Human Factors and Principles of Patient Safety: The James Reason Model

Human factors analysis deals with the role that individuals working within complex systems play in the errors and harms that occur in these systems. This chapter reviews the role of human factors analysis in healthcare delivery. Specifically, we describe the “Swiss Cheese Model” of accident causation proposed by James Reason, which focuses on the systemic failures of safeguards and barriers that can result in individuals causing harm to a patient. The chapter highlights the function of this model in enabling teams and hospitals to identify weaknesses in their systems of care in order to identify and rectify these problems before they result in patient harm. The second half of the chapter specifically reviews the strategies that can be employed to mitigate human error, such as creating a culture that supports widespread safety reporting, designing checklists, forcing functions, healthcare failure mode and effect analysis, and root cause analysis.