Introduction

Human factors (HF) is a term many involved in healthcare delivery are now familiar with, even though a decade ago most had never heard of the concept. The majority of clinicians and healthcare improvement specialists have learned of HF through a particular branch of practice that derived from aviation and arose from the need to address error, teamwork and communication issues. This behavioural safety approach, while entirely legitimate and increasingly well evidenced, is limited. Yet, it has dominated perceptions of what constitutes HF and shaped the application of HF principles in healthcare. Frequently espoused by well meaning clinicians and aviators, rather than academically qualified HF professionals, it has led to misunderstandings about the range of approaches, knowledge, science and techniques that can be applied from the field of HF to address patient safety and quality of care problems.

In this issue, Russ et al1 seek to redress some of the consequences of this misappropriation. They articulate the problems succinctly and expand on earlier calls2 ,3 for greater integration of HF expertise in healthcare. Repeatedly encountering recurrent misunderstandings and misuse of HF undoubtedly concerns academic experts. However, rather than feeling frustration over the ‘fictions’ discussed by Russ et al,1 HF professionals should be encouraged by the tremendous progress made in recent years—from a state in which clinicians had little exposure to HF work, and even fewer saw its value, to widespread acknowledgement of the value of human-centred systems thinking in healthcare.

Yet, the origins of the misunderstandings of HF discussed by Russ et al1 warrant reflection, as they may signal deeper problems in healthcare and the ways in which HF experts have worked in healthcare. One simple reason for misunderstandings about HF arising so commonly in healthcare may be that the spread of HF principles …