On the application of Human Reliability Analysis in healthcare: Opportunities and challenges

Abstract

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.

Application of the Structure Function in the Evaluation of the Human Factor in Healthcare

“…One of the interesting perspective applications of HRA methods is analysis of medical errors [32,[36][37][38][39][40]. Failures in healthcare are called medical errors, such as if a patient's condition worsens, or the patient contracts an illness.…”

“…The impact of the human factor on the reliability of medical devices is discussed in [40]. A detailed analysis of the specifics of medical error analysis and the efficient of well-known HRA methods in healthcare are provided by the authors of [38]. As documented in [41], 4 in 10 patients worldwide are harmed during primary and outpatient health care, and the cost of medical errors has been estimated at USD 42 billion annually.…”

“…It is logical to assume that application and adaptation of typical HRA methods in the healthcare domain serve this goal. However, healthcare is very specific domain for HRA method application, as shown in [32,38]. There are differences in organizational and institutional contexts, and the values and needs of stakeholders in healthcare (such as clinical and professional autonomy), as well as methods from other industries, have to be adapted appropriately.…”

“…Investigations into patient safety and medical errors based on the use of HRA methods are named the "technical" approach. Reviews of HRA method applications in healthcare [38,47] show a restricted development of these methods in healthcare. These reviews primarily show the potential for HRA method applications in medical error analysis.…”

Harveian Oration 2018: Improving quality and safety in healthcare

“…68 , 69 As one example, many systems engineering techniques that are common in other industries remain surprisingly little-used. 70 Similarly, though there has been a rapid increase in the number of improvement practitioners in the NHS, the same cannot be said of people with human factors and ergonomics expertise. NATS (the air traffic control service), with a staff of 4,500 people, employs 25 human factors practitioners.…”