Looking to aviation for tips on reducing errors in radiology
Conversations around the “human factor” in radiology—basically, the impact people have by nature of who they are and what they do—mostly center around the context of reducing errors. However, if those conversations aren’t also focused on improving the quality of life for radiologists and technologists, then reducing errors may be impossible, says Grainne Murphy, a radiology consultant from University Hospitals Birmingham.
In a presentation given at the Radiological Society of North America (RSNA) conference in Chicago, Murphy reflected on how her own career led her to study what it means for a person to work in radiology, and how factors inside and outside of work impact performance.
“Why (did I become) interested in human factors? Because every time I was shown an error, I thought I was the worst radiologist in the world. I wondered how I could be so stupid—and how could I miss such an obvious nodule,” she said. “And that became ... ‘What happened at that moment in time and how do I avoid doing the same thing next time?’"
Murphy took a look at aviation, using its extremely low rate of accidents (mainly plane crashes) as a metric for the level of success radiologists and techs should aim to achieve when reading reports and conducting scans. She also noted that, when airlines have some kind of accident, they’re typically attributed to human error.
How has the aviation industry worked to reduce these accidents over time? The same way radiology department leaders should, Murphy said, by looking at what “human factor” led to the incident occurring, be it a lack of communication, complacency, failure to work as a team, pressure, stress, lack of awareness—or something else related to how a person interacts with their job.
Murphy said airlines address these concerns by increasing pilot comfort, doing everything from improving chairs to ensuring they have the necessary resources to address issues in their personal lives, and conflicts they may have inside of work with their colleagues or employer.
“One of the things they do in aviation is look at the ‘I’m safe’ model of ‘are you fit to fly that day?’” she noted, spelling out that “I’m safe” is an acronym that stands for Illness, medication, stress, alcohol, fatigue, and emotions. Something as simple as ensuring a person is well fed and sober can mean the difference between life and death.
In healthcare, Murphy cites stress and burnout as major factors—but also, she thinks the understaffed, overworked hospital setting means clinicians tend to work while sick far too often. When a person’s body and brain are not functioning optimally, they’re simply going to make more mistakes.
“Again, we’re used to working longer hours—the work is overwhelming, and [that] can have the same impact as a blood-alcohol concentration of 0.1%, above the legal limit for driving in most states,” Murphy noted. “So, sometimes you just have to know when to pull back and take a break.”
While teleradiology, shorter shifts, and more days off all will improve the health and well-being of staff, Murphy suggested healthcare workers “just go for a nap, perhaps” and create a culture that values longer breaks.
Changing the culture at hospitals and health systems also is crucial to understanding the human factor and mitigating associated errors. Murphy recommends organizations aim for a “just culture,” where people are held accountable, but also rewarded and encouraged to simply do better.
“In your environment as well, it’s a just culture we should aim for. It’s difficult to have a ‘no blame’ culture, but in a ‘just culture’ you’re not blamed for an honest error, we just try to learn from a mistake,” she said. “But, [you’re] still held accountable if it’s a willful violation or gross negligence.”
Murphy’s presentation The Scope of Human Factors: What are They and Why are They Important? was part of a larger forum at RSNA focused on reducing errors in radiology.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.