Table 1

Overview of when training may or may not be appropriate as a human factors approach to improve patient safety

Training is likely an appropriate human factors approach to patient safety if…	Training is likely an inappropriate human factors approach to patient safety if…
A. The goal is for individuals to become familiar with new technologies, tools or devices to learn about the available options and functions (eg, training a physician when s/he is first introduced to an electronic health record; training when first learning how to use laparoscopic tools). Training should include knowledge about strengths and limitations of specific technologies.31 B. It allows individuals to develop and test new techniques or practice evidence-based techniques in a safe, low risk environment (eg, simulation of operating room to practice a team communication technique that has been demonstrated to improve situational awareness.32) C. It provides a mechanism for individuals to gain experience with specialised techniques that involve sensorimotor skills (eg, performing surgeries and catheter insertions with supervision or in a simulated environment). D. It is used to instantiate knowledge in realistic scenarios,33 34 such as to practice or test procedures for emergency situations (eg, rapid response). E. Other system components are considered first, redesigned, and addressed using human factors expertise and principles and no other system changes can possibly be made.	A. The goal is for individuals to stop using technologies, tools or devices ‘in the wrong way’. (This is described as the ‘bad apple’ fallacy.35 36) B. It is an attempt to change innate human characteristics or imperfections (eg, staff meeting to ‘be more vigilant’ unlikely to lead to sustainable safety improvements.2) C. It is intended to address a type of error that is occurring across multiple people. (This indicates the system design does not match human characteristics37 and that system changes, not training, are needed.) D. Individuals have been previously trained about the safety issue(s) and the problem persists. (Additional training is unlikely to be effective. The phenomenon above indicates there is an issue with other system components.20) E. Training is the only safety intervention or the primary intervention used, especially when other system components have not been carefully considered and modified first.

Training is likely an appropriate human factors approach to patient safety if…

Training is likely an inappropriate human factors approach to patient safety if…

A. The goal is for individuals to become familiar with new technologies, tools or devices to learn about the available options and functions (eg, training a physician when s/he is first introduced to an electronic health record; training when first learning how to use laparoscopic tools). Training should include knowledge about strengths and limitations of specific technologies.31
B. It allows individuals to develop and test new techniques or practice evidence-based techniques in a safe, low risk environment (eg, simulation of operating room to practice a team communication technique that has been demonstrated to improve situational awareness.32)
C. It provides a mechanism for individuals to gain experience with specialised techniques that involve sensorimotor skills (eg, performing surgeries and catheter insertions with supervision or in a simulated environment).
D. It is used to instantiate knowledge in realistic scenarios,33 34 such as to practice or test procedures for emergency situations (eg, rapid response).
E. Other system components are considered first, redesigned, and addressed using human factors expertise and principles and no other system changes can possibly be made.

A. The goal is for individuals to stop using technologies, tools or devices ‘in the wrong way’. (This is described as the ‘bad apple’ fallacy.35 36)
B. It is an attempt to change innate human characteristics or imperfections (eg, staff meeting to ‘be more vigilant’ unlikely to lead to sustainable safety improvements.2)
C. It is intended to address a type of error that is occurring across multiple people. (This indicates the system design does not match human characteristics37 and that system changes, not training, are needed.)
D. Individuals have been previously trained about the safety issue(s) and the problem persists. (Additional training is unlikely to be effective. The phenomenon above indicates there is an issue with other system components.20)
E. Training is the only safety intervention or the primary intervention used, especially when other system components have not been carefully considered and modified first.