Human Reliability Analysis (HRA) in surgery: Identification and assessment of Influencing Factors

Several authors encouraged the application of Human Reliability Analysis (HRA) to patient care, recognising the benefits it brought to high-risk industries in terms of human errors reduction, thanks to its anticipative approach. However, the literature on HRA in healthcare is still scanty, and shows significant gaps at methodological level. Only a very limited number of HRA studies implemented Influencing Factors (IFs) analysis in the quantification of the Human Error Probability, despite it represents a peculiar component and a well-established step in several HRA techniques. Furthermore, the need for a deep adaptation and translation of existing HRA techniques to the healthcare domain is emphasised by several authors. This paper aims at designing a taxonomy of Influencing Factors for HRA studies in surgery, and assessing their influence on surgeons’ technical performance by means of structured elicitation of experts’ judgement. An ad hoc taxonomy of 21 IFs has been validated through focus group and individual interviews, in Denmark and Italy; 215 questionnaires from expert surgeons in open and mini-invasive surgeries were then used for the quantification of the impact of each IF on surgeons’ performance. An investigation on the possible influence of different surgical techniques revealed that only two out of the twenty-one IFs show different probability density functions (pdf) when considered in open or mini-invasive surgeries. The study offers an original and relevant contribution to the development of domain-specific knowledge and, as such, to fostering the diffusion of HRA studies in healthcare, and in surgery in particular.