Human Factors is an interdisciplinary field that focuses on understanding the interactions between humans and other elements of the bigger systems in which we operate, aiming to improve human well-being, patient safety and overall system performance. The field is also known as ergonomics in some regions, and it encompasses a broad range of topics, including psychology, engineering, design, and physiology. In our modern veterinary environment we recognise that ‘knowing medicine well’ is not enough to ensure good outcomes and optimise patient safety. Human Factors is the field that bridges the gap between human limitations and the demands of the systems we operate in.

 Learning objectives
• Understanding Human Factors • Human Factors branches & stories
• Performance and Error
• Human Factors’ role in Veterinary Dentistry and its future

 One way to lead into describing what human factors are about is the quote:
 « Good performance is incredibly context specific. »

In Human factors, we study
1. The Work
2. The People
3. The Organisation/Environment
What are people expected to do? Who is doing it? Where is this happening? In what context?

Human Factors is about understanding and managing people’s abilities and limitations. Similarly, ergonomics describes a more physical aspect of ‘the study of people’s efficiency in their working environment.’ Essentially, human factors are a combination of psychology and engineering, with human factors leaning towards the psychological aspects.

 Another human factors saying says it’s about:
« Making it easy for people to do the right thing - and difficult to do the wrong thing »

The following story shows how this developed: Many decades ago, airplane levers to move flaps and landing gear looked similar and were located near to each other. Even though they were labelled and pilots were told to ‘be careful’, inevitably they sometimes used the wrong ones, sometimes with very bad consequences. Instead of continually trying to re-train pilots and telling them to ‘be more careful’, aircraft designers realised it would be better to ‘make it easier to do the right thing’ and made the following changes to the design of the cockpit…
• Put the levers in different parts of the cockpit
• Made the landing gear lever look like a wheel and the flap lever look like a flap
• Made them so they had to move in different ways to operate them
• Agreed between various manufacturers to follow a similar concept for standardisation

Mismatches between work requirements and people’s capabilities increases potential for human error. 80% of adverse events in veterinary primarily relate to challenges within the field of Human Factors (Oxtoby et al, 2015) 96% of respondents in an RCVS Mind Matters survey in 2021 (strongly) agreed that bullying and incivility was a serious problem within the profession (Survey, MMI 2021) 70% of preventable hospital deaths have been described as « due to communication errors » (Joint Commission of Healthcare Organisations, 2010)

 We do know… 100% of humans make errors. 3 key facets of HF studies revolve around:
• Psychological Safety
• Incivility
• Patient Safety 3 people and their stories illustrate why these facets are so important.
 - Amy Edmondson, Prof. of Leadership and Management at Harvard Business School: People report more errors in the presence of Psychological safety; “the feeling that taking interpersonal risks will not result in embarrassment, ridicule, or shame, enables people to engage, connect, change and learn” (Edmondson & Lei, 2014).
- Dr Chris Turner, Consultant in Emergency Medicine, Co Founder Civility Saves Lives Campaign: his campaign shows the science between how rudeness/incivility turns deadly.
- Martin Bromiley, Airline Pilot, Founder of the Clinical Human Factors Group: Martin’s wife, Elaine, suffered hypoxic brain injury and died after a routine operation. Elaine’s anaesthetists could not intubate her.

5 Performance principles - per the International Civil Aviation Organisation
What do we know about human performance?
1. People’s performance is shaped by their capabilities & limitations
2. People interpret situations differently & perform in ways that make sense to them
3. People adapt to complex, dynamic, work environments
4. People assess risks and assess tradeoffs (efficiency v thoroughness)
5. People’s performance is influenced by working with other people, technology, and their environment

Put into a vet dentistry perspective: What stands between the vet dentistry team and a successful outcome?
1. Dentistry requires anaesthesia, sometimes complex multidisciplinary work, technical skills
2. Dentistry may be invisible to clients and happens in isolated environments - client’s understanding and willingness to comply differ from our hopes and expectations
3. Emergencies, no shows, machine failures…there is an endless list of things that can and do not go according to plan in the veterinary clinic setting.
4. Anaesthesia duration vs procedural staging 5. Workplace culture, technology and staff availability Into The Future? How the Work-People-Organisation-Culture-Error-Performance points fit into the success of our veterinary and dentistry profession? One key lesson from HF is: How we do what we do depends on where, when, why, with whom, to whom, we are doing it. Any outcome is a result of multiple systemic and individual level factors. The more we understand about this, the better we can care for our patients and ourselves in the context of a demanding profession.

Resources
www.vetled.co.uk/campaigns
www.civilitysaveslives.com
https://humanisticsystems.com
https://humanfactors101.com
www.vetset2go.edu.au/vetset2go/resources
https://chfg.org/category/all-resources
https://research.abdn.ac.uk/applied-psych-hf