In recent years, “human factors” has appeared more frequently in healthcare articles, conferences and journals, suggesting growing awareness but also variation in interpretation. Too often, human factors is equated with human error, or the “factors of the human,” which is an oversimplification that misses its true scope. In reality, human factors engineering is a discipline that improves healthcare through design, not blame.
The International Ergonomics & Human Factors Association defines human factors (also called ergonomics) as “the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.”
In healthcare, “systems” are sociotechnical, composed of people (patients, clinicians, administrators), tools and technologies (devices, EHRs), tasks, workflows, policies, regulations, physical environments and culture. Human factors engineers design systems that maximize safety, quality, efficiency, reliability and well-being.
“Systems Thinking,” another term gaining traction, is a core underpinning of human factors and systems engineering. It’s both a mindset and a methodological approach emphasizing interdependence, feedback and adaptation. Four principles illustrate its relevance to healthcare:
- The Whole is Greater Than the Sum of its Parts
- Purpose and Goal Orientation
- Human-Centered System Design
- Boundaries and Perspective
No workflow, device or intervention can be evaluated in isolation. Each interacts with users, technologies, environments and cultural norms. A system’s properties emerge from the interaction of its parts. Suboptimizing a component independently may result in reduced overall performance. Example: An EHR alert may improve safety but increase workload and fatigue, compromising vigilance elsewhere.
Healthcare systems are purposive, meaning they’re designed with explicit goals. Due to competing priorities, such as safety, quality, equity or throughput, trade-offs will probably be required and must be intentional. Example: An ED implements a “fast track” triage protocol that increases throughput, but risks patient safety as patient severity is misclassified.
Humans are capable and adaptive, but not infallible. Human errors can be an indication of a problematic design. Rather than “fixing” people when errors occur, systems should be designed to accommodate human limitations such as fatigue, memory constraints and distraction. Example: Non-interchangeable connectors for IV tubing and epidural ports eliminate the possibility for deadly misconnections.
System boundaries are a choice. When designing interventions, one must decide what is inside vs. outside the system. While it may be tempting for speed or control to limit the scope, factors such as external supply chains, regulatory institutions or policy may be critical contributing factors. Example: Public trust, misinformation and policy may significantly impact an organization’s vaccine campaign.
Building Competence in Human Factors and Systems Thinking
While related to quality improvement and implementation science, fields that share approaches such as root cause analysis, mistake-proofing and participatory design, human factors and systems engineering are distinct. They bring specialized analyses for understanding complexity.
For example, Lean Six Sigma might use a fishbone diagram to identify causes of a sentinel event. A human factors approach might instead apply the SEIPS model (Systems Engineering Initiative for Patient Safety) to examine how interactions among people, tasks, tools, environments and organizational factors produce outcomes (planned or unexpected), avoiding linear oversimplification of complex problems.
Human factors practitioners come from psychology, industrial and systems engineering, human-computer interaction, and organizational design fields, among many others. Healthcare organizations can strengthen internal capability by hiring trained experts, encouraging certifications such as the IHI Certified Professional in Human Factors in Health Care, or seeking leaders trained in programs (GME, MHA, etc.) that integrate human factors and systems thinking.
Systems Thinking Starts at The Top
Executives and senior leaders hold the unique vantage point and authority to address systemic issues. For instance, a chief nursing officer can balance staffing ratios to optimize patient safety, fiscal responsibility and workforce well-being. Such decisions require systems thinking: seeing beyond immediate outcomes to long-term sustainability.
Developing this mindset requires discipline and intention. It means resisting quick fixes, broadening boundaries and asking, “How do the parts interact, and what unintended consequences might this change produce?” Leaders who adopt systems thinking foster organizations that are proactive, resilient and capable of learning from complexity rather than reacting to crises.
As healthcare systems evolve toward high reliability, digital transformation and artificial intelligence integration, human factors and systems thinking are not optional. Skills in human-centered work system design are sorely needed to withstand workforce shortages, healthcare worker burnout and demands for hybrid work. They are essential competencies for leaders and organizations striving to design care that is safe, efficient, equitable and humane.
Human factors moves us beyond asking “Who erred?” to “How did the system set them up to fail or succeed?” Systems thinking reminds us that improvement is not about perfecting parts, but about aligning people, processes and purpose to create better outcomes for all.
Jeena Velzen, PhD, FACHE, is senior director of strategic initiatives, East River Medical Imaging, PC, and has a doctorate in human factors engineering from the University of Nottingham.