Human Systems Integration: Managing Risk in Anesthesia

Abstract

The practice of anesthesia relies on clinicians’ ability to safely manage increasingly complex equipment. Devices such as ventilators, drug infusion pumps, and physiologic monitors use sophisticated algorithms to deliver care, but most clinicians are only trained to manage automated systems during normal operation. Few if any receive training on how to manage system failures. Although manufacturers are required to consult with human factors engineers as part of the equipment design process, most pieces of equipment are ultimately brought to market without extensive input from clinicians. Systems in the operating room can be as simple as an oxygen tank, or as complex as a multi-institutional healthcare organization. Humans are also a complex system, and play a critical role in the domains of operations, design, fabrication, maintenance, repair, and ultimately, dismantling and closeout. HSI seeks to provide a means for advocating the human side of the system. Human Systems Integration (HSI) is the cross disciplinary process used as part of the Systems Engineering process to reduce risk in systems. HSI professionals consider the human, hardware, and software elements of system design to optimize system performance and improve safety. HSI professionals work in domains of study that include training, management, human factors engineering, safety, and occupational health, among others. This article discusses the role of systems in the practice of anesthesia, and how consideration of the human during all phases of the system life cycle helps manage risks and promote a better patient outcome.