‘In psychologically unsafe environments, where poor practice has gone unchallenged or become normalised or where bad behaviour has become entrenched, equality training can start to unpick the issues and increase awareness among healthcare workers, which in turn can improve patient safety.’

Human factors is about looking at the different elements that can influence people and their behaviour. The knowledge can be used to optimise the fit between people and the systems in which they work in order to improve safety and performance. In the workplace, different elements to research include:

  • the environment
  • the organisation
  • equipment
  • culture
  • human thought processes (e.g. confirmation bias, situational awareness, decision making)
  • tasks
  • team working.

In healthcare, human factors is a significant approach to exploring how to reduce unsafe practice and poor outcomes. For example, poor situational awareness and lack of competent leadership can lead to mistakes, errors in judgement and distractions which affect patient outcome. A healthcare worker who lacks assertiveness and feels psychologically unsafe in the environment (perhaps due to a culture of bullying) is less likely to speak up about practices which put patients at risk. They are also less like to work at optimum efficiency due to the stresses in the environment. In such a climate it is also less likely that junior healthcare workers will challenge more senior ones in terms of best practice or questioning judgement. This can be particularly detrimental to patient care and organisational performance.

Staff health, wellbeing and assertiveness (being able to speak up for example) are inextricably linked with patient satisfaction ratings, patient safety, operational efficiency and performance standards in hospitals. These links are particularly well evidenced in the NHS. This includes staff in non-clinical areas – for example, ensuring accurate records are maintained to identify the right patient, audits to highlight areas for improvement, clean spaces to prevent infection.

Human Resources

The diagram above demonstrates the links and relationship between organisational culture, management practices, staff wellbeing and the overall performance of the organisation (including the delivery of safe, high quality healthcare).
At all stages of the diagram, equality, diversity and inclusion training has a part to play:
  • Managers who are well-versed and competent in equality issues are less likely to participate in unfair recruitment practices and are more likely to be approachable to staff who need guidance.
  • Staff who are competent in equality issues are less likely to tolerate or perpetrate acts of bullying, intimidation and unfair working practices. A study published in the British Medical Journal in 2015 found that one in five doctors in the NHS had felt victimised for having blown the whistle on poor clinical or managerial practice, and almost four in 10 (38%) had felt bullied during the investigation.
  • Staff are also more likely to think ahead about the diversity of patients who they may need to treat and therefore be more prepared to engage in listening and communicating with patients and carers in a respectful way. Awareness of patient diversity can help improve health outcomes of historically marginalised groups (e.g. those with learning disabilities, people who identify as transgender).
  • Staff are also more likely to be aware of their own stereotypes and prejudices when observing patients for risk assessments and care plans.
In psychologically unsafe environments, where poor practice has gone unchallenged or where bad behaviour has become entrenched, equality training can start to unpick the issues and increase awareness among healthcare workers, which in turn can improve patient safety. In addition it can help reduce absenteeism and sickness caused by stressful work environments (people are more likely to feel comfortable/safe about approaching managers early on about stress). This is beneficial to the NHS as a whole. On average NHS staff are absent from work 10.7 days each year costing the service £1.75 billion.

Employees add value to all aspects of the organisation in terms of their knowledge, skills and abilities. Equality training can help organisations embed fair workplace practices, demonstrate respect for their staff and develop sustainable healthy working environments to ensure that teams are functioning to deliver the safest and best quality care. There is a large body of research evidence which suggests that effective teamwork in healthcare is associated with reduced medical errors and increased patient safety. Respectful and open communication is central to developing effective teamworking – both of which are reliant on an awareness of diversity and inclusion issues.

Equality training is central to human factors in healthcare because it can help:

  • Staff forge alliances to improve front-line care.
  • Provide a positive representation of the organisation to outsiders.
  • Encourage staff to come forward with ideas to improve processes in an organisation.
  • Build a fair, healthy organisational memory which is culturally inclusive.
  • Improve organisational culture and therefore overall performance.
  • Develop a community feel within teams of multi-disciplinary staff and reduce reliance on hierachical entitlement, thereby increasing individual staff competence.


BMJ – Doctors facing complaints have severe depression and suicidal thoughts, study finds BMJ 2015;350:h244

Clinical Human Factors Group

Dawson J and West M (2012) Employee engagement and NHS performance, The King’s Fund.

Salanova M, Agut S and Peiró JM (2005) ‘Linking organizational resource and work engagement to employee performance and customer loyalty: the mediation of service climate’. Journal of Applied Psychology, vol 90, pp 1217–27.

 West M, Dawson J, Adamasachew L and Topakas A (2011) NHS Staff Management and Health Service Quality Results from the NHS Staff Survey and Related Data, Aston Business School.