Human Factors in Patient Safety - Fellowship Update 1

View of Downtown Baltimore from the roof of my apartment.

View of Downtown Baltimore from the roof of my apartment.


As my ST4 year draws to a close, I am fortunate enough to be spending the last few weeks of it in Baltimore thanks to Medic One and The Robin Mitchell Fellowship. I was awarded the fellowship back in February and I have been hotly anticipating the opportunity to have time to develop myself, learn something new and ultimately share my experiences with my colleagues. I am coming to the end of my first week and wanted to tell you about where I am and what I have been up to…

Baltimore, known fondly as “Charm City” is a major city in Maryland with a long history as an important seaport. The population is approx 600,000 compared to Edinburgh approx 480,000. Currently the weather is hot and humid reaching 35 degrees most days. The city is steeped in culture, has beautiful architecture and is renowned for its seafood such as crab and oysters. It is also home to amazing academic institutions like Johns Hopkins University which is one of the top ranked universities to study medicine in the United States. 

Since arriving in Baltimore I have come to understand that things are complex here and the word “diverse” springs to mind. The city has a significant problem with violence, crime and drugs. It is known as the heroin capital of the United States. To be more prepared for this aspect, I probably should have taken Dr Carter’s recommendation and watched “The Wire” before arriving! Top tip from the taxi driver: avoid areas with small blue flashing lights on the top of the street lights as this indicates a high crime area. There are well documented health disparities and inequalities not only within Baltimore but also when comparing the population of Baltimore to the rest of the United States. This is clear to see just walking around the city. 

The aim of my trip was to get exposure to and learn about a peer-led resilience programme (RISE) that is offered to hospital staff experiencing stressful events at Johns Hopkins, experience another health care system with observation in the Emergency Department at Johns Hopkins Hospital and to attend the summer institute course on Human Factors and Patient Safety at the Bloomberg School of Public Health of The Johns Hopkins University. 

My experience to date in the field of human factors is mostly through simulation training, where there has been an emphasis on situational awareness, team dynamics, effective leadership and communication.  As a department we also discuss cases at our monthly M&M meetings and when looking at why things have gone wrong or our performance has been suboptimal we often reference Reason’s Swiss cheese model of accident causation. Throughout my training so far there is also frequent reference to high-performing industries such as aviation, their approach to safety and how healthcare can learn from such industries. I was interested to learn more about human factors and the concept of human factors engineering, changing the system and the processes to “designs out” errors. The science of human factors accepts that healthcare professionals, like all humans, make errors. Human factors experts focus on designing systems that make it “easy to do things right and hard to do things wrong.” 

During my first week in Baltimore I attended the human factors in patient safety course. This was a three-day course and was essentially a condensed version of the year long course. The course was predominantly delivered by Dr Ayse Gurses and Dr Mike Rosen. Dr Gurses is the Director of the Armstrong Institute Centre for Health Care Human Factors. She is a human factors engineer with expertise in patient safety, healthcare technology design and usability evaluation. Her areas of interest include transitions of care/handovers and working conditions for nursing staff. Dr Rosen is a human factors psychologist with special interest in the areas of teamwork and patient safety as well as simulation-based training, performance measurement and quality and safety improvement. The class was small with only 10 students, most of which were taking the course for credit as part of their masters or doctorate in public health. Only one other student was a practising medical doctor. Everyone was friendly and most were coming to the course and “human factors” from a different perspective which really helped contribute to in class discussions and learning. 

I turned up on day one having completed the required pre-course reading of almost 30 different papers!!! Initially I was nervous and felt very out of my depth. It was all seeming very “academic” and the last time I had read actually read a anywhere near that many papers was studying for the dreaded critical appraisal exam! As I soon learnt, reading the papers served as a bit of background to the various topics which were covered in lectures throughout the course. These included an overview of human factors engineering (HFE), physical ergonomics, cognitive ergonomics, teamwork in patient safety, macro-ergonomics, introduction to HFE methods, retrospective and prospective risk assessment methods and an overview of organisational theory. Throughout the course we worked in pairs to critically appraise a paper of our choice related to the application of human factors principles in a healthcare setting which was presented on the final day. We also worked in two groups over the three days on a project applying human factors engineering principles to a real life clinical problem. Again this was presented on the final day as a PowerPoint presentation. 

By the end of the course I came to realise that this topic is vast and that the course only really scratches the surface. I have a better understanding of the importance of human factors engineering when it comes to designing safe healthcare systems. I felt that I could contribute with some real experience of frontline healthcare to the class and have some understanding of the challenges of working in such a complex environment. I am by no means now an expert in the field of human factors but I have definitely learnt some essential concepts, methods and tools which can be applied to patient safety interventions and quality improvement efforts. It also has me wondering if NHS Lothian has any human factors specialists, something I must look into on my return. Hopefully this is something that I will be able to continue developing and learning about throughout my training. It was thoroughly enjoyable to take some time to learn something new, not for an exam, but just out of interest.

Anyway, I will update you all soon on the next week of my adventure. I hope you are enjoying the wonderful weather in Scotland and that the department is less busy as a result (who am I kidding?!) The morale boosting ice-lolly freezer better be well stocked!! 

Carlyn Davie

Human Factors in Patient Safety Group

Human Factors in Patient Safety Group