Understanding the Human Factor
F. Jacob Seagull PhD
Have you ever accidentally poured orange juice in your cereal instead of milk? Have you ever tried to drive from work to the store and ended up driving home by accident? Most likely you have. Have you ever accidentally put sugar into your shoes instead of talcum powder? Probably not. Why not? Because “mistakes” do not happen randomly when humans are involved—they occur in systematic patterns. Some are likely, some are not.
Understanding how people think allows us to understand the types of mistakes that they might make and the types that they are unlikely to make. The study of how people act in the context of work—including the mistakes that they make—is known as “human factors.”
Applying the principles of “human factors psychology” to the domain of anesthesia can create an environment in which a serious mistake is much less likely to occur. Giving the wrong drug should be like putting sugar in your shoes, not like putting juice in your cornflakes. Anesthesia has been at the forefront of human factors in the medical domain for a number of years, adopting safety initiatives, making continuous process improvements, and attaining advances that significantly reduced the likelihood of adverse events. Anesthesia has been singled out by the Institute of Medicine as the medical discipline that can serve as a model of “safety culture.”
The concept of human factors has its roots in aviation. It was first used by the U.S. Air Force to help push human performance to the limit in order to beat the enemy. The fighter pilots in World War II were surrounded by advanced cockpit technology in life or death situations—not entirely unlike an anesthesiologist in an operating room. By designing the pilots’ environment to support the task at hand, human factors helped give them the edge they needed.
The field of human factors is multidisciplinary, encompassing domains from psychology to engineering to anthropology to computer science and more. Many different aspects of human activity relevant to anesthesiology fall under the scope of human factors. A few of the more relevant aspects are described briefly in this chapter.
DECISION MAKING
People make decisions in a very different manner than computers. Instead of using precise calculations, people often use heuristics, or rules of thumb,
to decide what to do. Heuristics can be a powerful tool that lets a person make quick decisions when relevant information is incomplete or unavailable. Unfortunately, there are times when using heuristics may lead to systematic biases in decision making, or put more simply, can make a mistake more likely. Human factors psychology has examined a wide array of decision-making aspects, including heuristics and biases. Through the application of human factors principles, one can remediate many common biases, leading to better, safer decisions in critical anesthesia situations.
to decide what to do. Heuristics can be a powerful tool that lets a person make quick decisions when relevant information is incomplete or unavailable. Unfortunately, there are times when using heuristics may lead to systematic biases in decision making, or put more simply, can make a mistake more likely. Human factors psychology has examined a wide array of decision-making aspects, including heuristics and biases. Through the application of human factors principles, one can remediate many common biases, leading to better, safer decisions in critical anesthesia situations.
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