Rethinking Healthcare Safety: Differentiating from Other High-Risk Industries

Much of healthcare has yet to realize the benefits of applying human factors engineering (HFE), in part because HFE solutions developed for other high-risk industries have been applied without appreciating the important ways that healthcare differs from those industries.

Key Similarities and Important Differences
Like aviation, ground transportation, and nuclear power, healthcare is:

• High-risk – Errors have profound consequences for patients, staff, and organizations.
• Complex and interdependent – Outcomes depend on seamless interaction between people, processes, and technologies.
• Decision-intensive – Often, high-stakes choices must be made under time pressure and uncertainty.

However, healthcare also has unique challenges, which must be taken into account when designing safety strategies:

• Every patient is different – No two care plans or work shifts are alike. The ability to standardize care processes is limited by biology and individuality.
• Care plans evolve constantly – Decisions are revisited and adapted, often multiple times a day.
• Communication is fragmented – Providers often work asynchronously, connected only through electronic health records.
• Teaming is fluid – healthcare teams are formed around a patient's immediate needs, rather than sustained partnerships.
• Patient satisfaction is not solely driven by clinical outcome – goals and values matter too.
• Motivation drives performance – Healthcare relies on judgment, collaboration, and intrinsic commitment so it cannot require or deliver strict controls.

These differences mean healthcare organizations cannot simply copy-paste HFE solutions developed for other high-risk industries. Instead, healthcare systems must apply proven HFE methods to develop solutions tailored for their specific system. 

Applying HFE Systems Thinking

The most effective way to improve healthcare safety is to redesign health system's physical environments, tools & technologies, organizational structures, and tasks & processes so they enable people to do their best work, even under stress. This is the only way to manage healthcare complexity and prevent inevitable human slips from causing significant harm.

Culture Counts

Realizing profound safety improvements requires not only designing systems that make safe care the path of least resistance, but also fostering and sustaining environments where staff are empowered to speak up without fear of blame. In other words, great system design and great safety culture are both required to enable healthcare systems to continuously learn from failures and near-misses.

Conclusion

By embracing HFE and applying systems thinking, healthcare systems can become not only safer, but also more effective, efficient, and resilient, leading to better patient outcomes, healthier providers, lower costs, and stronger public trust.

Author

Patrice D. Tremoulet, PhD
Director of Human Factors Engineering, ECRI

Dr. Tremoulet, Director of Human Factors Engineering at ECRI, has more than three decades of experience conducting applied research in the telecommunications, defense, education and healthcare sectors. Currently, her research focuses upon developing more resilient healthcare systems – systems which do not constrain healthcare workers’ ability to innovate yet enable them to recognize and mitigate errors before they can cause harm. She is especially passionate about applying human factors engineering to support vulnerable populations, such as children, senior citizens, individuals with disabilities, critically ill patients, and overextended caregivers. Dr. Tremoulet received her BSE in Operations Research Engineering and a certificate in Engineering Management Systems from Princeton University, an MS in Operations Research from Stanford University, and MS and PhD degrees in Psychology and a certificate in Cognitive Science from Rutgers University.