Identification and Introduction of a New Classification of Key Performance Shaping Factors in Staff Performance in the Healthcare System

Selection of the appropriate performance shaping factors (PSFs) is a vital challenge encountered by all experts in human reliability analysis (HRA) and plays a significant role in achieving reliable results. The main purpose of this research is to present a comprehensive set of staff PSFs that affect the emergence of errors and incidents in the healthcare system, referred to as healthcare- (H)-PSFs.

In this study, the set of H-PSFs was extracted using the PSFs presented for other fields and through consultation with HRA and healthcare experts. For investigation of whether the set of H-PSFs was comprehensive and appropriate, 318 reports of errors and incidents that had arisen at 14 hospitals during 12 months were examined, and the frequency values of each factor were obtained in two modes: where a PSF could and where it could not be repeated in an incident. The most significant H-PSFs were identified using Pareto charts. Also, using Minitab software, the Chi-square goodness of fit test was used to validate the proposed set of PSFs and demonstrate the appropriate accuracy of their frequency of occurrence.

According to experts, 43 PSFs were identified for the healthcare system. Using the medical error reports, the number of times that errors and mistakes were related to each PSF was calculated in two cases with and without repetition. To identify the most important PSFs, the Pareto principle has been used. According to the Pareto principle, 14 out of the 43 presented PSFs affected 80% of the errors and incidents that had arisen where PSF repetition was allowed, which amounted to 15 where repetition was not allowed.

The Chi-square goodness of fit test result showed that the proposed H-PSFs have sufficient validity to be generalized to other healthcare systems. The results of this article can be of great help to healthcare system managers so that they can make better decisions with the help of the results of this article in formulating general and healthcare system policies. Also, the findings of this study can be used in the healthcare system to analyze and improve human reliability, direct resources more efficiently to improve the performance of safety management systems, and reduce errors and incidents.