Design is the key for effective human factors
In a recent famous case, one surgeon and two anaesthetists were said to be anaesthetising two patients at the same time; this would be risky and unnecessary for patients to be anaesthetised for longer than absolutely essential. It is unethical.
The question is: how did this even happen? There must be policy in place to prevent this. There must have been people who could and should have questioned this and prevented this. Sure. Let’s assume we had policies and people in place – do they prevent for sure two patients being anaesthetised for the same one surgeon at the same time? No.
It happened because there was the structure, infrastructure and facilities to do it.
In UK hospitals there is something called the anaesthetic room which is separate from the operation theatre. This means for one surgeon, there could be a patient anaesthetised inside the operation theatre and another patient anaesthetised in the anaesthetic room.
This is a fairly unique UK NHS practice. Historically, the subsequent patient was brought into the anaesthetic room and the process of anaesthesia began or anaesthesia given when the patient on the table in the operation theatre was nearly done. This was thought to be efficient. It worked when the so called ‘registrars’ both anaesthetic and surgical were experienced. This anaesthetic room concept was then followed by UK private hospitals.
The presence of the anaesthetic room means that it would be physically possible for two patients to be under anaesthetic simultaneously for a single surgeon.
Recently, when designing the theatres of a private hospital, we argued for not having an anaesthetic room and prevailed.
This means that in that private hospital which does not have an anaesthetic room, there is no possibility of two patients being under an anaesthetic at the same time for a single surgeon because there is no physical infrastructure/facility that enables/allows it. No policy or person(s) would have been able to achieve this.
We cannot design a problem to be built into a system and then expect policies and people to overcome it consistently.
Design is the fundamental for human factors – people and behaviours are simply an add on bonus.