Human factors and ergonomics

Improving our understanding of interactions between people, their teams, technology and their environment when completing tasks can lead to the creation of safer systems. Learn more about Human Factors and Ergonomic theory, find materials to run simulation training and explore the field of psychological safety in healthcare.

Human Factors and Ergonomics (HFE) science combines:

  • Psychology (attention, motivation, cognition, perception, situational awareness and decision making
  • Anatomy and physiology (vision, hearing, strength, posture, reach and fit)
  • Organisational management (teamwork and organisational culture)

HFE aims to better understand the nature of interactions at multiple levels and tries to design a system to suit people’s needs rather than expecting people to adapt to an existing system. There needs to be flexible adaptation of people interacting with a system in recognition of the complexity and uncertainty of continuously changing work conditions.

There are 3 domains of HFE

  • Physical:  including areas of work like designing workplace layout, work-related MSK disorders and the impact of environmental factors (e.g. noise, temperature, lighting etc)
  • Cognitive: focusing on cognitive activities such as perception, memory, decision making and human error. Areas of work include designing medical devices and information technology (like patient records). Human error is a cognitive ergonomic issue which helps us understand underlying causal factors to patient safety events.
  • Organisational: this looks at the psychosocial characteristics of people and organisational-level structures, policies and processes including areas of work like work schedules, stress, burnout, teamwork and organisational cultures.

The core question that HFE aims to address is

‘Can this person, with this training and information, using these tools and technologies, perform these tasks to these standards, under these conditions?’

Psychological safety at work is the condition in which you feel:

  • Included
  • Safe to learn
  • Safe to contribute
  • Safe to challenge the status quo

without fear of being embarrassed, marginalised, or punished.

How we feel influences what we think and do. Individually, feeling psychologically safe improves performance and innovation, whilst feeling unsafe reduces productivity and harms retention.

In a highly productive team being psychologically safe is about feeling safe to take  risk, to learn from each other, to feel resilient and able to tackle the difficult and varying challenges of healthcare with a healthy mind-set.

In order to build a culture of psychological safety the following conditions need to be explored

Inclusion safety: Does everyone in the team feel included? Do your conscious or unconscious biases impact on others within the team?

Learner safety: If the learning environment is hostile, fear leads to self-censoring and disrupts learning. Learners become more defensive and less reflective, and they may stop trying. We need to enable the most inhibited and fearful member of the team to engage.

Contributor safety: Does your team all feel safe to contribute and participate in the team goals? Is the environment truly collaborative? By inviting team members to look beyond their defined roles gives them permission to contribute.

Challenger safety: Socialising a team to feel safe to challenge the status quo promotes innovation and productivity. By ensuring transparency, the fewer sources of stress the we worries about.

Psychological safety is shaped by a leader who is supportive and invites participation, creates shares expectations and conditions for continued learning. 

In healthcare:

Studies of healthcare teams have correlated high team psychological safety and effective disagreement management with improved patient outcomes.  Conversely psychologically unsafe practices like physician incivility have been shown to impair decision-making, procedural performance, information sharing, help seeking, and to promote demotivation, and emotional exhaustion.

The NHS patient safety strategy 2019 recognises the importance of psychological safety and outlines how important it is that we work in ‘a just culture where psychological safety means we can all hear more, learn more and can act more to improve care’.

Working in healthcare involves lots of stakeholders with multiple perspective and goals so the process of ensuring safety has to constantly considered and managed throughout the day-to-day interactions. Enabling people to feel able to speak up about anything they feel or know isn’t working as it should be, is an essential part of being assured that safety is being proactively and effectively managed. Leaders can improve psychological safety by being accessible, inviting and thanking others for input, acknowledging, and modelling fallibility and providing fair accountability.

NHSE programs include.


Thrive Paediatrics:

RCPCH programme of work that will support paediatric clinicans to improve their lived experience at work through the definition of workforce standards, developing a process for peer review and establishing momentum for positive changes through regional communities of practice.

They will create a consensus document outlining what ‘good’ looks like in clinician working lives, and defining a set of standards on areas of work including inclusivity and well-being,

‘Even more so than ever before we need to invest in opportunities that add value and make people feel valued. At our core we all have a desire to thrive and grow, to experience a sense of vitality and learning. Research has found that thriving employees are more confident and energised, better able to respond to challenges, and recover quicker from the demands of work. Through Thrive Paediatrics the college wishes to send a clear message to its member paediatricians that we are committed to supporting our paediatric workforce to thrive and improve their experiences of the NHS.’ Dr Hothi

London School of Paediatrics Patient Safety webinar series 2020 on emotional safety:

Further reading

Pollack MM, Koch MA; NIH-District of Columbia Neonatal Network. Association of outcomes with organizational characteristics of neonatal intensive care units. Crit Care Med. 2003 Jun;31(6):1620-9. doi: 10.1097/01.CCM.0000063302.76602.86. PMID: 12794396.

Developing collective leadership for health care

Second Victim Support recognises the impact that a patient safety incident has on the healthcare providers involved. Whilst the patient and their family are always the priority, this website seeks to help Second Victims identify the types of support they may need, and signpost them towards that help. It advocates for a safety culture where patient safety incidents are managed in a way that enables learning and improves systems.

Access resources on the Second Victim Support website.

Sir Robert Francis QC’s report “The Freedom to Speak Up” (2015) found that patients and workers were suffering as a result of an NHS culture that discouraged or did not support workers to speak up about their safety concerns. This prompted the creation of the National Guardian’s office and the role of the Freedom to Speak Up Guardians in England.

There are more than 900 guardians in the NHS and independent sector organisations that work to support workers to speak up without it impacting on their experience in the workplace.

Visit the guardians website for more information here: Freedom to speak up national guardians


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