Application of the human factors analysis and classification system methodology to the cardiovascular surgery operating room

Background. Improving patient safety by reducing human error is a priority in all surgical specialties. A model for assessing the myriad of factors affecting performance in the operating room (OR) has yet to be developed. We hypothesized that human factors identified in other domains would similarly be viewed as contributors to error in cardiac surgery. Methods. As a first step, we utilized a model previously employed in aviation to develop structured interviews of individuals in multiple roles (surgeons and allied health staff). To enhance relevance to the OR, Likert scale questions were formulated based on published sentinel event analyses and focus group studies in which specific factors found to be causally related to error in health care were described. Additional items from other high risk-consequence industries were generated to address theoretically important factors not highlighted previously. Results. Application of the modified model to the interview responses allowed the identification of factors impacting performance in the OR and estimation of their relative importance. Analysis of correlations among responses were consistent with predictions of the model that the origin of errors can be traced to organizational influences that impact supervisory processes, which in turn establish preconditions predisposing to errors. Conclusions. These data demonstrate a model of error causation derived from aviation can be modified and applied to the cardiac surgery OR. This tool may prove useful in identifying systemic factors impacting human performance and patient safety.