Why It Matters
Too often, well-meaning health care leaders believe they can address burnout without a systems approach. Instead of lessening the workloads that contribute to stress, they inadvertently add to them.
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Workload, Stress, and Patient Safety: How Human Factors Can Help

By Briana Cohen | Wednesday, February 5, 2020

Workload, Stress, and Patient Safety

Physicians, nurses, and other health care professionals around the world work long shifts full of interruptions, complications, and stress. Burnout is rampant. All these factors can lead to errors that harm patients or health care providers.

One of the biggest challenges in addressing work-related stress and burnout is the difficulty of knowing — before problems arise — when someone has reached their maximum workload. This is where human factors can come into play.

Human factors is the science of people and how we think, act, and interact in different circumstances. It pulls from a variety of disciplines to help us understand how humans behave when affected by external and internal conditions.

A recent WIHI audio broadcast, called Workload, Stress, and Patient Safety: How Human Factors Can Help, addressed this topic. During this episode, James Won, Program Manager for the Office of Safety and Medical Operations at Children’s Hospital of Philadelphia, and IHI Vice President Frank Federico spoke about using human factors to limit errors made by overworked and over-stressed health care professionals.

Won defined stress as the gap between perceived demands and the perceived ability to cope with the physical and mental requirements of one’s workload. According to Won, the higher the workload, the higher the stress and the greater likelihood of errors and burnout.

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Won described human factors as an “empathy science,” centered around making sense of humans and systems. The more we understand about human factors, he asserted, the more we can put better systems in place to reduce stress and prevent human error.

Applying human factors principles helps us understand our limits and acknowledge human error as a natural phenomenon, especially when working under stress. The goal of good human factors design is to “make it easy to do the right thing and make it difficult, or even impossible, to do the wrong thing,” said Won.

The Role of Leadership

Too often, well-meaning health care leaders believe it is possible to address problems like errors or burnout without a systems approach. Consequently, instead of lessening the workloads that contribute to stress, they inadvertently add to it with new trainings, checklists, or assessments.

Though leaders may also be experiencing overwork and burnout, Federico noted that they have an important role to play in addressing these problems. For example, if leaders ask the following questions with human factors in mind, they can create more effective solutions to stress and workload:

  • Are employees creating workarounds? If they are developing their own ways of doing things or otherwise avoiding the systems they are meant to use, the intended system may be poorly designed. Instead of assuming that training (or retraining) is necessary, consider asking staff why they use the workaround.
  • Do employees feel comfortable speaking up? A culture of safety means employees believe they can raise concerns or ask for assistance without facing negative consequences.

Lessons from IKEA

While designing systems, Won noted, it is important to keep human tendencies in mind. For example, people often overestimate their capacity and take on tasks that one person should not do alone. To compensate, individuals may use shortcuts and multitasking or other behaviors that indicate that one’s workload is too high.

An individual may be aware that they are reaching their maximum capacity, but they may view asking for help as a sign of weakness, ignore stress and fatigue, or avoid speaking up. Designing with human factors in mind means understanding these tendencies and putting systems in place that encourage asking for help and taking breaks when needed.

Won introduced the idea of “cognitive lifting” by referencing an illustration with which many people around the world are familiar. The retail company IKEA uses symbols like these on their ready-to-assemble furniture packages:

IKEA image

An illustration from an IKEA bed frame instruction manual

When the contents of a package are too heavy for one person alone to lift, the symbols inform the buyer that they will need assistance. Won noted that when a buyer sees these indicators, they have two basic options:

  1. Ask someone to help lift the box, or
  2. Remove some unnecessary parts from the box to lighten the load.

Won described how similar thinking can be applied to cognitive loads. When a task is too much for an individual, a person could use teamwork to divvy up the responsibility for its completion. The “unpack the box” solution involves redistributing or eliminating unnecessary tasks.

Human factors thinking can be applied in many situations by simply asking “why” — Why is this system in place? Why am I working around the system? Why do I resent this task? By asking such questions, we are on the hunt for understanding and understanding is the key to making improvements and establishing a healthy work environment.

To learn more, download a recording of the January 23 WIHI on Workload, Stress, and Patient Safety: How Human Factors Can Help from the IHI website (including a comprehensive list of additional resources) or find the podcast on iTunes.

Briana Cohen is IHI’s Multimedia Project Assistant.

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IHI Open School Exercise — Human Factors

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