Human Factor In The Surgical Environment

Human Factor In The Surgical Environment


            Patient safety has become a critical element of health policy (Watson, 2011; Stephens et al., 2016).   Despite the innovation of healthcare systems and processes, they may be unreliable and ineffective hence leading to the occurrence of errors.  For example, a study involving nurses conducted over a period of seven months in a hospital using the critical incident technique led to the identification of 178 medication errors by nurses. The medication errors largely involved drug overdose, wrong drug, wrong drug administration time, wrong dose, and omitted drug (Carayon, 2010; Carayon & Gurses, 2005). The study identified written miscommunication, failure to adhere to checking procedures, misfiled can calculation errors, and transcription procedures. Thus, human error may compromise patient safety, which underlines the significance of human factors in enhancing patient safety (Lingard, Espin  & Rubin, 2004).

Sevdalis, Hull and Birnbach (2012) affirm that there have been extensive changes undertaken in health policy in an effort to enhance patient safety. Amongst the notable changes include reducing the working hours, introducing safety checklists,  teamwork training, and setting the minimum nurse-to-patient ratio. The health policy changes have inclined toward human factors in the quest to enhance patient safety. The establishment of a perioperative team, which entails a healthcare team-based approach, is one of the ways through which patient safety can be enhanced.  Hamlin, Richardson-Tench and Davies (2011) define a perioperative team as a team that is comprised of medical practitioners drawn from different medical backgrounds and expertise. The perioperative team performs different activities that are aimed at achieving a common goal.  The perioperative team may be comprised of the non-sterile team and the sterile team. The non-sterile team is made up of the circulating nurse, perianaesthesia nurse, and anaesthesia provider. Conversely, the sterile team is made up of the surgeon, the first assistant, and the scrub person.  This paper evaluates how human factors in a perioperative team can affect safe patient care.


Hospitals have entrenched the perioperative philosophy in an effort to deliver holistic care to patients (Manser, 2009). Perioperative teams are based on a multidisciplinary approach (Brennan & Safran, 2004). In an effort to enhance the effectiveness of perioperative teams, there are a number of human factors that healthcare institutions should take into account as evaluated herein.


              The perioperative team is based on the concept of teamwork. Perioperative team members within the clinical settings have distinct but interdependent roles and responsibilities (Leonard, Graham & Bonacum, 2004). However, to be effective in undertaking the assigned roles and responsibilities, it is imperative for team members to nurture effective communication.  Salas and Frush (2013) assert that nurturing better communication amongst the surgical team is fundamental in promoting patient safety within the perioperative setting.  Poor communication can result in devastating outcomes because of human error. A study conducted by the Australian Institute of Health and Welfare indicates that approximately 50% of the total adverse events recorded in Australian hospitals arise from communication failures between the respective healthcare professionals such as doctors and nurses. This indicates that the integration of effective interpersonal communication across the perioperative team members during surgery is very vital in promoting patient safety.  

Communication within perioperative teams is not standardised. Therefore, the effectiveness with which communication occurs depends on the rapport developed between the cross-functional team members. Thus, to improve interpersonal communication, it is essential for team members to focus on nurturing connection or rapport with the respective team members.  This outcome can be achieved by establishing a balance between the communication models adopted by the respective team members.  According to Hamlin, Richardson-Tench, and Davies (2011), communication among doctors within clinical settings is largely based on the diagnosis-and-treatment model while nurses’ communication is based on the provision-of-care model. Therefore, nurturing effective communication among team members can significantly reduce the occurrence of errors. 

Hierarchical culture and team leadership

            The effectiveness of the perioperative team in hospitals is influenced by the quality of the hierarchical culture established within the hospital setting (Lillebo & Faxvaag, 2015).  As one of the team members in the perioperative team, physicians are positioned at the top of the hierarchy while nurses hold a relatively lower position (O’Daniel & Rosenstein, 2008). In spite of such a hierarchical structure, it is imperative for nurses to appreciate the importance of nurturing a collaborative working relationship. To achieve this outcome, effective leadership approaches should be entrenched in the team. The leadership approach should focus on eliminating hierarchical differences. Hierarchical differences significantly diminish collaborative interactions hence reducing the effectiveness with which treatment is delivered.  This arises from the fact that individuals at the lower levels of the hierarchy such as nurses may develop the perception that they are not valued. As a result of this aspect, nurses may feel uncomfortable speaking about any work-related issues.  The emergence of such perception may hinder the effectiveness with which the team members undertake their respective roles and responsibilities.

 Collaboration amongst perioperative team members can be stimulated through the integration of collaborative decision-making (Schmutz & Manser, 2013).  This approach can play a fundamental role in eliminating the feeling of ‘being looked down on’ by some members of the perioperative team hence nurturing a strong positive hierarchical culture.   Therefore, to enhance collaboration among team members, it is imperative for perioperative teams to ensure that their operations are based on a flattened hierarchical structure (Youngberg, 2013). In order to enhance collaboration amongst the team members, it is imperative for perioperative team leaders to appreciate the significance of nurturing trust and respect.  According to Sollami, Caricati, and Sarli (2015), the likelihood of perioperative teams that are not based on trust and respect tend to make mistakes in their operations is substantially high.  One of the most effective leadership styles that perioperative teams should be based on entails the democratic leadership style. Democratic leadership style can significantly enhance the operational efficiency of perioperative teams because of the high degree of inclusion amongst the respective team members in the team’s operation.


The analysis underlines the fact that the integration of human factors can contribute to significant improvement in the effectiveness with which perioperative teams undertake their roles and responsibilities hence improving safety and the quality of care offered to patients. Integration of an effective communication approach, development of positive hierarchical culture, and integration of effective team leadership are some of the approaches that can contribute to improvement in the effectiveness with which perioperative teams deliver care to patients.


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