“…The HFACS framework has been applied in retrospective incident analysis across numerous high-risk, high-reliability industries including aviation ( Li et al, 2008 , Li and Harris, 2013 , Wiegmann and Shappell, 2003 ; Zhou at al., 2018), maritime ( Chauvin et al, 2013 , Griggs, 2012 , Yıldırım et al, 2019 ), rail ( Baysari et al, 2008 , Madigan et al, 2016 , Reinach and Viale, 2006 ), mining ( Lenné et al, 2012 , Patterson and Shappell, 2010 ), oil and gas (Gholam Abbas et al, 2018; Theophilus et al, 2017 ), process safety management ( Theophilus et al, 2018 ), natural disaster management ( Brooks et al, 2018 ), and construction ( Sun et al, 2011 , Xia et al, 2018 , Ye et al, 2018 ). More recently, HFACS has been applied in the context of tertiary healthcare service delivery in hospitals ( Diller et al, 2014 ), surgery operating rooms ( Cohen et al, 2018a , Cohen et al, 2018b ; ElBardissi et al, 2007 , Thiels et al, 2015 ), pre-hospital emergency medical services ( Hughes et al, 2013 ), anaesthesiology incidents ( Neuhaus et al, 2018 ), trauma care ( Cohen et al, 2018a , Cohen et al, 2018b ), and in patient safety studies ( Hoffman et al, 2013 ).…”