Human Factors in Healthcare: Still Misunderstood, Still Underused

Human factors (HF) has gained more visibility in healthcare over recent years, particularly through the introduction of the Patient Safety Incident Response Framework (PSIRF). That progress matters and should be celebrated. But visibility is not the same as understanding – and understanding is not the same as meaningful integration.

Despite pockets of improvement, HF in healthcare remains broadly misunderstood, underused, and too often applied too late. If we are serious about improving safety, performance, and staff wellbeing across the NHS, that has to change.

The Reality of Human Factors in Healthcare Today

There has undoubtedly been progress. More people now recognise that HF is about more than non‑technical skills (NTS) training. However, the pendulum may simply have swung from one form of oversimplification to another.

Where HF was once stove‑piped as “just NTS”, it is now increasingly stove‑piped as a patient safety methodology. This framing risks narrowing the discipline once again. HF is not a tool that belongs solely to incident investigation teams; it is a systems science with relevance across quality improvement, operational delivery, digital transformation, estates, procurement, and service design.

From my own experience working within a Trust, senior leadership understanding of HF was limited. Despite demonstrable outcomes comparable to the established quality improvement programmes, I struggled to secure executive buy‑in for a sustained HF approach. I apportion no blame to this; it is not an isolated experience.

Across the NHS:

• HF is still commonly reduced to training, ergonomics, or investigations, rather than recognised as a discipline that shapes how work is designed.
• HF specialists are typically brought in after problems emerge, instead of being embedded at the start of design and planning.
• Staff are forced to compensate daily for poorly designed systems, lack of interoperability, and fragmented processes. Workarounds are normalised, increasing stress, fatigue, and risk.
• Despite PSIRF, many organisations continue to default to individual‑level fixes rather than system redesign.

Safety issues are rarely about individual behaviour – they are about the conditions in which people work. The NHS has not yet fully embedded this mindset.

The Capacity Problem

HF capacity across the system is wholly disproportionate to the scale of need. One HF specialist cannot support an entire Trust or Integrated Care System, yet a) this is often the expectation, and b) we struggle to even achieve this baseline.

While it is encouraging to see more MSc programmes emerging, many appear narrowly focussed on patient safety. Increasingly, HF knowledge is being embedded into patient safety roles that are then filled by clinical or patient safety professionals. While this strengthens safety capability, it risks marginalising generalist HF specialists who bring broader systems, design, and performance expertise.

In short: we are growing HF knowledge, but not necessarily HF capability.

The Value Human Factors Is Already Bringing

Where HF is being used properly, the benefits are clear.

PSIRF has helped shift incident investigation away from blame and towards systems thinking. HF methodologies have enabled richer analysis of how work actually happens, not how it is imagined in policy or procedure. This has led to more meaningful identification of system‑wide issues and learning.

However, this value is not always easy to measure. Improvements in psychological safety, teamwork, and system resilience do not translate neatly into short‑term metrics. HF is a long‑term investment. Expecting immediate, visible returns risks undermining the very conditions that make healthcare safer over time.

There are also unresolved tensions – particularly between systems‑based safety investigations and the requirements of the coronial processes – that require national attention and alignment.

What Needs to Change

If the NHS is serious about making better use of HF expertise, several changes are essential.

1. A Clear National Strategy and Workforce Plan

We need clarity on HF roles, career pathways, and minimum capability at Trust and ICS level. Without this, HF will remain vulnerable, inconsistent, and dependent on local champions.

2. Mandatory HF Involvement in Major Programmes

Other high‑risk industries mandate HF through standards and assurance processes. Healthcare does not. HF should be a requirement, not an optional extra, in, for example:

• Capital builds and estates projects
• Digital and IT programmes
• Equipment selection and procurement
• Service and pathway redesign

HF specialists should be involved at the earliest stages to capture user requirements, run user-based testing, and evaluate options before decisions are locked in.

3. HF in Regulation and Assurance

Regulators and national bodies should explicitly assess system design, not just compliance. CQC, NHSE, and professional bodies all have a role to play in reinforcing that safety emerges from well‑designed systems.

4. Integrating Human Factors and Quality Improvement

HF and QI are not competitors – they are complementary. Practitioners of one should have knowledge of, and promote the use of, the other. Treating them as separate silos weakens both.

5. Building HF Literacy Across the Workforce

Embedding HF starts with mindset. Leaders and frontline staff alike need a basic understanding of systems thinking, Just Culture, and proactive safety. Without this shared foundation, HF will never truly scale.

A Final Thought

Human factors is not about fixing people. It is about fixing systems so people can succeed.

Until we fully embrace that principle – in strategy, regulation, design, and culture – we will continue to ask staff to compensate for systems that were never designed with them in mind.

And that is neither safe nor sustainable.