Wednesday, 28 October 2015

Book of the month: Human Factors and Behavioural Safety by Jeremy Stranks

About the author

According to the book's blurb Jeremy Stranks "has 40 years' experience in occupational health and safety enforcement, management, consultancy and training." Stranks is the author of a number of books on health and safety, including "The Handbook of Health and Safety Practice" and "Stress at Work: Management and Prevention".

Who should read this book?

The book will be of use to simulation centre directors and managers. Specific chapters may be interesting for others involved in simulation-based medical education.

In summary

The book consists of 19 chapters:

  1. Human behaviour and safety
  2. Human sensory and perceptual processes
  3. Organizations and groups
  4. People factors
  5. Perception of risk and human error
  6. Organizational control and human reliability
  7. Improving human reliability
  8. Ergonomic principles
  9. Ergonomics and human reliability
  10. Principles of communication
  11. Verbal and nonverbal communication
  12. Written communication
  13. Interpersonal skills
  14. Systematic training
  15. Presentation skills
  16. Health and safety culture
  17. Change and change management
  18. Stress and stress management
  19. The behavioural safety approach

What’s good about this book?

How many criteria does your sim centre/programme meet?
Stranks provides good descriptions of theories which may be unfamiliar to healthcare professionals. Herzberg's two-factor theory of job (dis)satisfaction (p.10) argues that the basic needs of employees, "hygiene factors", need to be met before job satisfaction can be improved through "motivators". For example, an employee is unlikely to be satisfied with having a challenging job if her supervision  and working environment are poor.

McGregor's Theory X and Theory Y (p.73) are also explored. Theory X says that people don't like to work and will not work unless coerced. Theory Y says that people will work if they are provided with the right environment in which their inherent motivation will emerge. Stranks also provides an overview of other concepts more familiar to simulation and human factors personnel such as Rasmussen's model of behaviour (p.123), error classification (p.127), the Swiss cheese model (p.130) and others.

Stranks provides a good overview of the elements and implementation of a behavioural safety programme including significant workforce participation, a data-driven decision process and peer-to-peer monitoring (p.28-29). He also drives home the need for "clear and evident commitment from the most senior management downwards, which promotes a climate for safety..." (p. 93) A need which is evident (and largely unmet) in healthcare.

Hale and Hale (1970)
Stranks describes accident prevention strategies and classifies them according to whether they are pro-active or reactive. Proactive strategies include "safe place" and "safe person" (p. 43). This concept may also be applied to healthcare. The safe place aims to ensure that the the premises, the equipment, the processes, etc. are safe. The safe person refers to behaviour, vulnerable people (e.g. those lacking in experience) and personal hygiene (e.g. hand washing).

A number of chapters are of interest to simulation faculty and those involved in research, including the chapter on risk perception. Simulation faculty may find that Hale and Hale's model of human performance in relation to accident causation (p. 112) could provide a structure to a debrief analysis.

What’s bad about this book?

The lack of referral to references makes the book more difficult to read than it need be. For example, on page 15 Stranks states: "Most people can only take in and retain 3.1 'bits' of information at any one time." This is probably a reference to Miller's seminal "The magical number seven, plus or minus two: Some limits on our capacity for processing information". However Miller's paper refers to 3.1 bits only for some types of data, such as "hue" and "pitch and loudness". A similar problem occurs on p.26 when Stranks provides a (long-winded) definition of human factors. It is unclear if it is his own or from elsewhere.

Stranks talks about some concepts (e.g. task fixation, alarm fatigue) without referring to their titles. This makes it more difficult for the novice to link Stranks' writing with prior knowledge. Some of the concepts are poorly explained (such as fault tree analysis (p.40) and the total working system (p.213)) and occasionally the Figures are unclear (e.g. Figure 7.1, p.169). Some concepts are superficially covered but then not linked to anything else (e.g. Learning styles, p.174) and the chapters could generally have better introductions to show the logical flow of argument/idea. 

Stranks uses human factors in the plural: "What are human factors?" (p.90) and singular: "Human factors has an important role..." (p.100). He uses the term "ergonomics" to mean the scientific discipline. While this may be purely semantic, it would probably be clearer to define the terms and then stick to those definitions.

Stranks states that "The ultimate objective (for engineers) is to design equipment which requires the least physical and mental effort on the part of the operator" (p.208). One could argue that this is not true. The equipment should probably require just enough mental effort to keep the operator "in the loop" and engaged.

Stranks argues that "The use of posters... repeating a specific message are important features of the safety communication process" (p.275). This is argued against by a number of human factors experts including Terry Fairbanks (see urinal pic).

Lastly, the entire chapter on Presentation skills (chapter 15) should be skipped. If this is a problem then there are much better books out there such as "Talk Like Ted".

Final thoughts

The entire contents of Stranks' book will not be of interest (or use) to the majority of people working in simulation-based medical education. However it may be of use to managers and directors and to people involved in clinical human factors. In addition, some chapters may be of interest to a wider audience and therefore a glance at the chapter headings may be worthwhile. Reading it with a "clinical" mindset, one can appreciate that the progression in safety management systems, the changes in culture required, and the elements and implementation of a behavioural safety programme are, with minor modifications, relevant to the healthcare environment.