A novel framework for human factors analysis and classification system for medical errors (HFACS-MES)-A Delphi study...

Area of Science:

• Healthcare Systems Analysis
• Patient Safety Research
• Human Factors Engineering

Background:

• Medical adverse events (MAEs) pose a global challenge in healthcare systems (HCS).
• Human and organizational factors (HOFs) are primary drivers of MAEs, yet analytical methods are limited.
• Existing frameworks inadequately address the complex causation of medical errors (MEs).

Purpose of the Study:

• To introduce a novel, applicable framework for analyzing the causation of MAEs.
• To adapt the original Human Factors Analysis and Classification System (HFACS) for medical error analysis.
• To improve the identification and understanding of HOFs contributing to patient harm.

Main Methods:

• A descriptive-analytical study design was employed.
• HOFs related to MEs were identified through a comprehensive literature review.
• A Delphi study was utilized to develop the new HFACS-MEs framework, subsequently validated by analyzing 180 MAEs.

Main Results:

• The HFACS-MEs framework comprises 5 causal levels and 25 causal categories, including new additions like 'extra-organizational issues,' 'management of change,' 'patient safety culture,' 'patient-related factors,' and 'situational violations.'
• The 'extra-organizational issues' level demonstrated statistically significant relationships with lower causal levels (Φc≤0.41, p≤0.038).
• Newly added categories significantly influenced lower-level factors and ME causation (Φc>0.2, p<0.05).

Conclusions:

• The developed HFACS-MEs framework provides a valuable tool for dissecting MAE causes and pathways.
• This framework facilitates a comprehensive analysis of human factors impacting patient safety in HCS.
• The enhanced model offers improved insights into the multi-level causation of medical errors.