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Ergonomics. 2018 Jan;61(1):5-14. doi: 10.1080/00140139.2016.1245446. Epub 2016 Oct 20.

More holes than cheese. What prevents the delivery of effective, high quality and safe health care in England?

Author information

a Loughborough Design School , Loughborough University , Loughborough , UK.
b Faculty of Engineering, Human Factors Research Group , University of Nottingham , Nottingham , UK.
c NIHR CLAHRC South West Peninsula (PenCLAHRC) , University of Exeter , Exeter , UK.
d Link Ergonomics, Daneton Lodge, Manor Park , Nottingham , UK.
e Tapley Ergonomics Ltd , Ipswich , UK.
f Nuffield Department of Surgical Sciences , University of Oxford, John Radcliffe Hospital , Oxford , UK.
g Safety & Improvement, NHS Education for Scotland , University of Glasgow , Glasgow , Scotland.
h Institute of Health & Wellbeing , University of Glasgow , Glasgow , Scotland.


What prevents the delivery of effective, high quality and safe health care in the National Health Service (NHS) in England? This paper presents 760 challenges which 330 NHS staff reported as preventing the delivery of effective, high quality and safe care. Some problems have been known for over 25 years (staff shortages, finance and patient complexity) but other challenges raise questions about the commitment of the NHS to patient and staff safety. For example, Organisational Culture leading to 'stifling bureaucracy', 'odds stacked against smooth […] working' and Workload resulting in 'firefighting daily' and 'perpetual crisis mode'. The role of Human Factors/Ergonomics professional input (engagement with safety scientists) is discussed in the context of success stories and examples of Human Factors Integration from other safety critical industries (Defence, Nuclear and Rail). Practitioner Summary: 760 challenges to the quality, effectiveness and safety of health care were identified at Human Factors/Ergonomics taster workshops in England. These are used to challenge health care providers to think about a Human Factors Integration (HFI systems) approach for safety, well-being and performance for all people involved in providing and receiving health care.


Human factors; education; ergonomics; healthcare; human factors integration; patient safety; systems

[Indexed for MEDLINE]

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