Humans as Hazard or
Humans as Hero?
Douglas A. Wiegmann, Ph.D.
[email protected]
Opposing Viewpoints
Humans are:
•
•
•
•
•
Vague
Disorganized
Distractible
Emotional
Illogical
•
•
•
•
•
Creative
Flexible/Adaptable
Sensitive to Context
Resourceful
Intuitive
Viewpoints Change with Time
As complex, high-risk systems
evolve, there tends to be a shift in
the way society views human
operators.
The case of aviation...
During the early days of aviation, the
focus was on finding people who would
make good pilots.
• Many modern day aptitude and IQ
tests evolved out of this search for
people with the “right stuff.”
• Pilots were viewed as unique, elite
and brave individuals who possessed
heroic qualities.
• Accidents were caused mostly by
mechanical and technological
failures/hazards.
The case of aviation...
Overtime, accidents due to mechanical
and technological issues were
significantly reduced.
“Pilot error” became the common
factor underlying most accidents.
Now, the highly intelligent, trained and
motivated pilot was becoming the
“hazard.”
Pilots were seen as “more hazardous
than the aircraft they fly.”(Mason, 1993)
Human Factors and Systems Engineering
• There needed to be a shift in the
conventional approach and philosophy to
safety and performance.
• Conventional approach was to “match the
human to the machine”
• A new approach was to “design the
machine to match the human”
• Psychologists and engineers came together
to redesign aviation systems in a way that
capitalized on the strengths of humans while
also minimizing the negative impact of their
limitations.
Team
Task
Organization
Performance
Environment
Technology
The case of healthcare...
Similarities to aviation?
• Medical doctors have generally
been viewed as unique, elite and
dedicated individuals who possess
heroic qualities.
• Historically, patient mortality was
caused mostly by disease severity,
limits of science and technology, and
access.
The case of healthcare...
•As science, technology and
access have improved over the
years, death due to various
illnesses and diseases has been
dramatically reduced.
• Death due to medical error has
become more prevalent.
• Medical error is now estimated
to be the 3rd leading cause of the
death in the U.S. (Makary & Daniel, 2016)
Human Factors and Systems Engineering
• We need to better understand
what prevents physicians from
practicing excellence and
providing optimal care.
• We can then better design
systems that capitalize on their
strengths of humans while also
reducing errors.
What about surgery?
Hero vs. Hazard Perspective
“Once outcomes (usually mortality) have been correctly adjusted for
patient risk factors, the remaining variance is assumed to be
explained by individual surgical skill.”
Surgeon
Factors
Patient Risk
Factors
+
Outcome
=
Vincent et al: Ann Surg 239(4):475, 2004
Human Factors Perspective
“Refinements in skill may be a relatively small element in the drive to reduce mortality from 10%
to 1%. Optimizing the surgical environment, attention to ergonomics and equipment design,
understanding the subtleties of decision making in a dynamic environment, enhancing
communication and team performance may be more important than skill when reaching for truly
high performance.”
Patient Risk
Factors
Work System Factors
Technology
+
Surgeon
Factors
• Equipment design
• Maintenance
• Training
Environment
• Scheduling
• Distractions
• Interruptions
Teamwork
• Communication
• Familiarity
Outcome
Supervisory
• Staffing
Organizational
=
• Procedures
• Policies
• Resources
Vincent et al: Ann Surg 239(4):475, 2004
Conclusion...
Conclusion...
Surgeon as Hero?
Conclusion...
Surgeon as Hazard?
Conclusion...
Surgeon as Human
We need a human factors approach!