure that Anders Ericsson would disagree, but perhaps there are some people who think they are born leaders.

Final thoughts

This book is not a bad start for the ALSG. However given the number of people for whom this will become the bible of human factors an improved second edition (where is the mention of feedback loops?) should be published fairly rapidly.

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