Original article
Cardiovascular
Application of the Human Factors Analysis and Classification System Methodology to the Cardiovascular Surgery Operating Room

Presented at the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.
https://doi.org/10.1016/j.athoracsur.2006.11.002Get rights and content

Background

Improving patient safety by reducing human error is a priority in all surgical specialties. A model for assessing the myriad of factors affecting performance in the operating room (OR) has yet to be developed. We hypothesized that human factors identified in other domains would similarly be viewed as contributors to error in cardiac surgery.

Methods

As a first step, we utilized a model previously employed in aviation to develop structured interviews of individuals in multiple roles (surgeons and allied health staff). To enhance relevance to the OR, Likert scale questions were formulated based on published sentinel event analyses and focus group studies in which specific factors found to be causally related to error in health care were described. Additional items from other high risk-consequence industries were generated to address theoretically important factors not highlighted previously.

Results

Application of the modified model to the interview responses allowed the identification of factors impacting performance in the OR and estimation of their relative importance. Analysis of correlations among responses were consistent with predictions of the model that the origin of errors can be traced to organizational influences that impact supervisory processes, which in turn establish preconditions predisposing to errors.

Conclusions

These data demonstrate a model of error causation derived from aviation can be modified and applied to the cardiac surgery OR. This tool may prove useful in identifying systemic factors impacting human performance and patient safety.

Section snippets

Human Factors Model

Reason’s model of accident causation provides a theoretical framework that dissects the potential etiology of errors. The theory explains that accidents are caused by active failures (decisions performed by individuals at the delivery end of a system) and latent failures, which are a result of deficiencies in the organizational and management levels of a system. Latent failures predispose a system to error and may result in adverse events if many deficiencies are present within the levels of an

Results

Thirty-three males and 35 females were interviewed: 16 cardiac anesthesiologists-CRNAs, 13 monitor technicians, 11 RNs, 10 CSTs, 7 perfusionists, 4 residents, 4 senior cardiac surgeons, and 3 SAs. The mean age of the participants was 41 ± 11 years with 12.27 ± 10 years of experience.

The mean composite scores for the 68 participants are shown in Figure 2. Each of the four sections represent the four main human factor levels according to the HFACS model, and bars within each human factor level

Comment

The principle finding of this study is that HFACS (a classification system that has provided a successful interface to scientifically quantify the role of human factors in error creation) can be applied to the cardiovascular surgery OR in a comprehensive and global way, aimed at understanding the interplay of human factors in the immediate OR environment and the organizational structure. We applied and adapted HFACS by compiling factors discovered in previous studies known to affect patient

References (8)

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Recipient of the 2006 Southern Thoracic Surgical Association President’s Award.

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