Promoting Clinician Well-Being through Human Factors Engineering

Healthcare providers dedicate their lives to patient care, often working within systems that unintentionally contribute to stress, fatigue, and burnout. Human Factors Engineering (HFE), a discipline focused on optimizing system performance by considering all aspects of the healthcare environment—including the people who work within it—offers a powerful framework for addressing these challenges. By applying HFE principles, healthcare organizations can create environments that support clinicians, leading to improved patient outcomes, enhanced provider satisfaction, and safer care delivery. 

Understanding HFE in Healthcare 

HFE is an interdisciplinary, research-driven safety science that recognizes healthcare as a sociotechnical system with the following interconnected components: 

• External Environment—external factors beyond the immediate control of the facility, such as federal and state regulations, public health emergencies, and community attitudes toward healthcare policies (e.g., mask-wearing), must be anticipated and accounted for to ensure system resilience.
• Organization—the mission, vision, policies, infrastructure, culture, and leadership that shape how work is performed. A supportive organizational culture is critical for identifying and addressing system-level stressors that impact provider well-being.
• Tasks and Processes—the steps and procedures that define how work is carried out. Intuitive, streamlined processes empower providers, whereas cumbersome or inefficient workflows contribute to stress, fatigue, and errors.
• Tools and Technology—the devices used to support tasks and processes. Well-integrated technology enhances efficiency and accuracy. Poorly designed or incompatible systems, however, can increase cognitive load and introduce errors.
• Physical Environment—the physical layout and infrastructure where work takes place. Beyond spatial design, factors such as noise, lighting, proximity of equipment, and even HVAC systems play a significant role in shaping provider performance and satisfaction.
• People—the individuals involved in all aspects of care, including providers, patients, and families. People are at the heart of every healthcare system, and their resilience often compensates for system shortcomings. 

It's no coincidence that people are at the center of this system. Healthcare providers are remarkably adaptable, often navigating imperfect systems to deliver high-quality care. However, relying on human resilience to overcome poor system design has consequences—ranging from patient harm and low satisfaction scores to rising costs, record levels of burnout, and providers leaving the field. 

There's a better way. HFE enables organizations to design systems that align with human capabilities while acknowledging human limitations. When systems are designed with HFE principles—safety, performance, and efficiency—it leads to healthier, more satisfied providers and, ultimately, better patient outcomes. 

Addressing Provider Wellness Through HFE 

A solid understanding of HFE and the complexities of healthcare as a sociotechnical system provides a strategic advantage for leaders responsible for improving care quality, controlling costs, and enhancing the experiences of both patients and providers. Below are key considerations for addressing provider well-being at the component level: 

1. External Environment 

While external factors may be unpredictable, proactive preparedness can mitigate their impact. Leaders can develop crisis staffing plans to ensure adequate personnel during emergencies and implement strategies to manage staff shortages and fatigue effectively. Establishing feedback mechanisms that empower frontline staff to share real-time insights equips senior leaders with information needed to make timely, midcourse corrections. By applying HFE principles, organizations can identify vulnerabilities within their systems and anticipate external challenges, enhancing overall system resilience. 

2. Organization 

A culture that prioritizes provider wellness fosters open communication, psychological safety, peer support programs, and leadership that genuinely values employee well-being. Leaders must proactively identify and address sources of stress and burnout that fall within their control—such as inefficiencies in tasks, processes, tools, and the physical environment. 

3. Tasks and Processes 

Too often, healthcare administrators change processes without consulting frontline workers—the very people who perform these tasks daily. This top-down approach can lead to frustration, increased cognitive load, and reduced performance. Instead, involving frontline staff in solution development through participatory design leads to more effective, user-centered solutions. Research consistently demonstrates that collaborative solution development improves task efficiency and fosters greater buy-in from staff. 

4. Tools and Technology 

Purchasing and implementing new technology without a thorough understanding of user needs often leads to unintended consequences—such as increased cognitive workload, errors, and integration challenges. HFE offers proactive methods to assess user requirements, critically evaluate potential technologies, and select the best solutions for seamless integration. This approach saves time, reduces frustration, and minimizes costly implementation errors. 

5. Physical Environment 

Even seemingly minor design decisions can significantly impact provider performance and satisfaction. Simple tabletop mockups and a cognitive walkthrough of new facility designs with those who do the work can reveal potential workflow challenges and equipment placement issues before they become costly problems. Engaging human factors engineers early in the design process helps identify barriers to efficient care delivery, ultimately reducing stress and saving money by avoiding late-stage redesigns. 

6. People 

The most resilient and hardworking part of any healthcare system is its people. Supporting them requires designing systems that prioritize safety, performance, and efficiency with their input. When adverse events occur, a system-level analysis using HFE methods provides deeper insights than traditional root cause analysis (RCA). By identifying all contributing factors, organizations can implement sustainable, effective solutions that prevent recurrence. Moreover, collaborating with human factors engineers empowers healthcare professionals to apply systems thinking, enhancing their ability to address patient safety challenges. 

The Future of Provider Wellness 

As healthcare systems continue to evolve, integrating HFE into system design will be essential to achieving goals related to quality of care, cost management, safety, and provider retention. Investing in HFE is more than just a strategy to reduce burnout—it's a commitment to creating a sustainable, high-performing healthcare environment where providers can thrive. When senior leaders, management, and healthcare professionals adopt systems thinking, they gain the ability to identify and address potential challenges before they escalate. By making more informed upstream decisions, organizations can prevent workflow bottlenecks, reduce wasted time, and minimize unnecessary cognitive load—creating a more efficient and supportive system for everyone involved. 

By addressing the root causes of provider stress through thoughtful design and systemic improvements, healthcare organizations can cultivate an environment where both patients and providers experience better outcomes. 

Partner with ECRI to Advance Provider Wellness 

As your organization works to enhance safety for patients and staff, consider partnering with human factors engineers from ECRI. Learn how  

We can help you take a truly human-centered, total-system approach to safety. 

Coauthors:

Vicki R. Lewis, PhD
Senior Manager of Human Factors, ECRI 

Dr. Lewis recently joined ECRI after working as a healthcare consultant with hospitals, outpatient facilities, and home care organizations. Dr. Lewis has extensive experience applying the safety science of HFE to complex work systems in the healthcare domain. She has an established research portfolio, which includes directing, collaborating, managing, and consulting on topics such as healthcare-associated infections, usability of health information technology, evaluation of RCA effectiveness, and safety process improvement. She is practiced in facilitating sentinel event analyses to identify root causes of adverse events and develop system-based solutions that maximize effective and sustainable safety solutions. Dr. Lewis received her Ph.D. in Industrial and Systems Engineering with an HFE option from Virginia Tech in Blacksburg, Virginia. 

Michael R. Privitera, MD, MS
Professor Emeritus of Psychiatry, University of Rochester Medical Center 

For the last 15 years, Dr. Privitera has developed and applied human factors/ergonomics science from human/machine application to human/system organizational ergonomics application for healthcare- system leadership. He was nominated for NASA's Technical Interchange Meeting on Task Load Management and was awarded a patient safety grant in 2018 from his malpractice carrier MCIC to deliver a human factor-based leadership curriculum. Dr. Privitera is also on the faculty of the Institute for Healthcare Improvement in Boston and has been a member, NIOSH Office for Total Worker Health and the NIOSH Healthy Work Design and Well-Being Program: Healthy Work Design Council. In addition, he was a content reviewer for CDC/NIOSH recently released "Impact Wellbeing" Guide for Hospital Leaders. Website: www.MichaelRPriviteraMD.com