title: More holes than cheese. What prevents the delivery of effective, high quality and safe health care in England?
abstract: What prevents the delivery of effective, high quality and safe health care in the National Health Service (NHS) in England? This paper presents 760 challenges which 330 NHS staff reported as preventing the delivery of effective, high quality and safe care. Some problems have been known for over 25 years (staff shortages, finance and patient complexity) but other challenges raise questions about the commitment of the NHS to patient and staff safety. For example, Organisational Culture leading to 'stifling bureaucracy', 'odds stacked against smooth […] working' and Workload resulting in 'firefighting daily' and 'perpetual crisis mode'. The role of Human Factors/Ergonomics professional input (engagement with safety scientists) is discussed in the context of success stories and examples of Human Factors Integration from other safety critical industries (Defence, Nuclear and Rail). Practitioner Summary: 760 challenges to the quality, effectiveness and safety of health care were identified at Human Factors/Ergonomics taster workshops in England. These are used to challenge health care providers to think about a Human Factors Integration (HFI systems) approach for safety, well-being and performance for all people involved in providing and receiving health care.
authors.affiliation: a Loughborough Design School , Loughborough University , Loughborough , UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Hignett
authors.affiliation: b Faculty of Engineering, Human Factors Research Group , University of Nottingham , Nottingham , UK.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lang
authors.affiliation: c NIHR CLAHRC South West Peninsula (PenCLAHRC) , University of Exeter , Exeter , UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Pickup
authors.affiliation: a Loughborough Design School , Loughborough University , Loughborough , UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Ives
authors.affiliation: a Loughborough Design School , Loughborough University , Loughborough , UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Fray
authors.affiliation: d Link Ergonomics, Daneton Lodge, Manor Park , Nottingham , UK.
authors.forename: Celine
authors.initials: C
authors.lastname: McKeown
authors.affiliation: e Tapley Ergonomics Ltd , Ipswich , UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tapley
authors.affiliation: f Nuffield Department of Surgical Sciences , University of Oxford, John Radcliffe Hospital , Oxford , UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Woodward
authors.affiliation: g Safety & Improvement, NHS Education for Scotland , University of Glasgow , Glasgow , Scotland.|h Institute of Health & Wellbeing , University of Glasgow , Glasgow , Scotland.
authors.forename: Paul
authors.initials: P
authors.lastname: Bowie
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D004739:England; D006804:Ergonomics; D006801:Humans; D015279:Organizational Culture; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D013222:State Medicine / Q000458:organization & administration* / Q000592:standards; D013597:Systems Analysis
keywords: Human factors; education; ergonomics; healthcare; human factors integration; patient safety; systems