SHELL model of human factors research provided a conceptual frame-
work for understanding the multifaceted work environment of an OR
team member:
Software (procedures, cultural norms, skills)
Hardware (machines, instruments)
Environment (sound, noises, competing demands)
Liveware (individual)
Liveware (group)
"Human factors" are concerned with the human limitations and
capabilities that rise out of interactions with these external ele-
ments, which can lead to variability of performance and opportuni-
ties for error. Research suggests interruptions occurring during sur-
gery accumulate during the course of the procedure to create an
ever-increasing
"threat window." How
then do we navigate a
procedure to mini-
mize interruptions
and reduce the oppor-
tunity for error?
Knowing that suture
needle sticks were
our primary concern
for quality improve-
ment, the project was
structured to observe
wound closures for 35
cases, from comple-
tion of the procedures
through to completion
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