Abstract
Medicine is practiced by human beings to save humanity. The quality of life has improved while death and suffering greatly reduced since the discovery of antibiotics and soaps. With improving health, human populations have increased magnificently. The application of medicine has also been extended to other forms of life, plants and animals. However, health practice has not been a smooth sailing. There are instances where human capabilities manifested as factors have affected the protection of life. These human factors can be incidental or accidental. Accidental human factors result in human error in medicine and are popularly called medical errors. The unintended effect of human factors cannot be ignored in the provision of healthcare services.
Key words: human factors, human error, medical error, healthcare
Introduction
Medical professionals provide vital services that continuously improve lives of human beings in societies. The extent of this importance underscores the existence of life on planet Earth. Thus, in practice, medical professionals should help save lives. Throughout the existence of societies, the idiom ‘err is to human’ has been coined to validate the natural existence or perception to error by human beings. According to Carayon (2012), error is a situation where one is wrong in conduct or judgment. It represents a deviation from the norm that is normally expected, value or popular practice. Therefore, there is some aspect where the item at hand falls short of expectations. Nonetheless, in not doing something, an error of omission is also committed. People in all careers are bound to make mistakes at one time or another. The current paper seeks to address aspects of human factors in the medical field by analyzing the possible way it results in errors. It also considers human factors resulting into medical errors and how counter measures can improve the sector.
The medical fraternity operates under the framework of the Hippocratic Oath. In the oath, health professionals swear to be good to their patients and never to harm them to the extent of the best of their knowledge and capability. The current version has been modified to address the various types of discriminations such race, age, gender and so on. The basis of this oath is to prevent health specialists from disrespecting life and violating other human rights. It is an acknowledgement of the use of medicine in harming innocent lives as acknowledged during the Nazism regime. Therefore, the Hippocratic Oath is a tool for guiding and controlling the character of practitioners in the sector. Nevertheless, it is not legally binding even though its ethical considerations are strong. With respect to human error, the oath only puts into context intentional errors whether by omission or commission. Errors might also result from accidents – a fact that is also appreciated in the current paper (Vincent 2010).
Human factors include all those issues that can affect people’s ability, character and motivation to perform a given function. These factors in a work environment can be intrinsic individual capabilities or external environmental, organizational or job related pressures (Reason 2000). Thus, there are system and personal related errors. The factors are able to influence a career positively or negatively. If a negative situation arises then it is deemed as human error. In medicine, human error of commission is a two dimensional process. The first instance is where process of treatment is not completed after diagnosis. In the second, there is a complete misdiagnosis of a disease and subsequent application of wrong treatment. Therefore, the patients are harmed by their treatment or course in seeking a positive feedback mechanism from hospitals. For an omission, the error is not doing anything to help a patient. The common result is unpleasant drug effects, surgical injuries, mistaken patient identity, wrong site surgery and suicides. These errors result in deaths and irreversible medical conditions.
According to Reason (2000), the exhibition of human errors attests to ‘forgetfulness, inattention, poor motivation, carelessness, negligence and recklessness. In this facet of errors, people have the ability to choose which part of the divide they want to be in. Traditionally, it was assumed that such kind of human errors could be corrected by adequate training, supervision, motivation, punishment and well laid out rules and regulations” (Heard 2005). Unfortunately, accidently errors rarely occur because of a single act. It encompasses the balancing act between personal and system approaches. Thus, the modern error mitigation measures welcome this fact including the impact of technology, such as equipment failure in the health practice. In the old way, the occurrence of errors can have some myths and bias surrounding it. It is often considered that the people who commit errors are bad; errors are increasingly random and unpredictable and high qualified specialists rarely commit errors.
In other cases, an error can result due to repeated attempts of the same procedure because it is the conventional way. Medical practitioners in the end lose the plot of the situation. It is because they fail to get to notice how severe the situation becomes. Statistics from medical errors can be very disturbing. According to a report by IOM (1999), medical errors in the United States result in 44,000 to 98,000 deaths. This death toll exceeds that from medical accidents and HIV/AIDS. The total monetary value that is lost is estimated between $ 17 and $ 29 billion per year. These estimates are derived from additional income spent in seeking health services and lost income due to hospitalization or disability. Everything is not lost, however. The situation of medical errors can be reversed because these errors can be prevented once identified.
To find solutions for human error in health care, system specialists should be engaged to study the process. As already pointed out in modern error evaluation procedures, errors are continued practice of mistakes in a process. Thus as for an industrial and system engineer, the role will be to analytically evaluate a medical process. The engineer should view the process as a system with sub systems. The role is based on the ability to model and simulate medical processes. The subsystems include the operations at reception, filing, consultation, prescription, pharmacy, anesthesia, therapy and including the infrastructure like electricity, machines and so on. Engineering like other processionals are also affected by human errors. The errors start in the design where the model is developed. The subsequently, the implementation is done through an appropriate simulation model. Errors in simulation itself are small because most systems are computerized. However, during verification and validation, human factors come to test. The principals of scientific practice are applicable such as comparing the results objectively against the objectives (Dong et al, 2012).
One of the main factors of human error in the medical field is access to information. It is an organizational problem. The problem is caused by decentralization of medical services. The overall effect of this practice is the availability of incomplete information because health care services do not work as a complete system. From another dimension there were frequent incidences of wrong drug administration. These drug errors were a result of poor ordering and dispensing systems. According to Bates (2000), the restructuring of the operations of pharmacies reduced drug errors by 82%. On the same note, an online simulation trail where physicians entered prescription online showed a possibility of reducing this kind of an error by 55%. On the other hand, a clinical pharmacist’s problem in an intensive care unit reduces the effect of preventable severe drug events by 66%. Anderson (2010) noted that about 7,000 patients in America die from adverse drug effects annually. Furthermore, about 20% of severe medical errors can be life threatening, while 42% of the errors warrant the increased use of life supporting medication.
The professional decree derived from the Hippocratic Oath can often ignite pressure, especially in severe cases where the patient’s life is at risk. Its numerous corrective measures are always floated and sometimes the wrong one can be picked. The procedures in anesthesia can result in such risks due to their complexities and dynamism. Here, there are numerous specialists treating the same patient whose physiology may have different responses. The procedures in the room are time sensitive. There is a sequence in which activities should flow with associated physiological response. The omission of single step results in quite significant responses. If this should happen, stress levels build up immediately increasingly chances of other human errors. There are also instances when the wrong is allowed to undertake a medical function. There are instances where technicians stock automated liquid dispensers. In such cases, there are high chances of incorrect drug composition (Anderson 2010).
Equally, within the organizational framework procedures, a patient may lack guidance. In other words, many doctors can treat a patient without a leader guiding all the treatment procedures or particular phases of such treatment on the patient. The process, if not well monitored, runs the risk of exposing the patient to duplication or exemption from some treatment. Accordingly, there are often situations where the hierarchy established does not permit junior professionals to take positive measures in the event that their seniors apply wrong procedures. For instance, nurses might not raise corrective concerns because of the superiority existence of doctors. The existence of poor communication structures among medical personnel results in more than 60% of sentinel cases to the Joint Commission.
Environmental factors can also results in human error in medication. The factors can be both physical and anthropogenic. They include poor lightning, ventilation, overcrowded health facility and distraction when administering drugs. In a case where medical officers are overworked, the probability of human error is always high. The workload can be a matter of long working hours or multitasking. The most affected health officials are nurses. They are always at the hospital bed, cleaning the hospital, getting meals and responding to telephone queries. The situation is further worsened by the shortage of nurses. Fatigue results in sleep disruptions, memory loss and decreased vigilance that eventually translate into poor performance. Therefore, nurses’ ability in identifying critical health changes in patients is compromised (Anderson 2010).
Consequently, the processes of licensing and accrediting medical professionals place more emphasis on the prevention of human errors. This process, which is not that comprehensive, has met opposition from medical organization and providers. On the same note, the system on medical liability restricts any possible corrective measure that can be learnt from such errors. Medical officials operate under an environment where the health care system is in no way expected to harm the patients. It is important to remove the fear in admission of error from individuals as well as a shift of blame by the health administration. The health sector has to restructure itself so that the person responsible acknowledges the adversity of the occurrence of an error. It should be done through clear reporting procedures and agitation for improvement. If errors and accidents are monitored, they can be used to improve health services (Reason 2000).
In addition, continuous education for medical practitioners is very necessary. Health officers should be updated about medical policies, procedures and protocols (Anderson 2010). The training should not only cover aspects or medicine, but administration as well. Administration errors account for up to 32% of all medical errors. Tools in administration cover patient and drug information, equipment acquisition, medicine stocking and distribution. According to Anderson (2010), this strategy will be used to reduce medical errors.
The assessments of human factors are important in improving health care systems. The corrective measures help in understanding why medical professional makes errors and which systems affect the well being of patients (Heard 2005). It can also improve the relations between junior and senior health official including a sustainable review of administration of medical procedures. Whereas life is a sensitive matter, health care oversight boards and rights groups should allow review of situations that go wrong and prediction of such situations (IOM 1999). These assessments can likely reduce the chances of affecting a patient. For instance, the Swiss Cheese Model provides defenses levels for the prevention of accidents in systems. Human error in medicine practice can be reduced through the use of the five rights. These include the right patient, right drug, right dosage, right time and right route. Above these should be stringent practice and observance of safety systems (Anderson 2010).
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In conclusion, modern approach to errors from a system perspective is continuously becoming popular. Equally, it is worth noting that the solution brought forth for error management have been a result of industry related issues as well borrowed strategies, especially in sensitive areas like aviation. Human factors are considered at individual level and in the wider picture where there are conditions under which the individual operates. The conditions are complex and dynamic medical procedures.
