Towards a Taxonomy of Influencing Factors for Human Reliability Analysis (HRA) Applications in Surgery

Despite the growing interest in HRA applications in healthcare and in particular in surgery, in literature there is a limited number of HRA studies that use the so called Performance Shaping Factors or Influencing Factors to describe the working context. These factors (IFs) are those human, environmental, organizational or task specific factors that positively or negatively affect surgeons’ performance and the Error Probability. This study aims at developing an ad hoc taxonomy of Influencing Factors for surgery and it is meant to represent a first contribution towards the application of IF-based HRA in healthcare. The study methodology is twofold: firstly, literature review was used to identify and select personal and organizational factors that shape surgical performance; secondly, a field study was carried out to validate the preliminary list of IFs. Minimally Invasive Surgery (MIS) has been chosen as the field study domain. Ten factors have been extracted from the literature and classified according to the SHEL model. All the IFs in the taxonomy were observed throughout observation sessions. Furthermore, the observations prompted the addition of one more factor, namely “distractions”. In order to arrive at a stronger validation of the taxonomy, further research is needed to develop extensive validation of the conceptualization, clustering and assessment of IFs, by eliciting surgeons’ perceptions through multiple qualitative and quantitative methods.