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A note on versions:The version presented here may differ from the published version or, version of record, if you wish to cite this item you are advised to consult the publisher's version. Please see the 'permanent WRAP url' above for details on accessing the published version and note that access may require a subscription.For more information, please contact the WRAP Team at: wrap@warwick.ac.uk ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P TResearch Highlights: Experience-based analysis of opportunities and challenges for using HRA in health  Considers reliability, performance variability, regulator, and patient role  HRA should have clinical engagement and patient participation  HRA cost-effectiveness should be rigorously evaluated  HRA can provide requisite imagination and build social safety infrastructure Abstract: Safety in healthcare is a relatively recent field, but has received considerable attention over the past 15 years. Healthcare organisations have been encouraged to learn from safety management practices in other industries. In this paper we analyse opportunities and challenges for the application of Human Reliability Analysis (HRA) in healthcare. We consider the poor levels of reliability of many healthcare processes, performance variability, the absence of regulatory frameworks that incentivise proactive risk management, and the unique role of the patient. We conclude that HRA could provide a useful framework for the analysis and reduction of risk in healthcare, but techniques might have to be adapted and applied with due consideration of the specifics of the cultural and regulatory context of this domain. This includes clinical engagement with and ownership of the HRA process, greater focus on rigorous evaluation of costeffectiveness of HRA techniques, and active involvement of patients.

This article describes the current status of the Success Likelihood Index Method (SLIM) approach to the quantification of human reliability in risk and reliability assessment. The technique has now been implemented using an interactive computer program called MAUD to give a stand‐alone package (SLIM‐MAUD) which can be easily used by engineers without specialist knowledge of human reliability assessment. The article describes the use of the technique to provide design recommendations. The application of SLIM‐MAUD to a series of nuclear power plant tasks is described.

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