Performance Health Partners
Despite recent advancements, safety incidents remain prominent in healthcare, underscoring the need for a structured, proactive approach to uncover the root causes of these events and develop meaningful solutions. The Human Factors Analysis and Classification System, or HFACS, has emerged as a pivotal tool in dissecting, categorizing, and analyzing these complex factors, offering a structured approach to enhance the incident management process in healthcare settings.
What is HFACS?
Originally developed for aviation by behavioral scientists in the United States Navy, HFACS is a structured framework that helps organizations analyze errors by breaking them down into four levels:
- Unsafe Acts: Errors or violations made by frontline staff, such as a nurse miscalculating a medication dosage
- Preconditions for Unsafe Acts: Factors that contribute to errors, such as fatigue or burnout, high workload, or miscommunication
- Unsafe Supervision: Issues with leadership, such as inadequate training or failure to enforce safety policies
- Organizational Influences: System-wide issues, such as poor staffing policies or an ineffective or nonexistent culture of safety
By identifying which of these areas contributed to an incident, healthcare teams can implement targeted solutions to prevent similar mistakes in the future.
Why HFACS Matters in Healthcare
When incidents occur, organizations often focus on the individual who made the mistake. But research shows that most errors are the result of deeper systemic issues. HFACS shifts the focus from blame to understanding the root causes of mistakes so they can be prevented in the future.
For example, one study that utilized the human factors analysis and classification system to analyze radiotherapy errors determined that when there is inadequate supervision, there is a 25% increased likelihood of decision errors.
They were also able to easily identify multiple associations between human factors and errors. For example, safety events in quality assurance (QA) work were associated with decision‐type errors, or errors made when there is a lack of knowledge or skill, and treatment planning errors were associated with skill‐based errors, or mistakes made without a great deal of thought while performing routine tasks. By identifying patterns and addressing systemic issues, such as inadequate supervision, healthcare facilities can enhance safety without focusing on errors made by individuals.
Furthermore, studies have shown that traditional root cause analysis in healthcare often fails to fully identify human factors contributing to incidents. As such, HFACS offers a structured approach to examine the quality and the continuity of identifying human factors in the RCA process that are sometimes missed.
HFACS is particularly effective when used together with RCA, as they complement each other by ensuring that contributing factors to incidents are not only identified but linked to actionable interventions. Overall, HFACS is a proven methodology that can be used to complement RCA in evaluating the human and systemic factors within incident investigations.
How HFACS Strengthens Incident Management
HFACS can significantly improve the way hospitals and other types of healthcare organizations approach the incident management process. It identifies patterns by categorizing errors in a structured way, making it easier to spot trends around issues or associations between them.
If multiple incidents stem from miscommunication during handoffs, leadership can then take action to standardize protocols and prioritize or encourage communication between staff. This way, organizations can not only effectively address present issues but prevent similar ones from occurring in the future.
An analysis of surgical near-miss events at a hospital using HFACS found that the majority (60%) were related to preconditions for unsafe acts, followed by unsafe acts (35%), organizational influences (3.7%), and supervisory factors (0.8%).
This is significant as the majority of near-miss events were not purely the result of frontline workers’ actions, but related to systemic issues causing error, such as high workload, poor staffing levels, or environment of care issues. This insight is crucial because it shifts the focus of incident management from punishing individuals to addressing and acknowledging systemic failures.
The human factors analysis and classification system also encourages the prevention of incidents. Instead of reacting to incidents after they occur, HFACS helps organizations take a more proactive approach by analyzing the root causes of previous incidents to prevent them from reoccurring. Overall, HFACS not only improves incident management process efficiency, but also fosters a culture of continuous learning and improvement.
Overcoming Challenges with HFACS
While the human factors analysis classification system is a powerful tool, it does require commitment from both leadership and staff to be successful. Some of the biggest challenges, along with their solutions, are:
Training Staff
Challenge: Without proper training, incidents may be misclassified, not reported, or missed altogether, reducing the effectiveness of the analysis as well as employee understanding of the importance of the process.
Solution: Organizations should invest in structured training programs to ensure accurate data collection and meaningful insights, providing ongoing education and refresher courses to keep staff proficient in HFACS methods and best practices.
Shifting Organizational Mindset
Challenge: Many healthcare organizations still operate within a blame-focused or punitive culture, where failures are attributed to people rather than systemic problems.
Solution: Leadership must foster a just culture that prioritizes learning from mistakes rather than punishing those that make them. Encouraging open and honest discussion about errors and implementing anonymous reporting can help shift the mindset away from blame and shame.
Leadership Commitment
Challenge: Successful implementation of the human factors analysis and classification system requires strong leadership support, but some executives may not fully understand its vale or prioritize its adoption for the long-term.
Solution: Demonstrating how HFACS aligns with organizational goals through real-world case studies and research can encourage both greater commitment and long-term engagement. Leadership should be actively involved in supporting the use of HFACS in the incident management process by setting clear expectations and providing the necessary resources.
Final Thoughts
HFACS is transforming the way healthcare organizations approach the incident management process. By focusing on the root causes of errors rather than individual blame and punishment, healthcare organizations can create safer environments for patients while gaining the trust and support of staff.
As healthcare continues to advance, organizations that embrace a proactive approach to incidents using the human factors analysis and classification system will be better equipped to prevent errors, improve outcomes, and foster a continuous culture of safety and improvement.
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