In the Human Factors world, we roughly define ‘work procedures’ as those written instructions, guidelines, clinical protocols, checklists, decision-aids, standard operating procedures, care plans and flowcharts that we (or others) have agreed represent a safe, efficient and helpful way of doing things in healthcare.

They are everywhere in healthcare whether it’s to guide handovers between teams, help triage patients, order laboratory tests or ensure safety-critical tasks are reliably performed. All in all, they are seen as an essential aid in ensuring compliance, often with “best practices”, quality standards or regulation, and supporting the everyday performance of healthcare professionals and others. Well, that’s the theory anyway…!

So, What’s The Problem?

Unfortunately work procedures are cited as being problematic in most patient safety incidents that happen across all healthcare settings. A variety of reasons contribute to this state of affairs, including ongoing cultural issues, how they were designed and introduced and by whom, as well as challenges around their practical feasibility and usability as a useful support tool (see Figure 1).

Arguably, the biggest contributing factor is the lack of workforce (and educator) knowledge about how to develop, implement and sustain their use in everyday healthcare practice This is likely to be a significant learning need globally given there does not appear to be any evidence that healthcare professionals are formally trained in this critical area, despite this being identified as a significant patient safety issue for decades.

Figure 1. Examples of why healthcare staff can find work procedures challenging

So, What’s The Fix?

A pragmatic fix potentially exists.  Multiple principles and approaches are useful in ensuring the human-centred design of safe and usable work procedures in healthcare that can make them more likely to be used and sustained in practice – and therefore contribute more effectively as a patient safety intervention (Figure 2). At a basic level this includes:

• Ensuring a full-on co-design process involving all team members (or representatives of different user groups) at every stage of the development, introduction and evaluation of the work procedure – this is hard work but is vital if you wish it to be properly designed, useful and be used. When this is not done, you can almost guarantee failure!
• Recognising that to be useful the content of the work procedure needs as much as possible to accurately reflect the everyday complex reality of how the ‘work-is-done’, rather than how we and others ‘imagine’ how this is done. Hence, the reason why we need a co-design process involving the team, they are the local experts.
• Undertaking a ‘systems approach’ with the team to exploring and identifying the worst things that can go wrong and how they might occur (hazards) – these could be related to task complexity, technology, physical workspaces, workloads, training, culture, shiftwork, regulation, legislation etc. Doing this will contribute to more effective work procedure development.

Figure 2. Examples of human-centred design principles for developing usable and useful work procedures in any healthcare setting

Quick Reflection

Perhaps reflect for a moment on a current or past work procedure that you and your colleagues were expected to use, but had clear problems with - can you think you of one or two, or maybe many more?  I’m sure you can, and you won’t be alone. What were the consequences (actual or potential)?  What would you now do differently?

Paul Bowie

Education Editor

April, 2025

If you wish to know more about the issues involved, this free guidance on the design of effective work procedures for healthcare professionals by the United Kingdom Chartered Institute of Ergonomics and Human Factors (May, 2020) will be helpful.