Understanding and improving the relationship between people and their working environment can reduce the chance of errors, improve human performance and thus enhance the performance of the whole system.1 One way of achieving this is to train humans to better understand the environment that surrounds them. Another is to configure a better environment in the first place. As technology advances, so the multitude of ways to achieve this latter aim increases, and the more important it becomes to consider not just what the technology can do but what it should do to assist humans. This human-centred approach to systems—the science and practice of what is now known as human factors engineering (or ergonomics)—has not always been prevalent2 ,3 but has become a key component of how we develop better ways of doing things, especially in the military, transport and high-risk industrial domains. In healthcare, this realisation has been slower but is now also becoming widely recognised.

The application of human factors in healthcare has largely focused on problem identification and training based on models from aviation.4 Though this has produced some notable successes,5 substantial and sustained behavioural change remains a challenge.6 A key limitation of this approach in healthcare is the superimposition of training on systems that are already deficient in design and thus continue to be predisposing to error.7 In the application of training, checklist and other behavioural adaption principles from other high-risk industries, the extant level of human-centred engineering in these industries has been somewhat forgotten. All too often we place the emphasis on changing humans because they are flexible …