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Proactive Safety Management in Trauma Care: Applying the Human Factors Analysis and Classification System

Cohen, Tara, N.; Cabrera, Jennifer, S.; Litzinger, Tracy, L.; Captain, Kevin, A.; Fabian, Michael, A.; Miles, Steven, G.; Reeves, Scott, T.; Shappell, Scott, A.; Boquet, Albert, J.

The Journal for Healthcare Quality (JHQ): March/April 2018 - Volume 40 - Issue 2 - p 89–96
doi: 10.1097/JHQ.0000000000000094
Original Article

Introduction: This article examines the reliability of the Human Factors Analysis and Classification System (HFACS) for classifying observational human factors data collected prospectively in a trauma resuscitation center.

Methods: Three trained human factors analysts individually categorized 1,137 workflow disruptions identified in a previously collected data set involving 65 observed trauma care cases using the HFACS framework.

Results: Results revealed that the framework was substantially reliable overall (κ = 0.680); agreement increased when only the preconditions for unsafe acts were investigated (κ = 0.757). Findings of the analysis also revealed that the preconditions for unsafe acts category was most highly populated (91.95%), consisting mainly of failures involving communication, coordination, and planning.

Conclusion: This study helps validate the use of HFACS as a tool for classifying observational data in a variety of medical domains. By identifying preconditions for unsafe acts, health care professionals may be able to construct a more robust safety management system that may provide a better understanding of the types of threats that can impact patient safety.

For more information on this article, contact Tara N. Cohen at

The authors declare no conflicts of interest.

© 2018 National Association for Healthcare Quality
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