The Use of Human Factors to Promote Safety and Efficiency in the Operating Room

The application of systems engineering principles, tools, and methods to health care almost coincided with the turn of the 20th century, with a focus on surgical procedures. Nearly 100 years later, the potential of systems engineering, including human factors and ergonomics, remains largely umealizcd when it comes to improving the conditions in the operating room (OR). The OR is the most complex environment in health care with an exponential increase in complexity in the past decade. With the shift from open procedures to minimally invasive (laparoscopic, natural orifice), the skills required of surgeons and surgical teams have also increased. Whereas in open procedures, surgeons view the target area directly, in minimally invasive procedures, the surgeons are required to gather, interpret, and integrate the information they need to proceed with the operation from monitors projecting images captured by cameras. This changes not only the surgeons’ individual workload physically (new tools and postures) and cognitively (new interpretation and decision making requirements), but it also affects the work of the team, as additional tasks (such as manipulating the cameras or moving the monitors) and skills are now required of the team members. With all of these changes come a host of safety concerns, including those related to the physical environment and use of numerous pieces of new equipment (with cords, cables, and space requirements) as well as those related to the cognitive workload. Surgeons are expected to gather bits of information from a host of disparate sources, compile the pieces to make specific decisions, and then both communicate and act upon those decisions. This paper reviews the history of human factors engineering in health care, focusing on the OR as the pinnacle of health care complexity. We will emphasize the changes and trends seen during the last ten years and identify different areas in which process and systems tools and methods can (and should) be applied to improve the safety and efficiency of the OR in the future.