Human factors in medicine

Most people who drive consider themselves good drivers, and they probably are when you consider the way the car as a machine is handled. However, road rage is not a good quality and you can see good drivers disgrace themselves by becoming unreasonable, rude and even violent when things don't go their way. This is bad driving in my view.

Aviation accidents can happen to even the best pilots, and taking aside environmental factors, weather, aircraft malfunction and ground instruction errors, there is still a significant part that is due to human factors. 70% of aviation accidents involve some element of human error. (1) These include a wide group of behaviours such as performing checklists from memory, errors of computer input, misunderstanding of data and visuals, and decision-making that increases risk. There is then the huge area of how the relationship dynamics of the team affect performance. Errors are always multifactorial, but the human factors make up a much larger part of the story than pilots imagine.

A study by Sexton et al (2) compared aviation human factors to those in an operating theatre and found that consultant surgeons grossly underestimated the effects of fatigue on their performance, compared to anaesthetists - pilots were the best at respecting fatigue as a factor. Similar results were found with the performance of the surgeons predicting their ability to make decisions under the stress of an emergency, and their ability to put aside personal problems. These results continued into attitudes to teamwork and hierarchy within teams, with a significant finding that juniors’ responses were less heard and acted upon than in aviation situations. The overall finding was that surgeons and others in operating theatres did not accept or expect errors, and that the culture of managing errors was fraught with the human factors of personalities and attitudes.

The aviation industry has improved safety in flying amazingly, and we would do well in medicine to learn from them, and to accept that we are all human, that we think we are stronger than we are, that teams must be equal, and that working as a team that helps and respects its members is a safer and less stressful place to be.

Looking back on clinical events that did not work out well, I can see the failings in my own actions, and how to prevent them happening again. I can now see how stressed and unreasonable I was when at the time, I thought I was in the right and being helpfully assertive. The tongue is a two edged weapon to be controlled at stressful times. I am sorry now about how I behaved and hope to have learned from the reflection of the event.

Take a moment when things are stressful next time to consider the human and relational factors that are acting at the time, acknowledge them, say them aloud and allow the team to adjust and love each other, for the sake of the patients’ safety and good health.

References:

1.  Helmreich, 2000 BMJ On error management: Lessons from Aviation. 320: 781-785
2. Sexton, Thomas and Helmreich, 2000 BMJ Error, stress and teamwork in Medicine and Aviation.  320: 745-9