Increased concern for patient safety has put the issue at the top of the agenda of practitioners, hospitals, and even governments. The risks to patients are many and diverse, and the complexity of the healthcare system that delivers them is huge. Yet the discourse is often oversimplified and underdeveloped. Written from a scientific, human factors perspective, Patient Safety: A Human Factors Approach delineates a method that can enlighten and clarify this discourse as well as put us on a better path to correcting the issues.
People often think, understandably, that safety lies mainly in the hands through which care ultimately flows to the patient—those who are closest to the patient, whose decisions can mean the difference between life and death, between health and morbidity. The human factors approach refuses to lay the responsibility for safety and risk solely at the feet of people at the sharp end. That is where we should intervene to make things safer, to tighten practice, to focus attention, to remind people to be careful, to impose rules and guidelines. The book defines an approach that looks relentlessly for sources of safety and risk everywhere in the system—the designs of devices; the teamwork and coordination between different practitioners; their communication across hierarchical and gender boundaries; the cognitive processes of individuals; the organization that surrounds, constrains, and empowers them; the economic and human resources offered; the technology available; the political landscape; and even the culture of the place.
The breadth of the human factors approach is itself testimony to the realization that there are no easy answers or silver bullets for resolving the issues in patient safety. A user-friendly introduction to the approach, this book takes the complexity of health care seriously and doesn’t over simplify the problem. It demonstrates what the approach does do, that is offer the substance and guidance to consider the issues in all their nuance and complexity.
Medical Competence and Patient Safety
Competence as Individual Virtue or Systems Issue?
Why the Difference in Competence Assumptions?
Good Doctoring and the Pursuit of Perfection
Standardization and the Fear of Scientific-Bureaucratic Medicine
The Expectation of Perfection versus the Inevitability of Mistake
The Problem of "Human Error" in Healthcare
Numbers Are Strong
The Human Factors Approach
Human Error as Attribution and Starting Point
"I Knew This Could Happen!"
The Local Rationality Principle
Cognitive Factors of Healthcare Work
New Technology, Automation, and Patient Safety
The Substitution Myth
Evaluating and Testing Medical Technology
Safety Culture and Organizational Risk
Safety Culture and Drifting into Failure
Risk as Energy to Be Contained
Risk as Complexity
Risk as the Gradual Acceptance of the Abnormal
Risk as a Managerial or Control Problem
Practical Tools for Creating Safety
Safety Reporting and Organizational Learning
Adverse Event Investigations
Human Factors and Resource Management Training
Briefings and Checklists
Accountability and Learning from Failure
Learning and Accountability—Just Culture
Criminalization of Medical Error: A Growing Problem?
The Second Victim
New Frontiers in Patient Safety: Complexity and Systems Thinking
Complicated versus Complex
Newton, Components, and Complexity
The Cartesian-Newtonian Worldview and Adverse Events
About the author: Sidney Dekker (PhD, The Ohio State University, 1996) is Professor and Director of the Key Centre for Ethics, Law, Justice and Governance at Griffith University, Brisbane, Australia. He was previously Professor and Director of the Leonardo da Vinci Center for Complexity and Systems Thinking at Lund University, Sweden, and Professor of Community Health Science at the Faculty of Medicine, University of Manitoba, Canada. He has been Visiting Professor at the Alfred Hospital in Melbourne, Australia. He recently became active as airline pilot, flying the Boeing 737.
"User-friendly and well written, this book takes the complex nature of healthcare seriously and pulls no punches. It demonstrates what the human factors approach can and does do, providing excellent examples to tease out the subtleties of this fascinating subject."
—The RoSPA Occupational Safety & Health Journal, June 2012
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