BMJ Qual Saf doi:10.1136/bmjqs-2011-000421
  • Viewpoint

Time to accelerate integration of human factors and ergonomics in patient safety

  1. Peter J Pronovost1,3
  1. 1Johns Hopkins University Medical School and Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Department of Information Systems, UMBC, Baltimore, Maryland, USA
  3. 3School of Nursing, Baltimore, Maryland, USA
  1. Correspondence to Dr Ayse P Gurses, Anesthesiology and Critical Care Medicine, Johns Hopkins University Medical School, 1909 Thames Street, 2nd floor, Baltimore, MD 21231, USA; agurses1{at}
  1. Contributors Dr Gurses is a human factors engineer whose research primarily focuses on patient safety and quality improvement in healthcare. Her expertise includes teamwork/communication and coordination of care, transitions of care, risk analysis, and healthcare working conditions. Dr Ozok is a human–computer interaction expert with a research focus on healthcare technology design and evaluation, and medication adherence among older people. Dr Pronovost is a practicing anaesthesiologist and intensivist, and has extensive experience as a health services researcher. His expertise in the rigorous design, implementation, and evaluation of patient safety and quality improvement research is well known. This article was written as a result of the authors' longstanding interest and collaboration in using human factors and systems engineering to improve patient safety. APG wrote the first draft, AAO and PJP contributed with critical input and providing revisions for the several drafts of the manuscript. APG is guarantor.

  • Accepted 6 November 2011
  • Published Online First 30 November 2011


Progress toward improving patient safety has been slow despite engagement of the health care community in improvement efforts. A potential reason for this sluggish pace is the inadequate integration of human factors and ergonomics principles and methods in these efforts. Patient safety problems are complex and rarely caused by one factor or component of a work system. Thus, health care would benefit from human factors and ergonomics evaluations to systematically identify the problems, prioritize the right ones, and develop effective and practical solutions. This paper gives an overview of the discipline of human factors and ergonomics and describes its role in improving patient safety. We provide examples of how human factors and ergonomics principles and methods have improved both care processes and patient outcomes. We provide five major recommendations to better integrate human factors and ergonomics in patient safety improvement efforts: build capacity among health care workers to understand human factors and ergonomics, create market forces that demand the integration of human factors and ergonomics design principles into medical technologies, increase the number of human factors and ergonomic practitioners in health care organizations, expand investments in improvement efforts informed by human factors and ergonomics, and support interdisciplinary research to improve patient safety. In conclusion, human factors and ergonomics must play a more prominent role in health care if we want to increase the pace in improving patient safety.


  • Funding Dr Gurses was supported by a grant from the Agency for Healthcare Research and Quality (K01HS018762). Dr Gurses reports receiving grant support from the Agency for Healthcare Research and Quality, the National Patient Safety Foundation, and the Robert Wood Johnson Foundation. Dr Ozok reports receiving grant support from the National Science Foundation, Erickson Retirement Communities, State of Maryland Judiciary, and United States Department of Education. Dr Pronovost reports receiving grant or contract support from the Agency for Healthcare Research and Quality, the National Institutes of Health, the Robert Wood Johnson Foundation, and the Commonwealth Fund for research related to measuring and improving patient safety; honoraria from various hospitals and healthcare systems and the Leigh Bureau to speak on quality and safety; consultancy with the Association for Professionals in Infection Control and Epidemiology, Inc.; and book royalties for authoring Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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