Executive Summary
An approach called Safety II calls for more focus on human factors in preventing patient harm. It also can help eliminate unnecessary tasks that burden clinicians.
- Human beings should be seen as the greatest safety resource.
- Human factors engineers should be included in all safety improvement.
- Moving to Safety II may require disruptive leadership.
A better approach to patient safety can eliminate much of the useless and redundant tasks that burden clinicians and do little to avoid harm, says a researcher who encourages risk managers to consider the natural tendencies of people in the workplace. Human relationships should be a primary focus in patient safety efforts, says Edward R. Melnick, MD, MHS, interim research section chief and associate professor of emergency medicine at Yale School of Medicine in New Haven, CT. Melnick is co-author of a recent commentary in Mayo Clinic Proceedings promoting this approach.
Attention to human relationships can help eliminate some problems that contribute to the high rates of physician burnout while also protecting patient safety, he says.
The commentary advocates moving from the traditional approach to safety, which they call Safety I, to a framework called Safety II, in which a systems-based approach looks at safety as the presence of resilience rather than a system with no errors.
“It is based on the understanding that errors can and will always occur, no matter how well a system is designed,” Melnick and his co-authors wrote. “Rather than attempting to eliminate all errors, we should instead focus on creating systems that are able to not only anticipate and avoid error, but also adapt and recover from errors in a way that supports and leverages human capacity.”
The commentary is available online at https://bit.ly/3JDLL02.
“Safety I is kind of the older model for risk management and improving safety, in which you look often for the root cause of an error, uncover what that cause was, and try to fix that part of the system. Then you can prevent a future error with the Swiss cheese model for setting up a system where human error is more likely to be caught by another member of the team or the system itself,” Melnick says. “No one is saying that that’s going away, but certainly medicine historically has had a culture of blame and pointing out the errors of the human in the system. So Safety II is sort of flipping that a little bit, in terms of thinking more about how humans are actually the failsafe and that the system itself is imperfect as currently designed.”
Recognize Human Limitations
Healthcare organizations should be building systems that recognize human limitations but also their ingenuity and ability to be creative and to stop errors before they happen, he says. As opposed to seeing the human being as the source of error, Phase II emphasizes that human beings are the best resources for preventing that error, he says.
“I work in the emergency department, in the ER and our resources are vast but also at the same time limited. In so much of what I do, there’s opportunity for error at every step of the way, and based on my training, I’m catching a lot of it but also some of it is just the system is really not designed to catch everything,” Melnick says. “So, I’m doing a lot of creative thinking to try to get the right care for the right patient in that moment. It’s kind of counter to that Safety I of ‘let’s just build the system so that people don’t make mistakes’ if more people are bending over backwards to help the system to succeed.”
In addition, Safety II encourages the elimination of repetitive tasks and data entry that yield little for patient safety, he notes. Safety II encourages the design of systems that address not just the complexity of medicine but the complexity of the environment that medicine is delivered in, and what the role of the human plays in that environment, he says.
“What is the role of a human? Can we design an idea that might work, and before we deploy it, really engineer it in a human-centered way where we understand what the user’s needs are?” he says. “We need to build for those needs, test it, iterate upon it make it better, before deploying it.”
Integrate at Local Level
The concept of human engineering applies in many ways throughout the healthcare process, he says. Just the simple act of navigating through a hospital can be complicated for someone who is healthy and has a good sense of direction, but Melnick says a patient who needs to make it to a doctor’s appointment may have much more difficulty.
“It’s not just what they’re trying to do for one individual patient but how do they provide that care within the practice environment and balance the needs of that individual patient with the needs of the group of patients that they’re working with, and the team that they’re a part of,” he says. “It’s about thinking of that big picture in terms of the humans needs, function, and then the system itself.”
Melnick says human factors engineering should be more integrated at the local level within individual health systems. He notes that when building healthcare devices, a human factors engineer will be involved, but that should be the case for many other projects and risk management activities within a hospital or health system.
“Having a human factors engineer as a member of the local team, fully embedded into the team, is probably something that will eventually percolate into the world,” he says. “It’s tough because that sort of thing is up-front investment, and, right now, healthcare systems are still recovering from financial hardship from the pandemic. I’m a little bit skeptical that we’re going to see change soon unless people recognize the need to make that sort of investment.”
The move to Safety II and the incorporation of human factors engineering may require some disruptive leaders who are willing to invest in the change, Melnick says. “As a leader of a healthcare system, you want to be the place where patients want to go and you want that patient experience to be really exceptional,” he says. “You also want the best and brightest in your staff and clinicians. Being in a work environment where things are built for them to thrive should be a priority.
Source
- Edward R. Melnick, MD, MHS, Interim Research Section Chief and Associate Professor of Emergency Medicine, Yale School of Medicine, New Haven, CT. Email: [email protected].
A better approach to patient safety can eliminate much of the useless and redundant tasks that burden clinicians and do little to avoid harm, says a researcher who encourages risk managers to consider the natural tendencies of people in the workplace.
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