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.

Keywords:

• Human factors
• education
• patient safety
• systems
• healthcare
• ergonomics
• human factors integration

Acknowledgements

This project was a collaboration between Health Education England national and regional groups (East Midlands, East of England) and the CIEHF. We would like to thank both organisations for their continuing support in applying Human Factors & Ergonomics to improve safety, well-being and performance in the health care industry. Special thanks to Patrick Mitchell, Renée Knopp, Anna Lee and Margit Veveris from Health Education England; Chetna Modi, Waseem Shahzad and Will Green from Health Education East Midlands and Alex Baxter, Ann Smith and Robin Holland from Health Education East of England. Finally, thanks to Ruby Allen for her creative expertise for the modified cheese model.

Notes

1. HEE is a non-departmental Government Public Body that exists to support the delivery of excellent health care and health improvement to the patients and public of England by ensuring that the workforce of today and tomorrow has the right numbers, skills, values and behaviours, at the right time and in the right place.