1. What is your job title?

     I am the Endowed Chair in Clinical Practice and Human Factors at the Medical University of South Carolina.

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2. Why did you go into Human Factors?

     In 1989 a careers adviser suggested that I might enjoy studying Ergonomics at University. It totally suited me from day one!

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3. Why did you choose the healthcare route?

     In 2003, after a PhD and 3 years in defense consultancy, I was looking for a new challenge and applied for a job in a UK Children’s Hospital researching “errors” in congenital heart surgery. On my first day, I was completely overwhelmed trying to understand what was going on and what on earth I could do to help such amazing people do amazing things. Then I realized how much the systems of work set people up for failure, and that nearly everyone in healthcare was unaware of this. I was hooked. My aim quickly became to apply human factors (HF) principles to reduce accidental harm in healthcare by focusing on and improving systems of work.

 

4. Why did you decide to be embedded as opposed to work in academia or industry?

     It is the best, and probably only, way to understand the complexity and unique challenges of healthcare then apply HF perspectives for the benefit of acute care staff and patients. Clinical systems grow organically and are rarely designed, which makes them incredibly complex, opaque, difficult to uncover, and easy to over-simplify. Safety issues are often not talked about, are insufficiently understood, while analyses rarely involve safety scientists or engineers, and omit key things that HF professionals might identify. Being in a hospital means you can work alongside clinicians, learning their language, gaining their trust, recognizing the problems they have, and trying different solutions that encompass more than just HF perspectives. There is no shortage of opportunities to apply HF. If I want to understand work on the ICU, I go up to the ICU (5 mins walk from my office), talk to staff, and observe what they do. Industry or academia simply don’t provide those opportunities to learn, experiment and apply HF principles, and consequently often exist in the “work as imagined” world.

 

5. What do you enjoy most about being an embedded HF practitioner?

     Changing people’s view of the world. Coming to a problem – big or small – and being able to apply experience and principles to help understand why a system isn’t working and what can be done about it. Being able to listen to amazing, dedicated people doing incredibly difficult, worthwhile, but often under-appreciated jobs; and then being able to give them hope and direction to improve their working lives and the outcomes for their patients. Applying critical thinking and HF expertise to incident analysis that identifies issues that no-one else has seen. Everyday, being astounded at what humans can do; and the multitude of ways in which things fail. Ultimately, being able to support the people at the bottom of the organization doing their best in challenging situations by identifying and addressing issues across the organization – and not being afraid to link patient harms with business decisions.

 

6. What is one piece of advice you would give up-and-coming HF professionals who want to be embedded in healthcare?

     Your HF training tells you only one third of what you need to be successful. Another third is clinical expertise, which you won’t ever have, so you need to develop relationships and understand clinical language and culture so you can work with people who have this knowledge. The final third is the bit in the between - learning how to work with clinicians to apply HF principles in incredibly complex and opaque clinical settings where your efforts may not always be valued. Don’t think that it will be easy or change will be fast; don’t expect to be always welcomed or understood; expect to fail, but do it anyway and learn from it.

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7. What is the one piece of advice you would give to healthcare professionals to help those up-and-comers?

     Help them understand the everyday clinical challenges you face, introduce them to your colleagues, help them get involved in projects. Your voice, as a clinician, is far more respected and trusted than theirs is, as a non-clinician, so be vocally supportive of them wherever possible. And be prepared to challenge their perspective; and to have yours challenged too.