“Humanness”—A crucial component of knowledge sharing for patient safety

In the late 1990s, the idea that the human element of delivering health care in a messy system contributed to the lack of safety was a new concept for many. The National Patient Safety Foundation sought to change that in its early awareness-building efforts. In 1998, the Tale of Two Stories report ¹ initiated an effort in health care to see how the melding of safety science, human factors, ergonomics, and incident investigation could set a path to address the complexity of what clinicians do and effectively learn from error. The 1998 Annenberg conference ² on patient safety had a session devoted to human factors. Shortly thereafter, the subject was discussed in To Err is Human ³ and the rest, as they say, is history.

Fast forward 20 years. Opportunities to understand the “humanness” of care delivery are more main stream. There are more efforts to design processes and embed interactions that manage that humanness safely and reliably. ⁴

One undercurrent of the humanness of care is that knowledge and its effective application are substantially human processes. Despite efforts to use technology to share what is tacitly “known,” knowledge as a human characteristic allows situational awareness and transfer of knowledge. For example, a 2013 study ⁵ looked at elements of situation awareness that enabled early recognition of clinical deterioration. The research illustrates how situation awareness helps clinicians anticipate problems and inform their interactions. It is especially helpful if practice is enabled by knowledgeable, informed leaders who diffuse improvements drawn from care activities within the unit and the team.

Despite increasing interest in technology as an important tool for sharing data, information, and knowledge, old-school methods of sharing and diffusing knowledge still have value: teams talk, walk, and work together. ⁶ Stories are told—creating powerful contextual insights that enable experiences to be applied to improve patient safety at the organizational, unit, and individual level.^7,8 Experts share what they know in the X-ray reading room, ⁹ diagnostic huddles, and over coffee. The ease of using mobile communication devices, high-demand work environments, and digital test result review may chip away at low-tech opportunities for knowledge exchange. But there are individuals that retain these behaviors in their practice and find value in sharing what they know in this way on a regular basis.

Certain people and roles are hubs for gathering, surfacing, and sharing what they learn with teammates. Understanding how these knowledge conduits do what they do successfully could contribute to patient safety, patient-centered care, and innovation efforts in medicine. Social network analysis tools use software to visualize patterns and document how individuals interrelate to share information and knowledge during the course of daily activities. Through the use of these tools, researchers can begin to see how health care can design work and teams to optimize sharing. For example, if over time one role emerges as a core element in how information sharing happens, units could better prepare to address a break in information sharing should a team’s makeup or location change. Potential problems are illustrated with one surgeon's story:

I’m the new guy, I show up and within no time at all [the nurses in the ICU] knew exactly the things that I liked … Fast forward 10 years later. Same intensive care unit … the population of nurses in that unit had tremendously changed. And each of these nurses was wonderful … But in the process of that sort of outflow of the experienced nurses and the inflow of the well trained, but not of that environment, nurses, a huge amount of tacit knowledge was lost. ¹⁰ (p. 82)

This change presents a potential for failure that can be mitigated through understanding knowledge flow and considering the impact of personnel changes can have on unit knowledge as a failure prevention strategy. It is intuitive that knowledge helps teams and individuals be proactive and anticipate problems but only when it is built^8,11 and shared amongst the team in a way that considers how humans interact. Static materials and guidelines don’t facilitate this element of safety in the same way. Seeing the work of knowledge sharing through a safety lens helps to apply the concepts and appraisal of human factors. This allows teams to adopt new interaction and communication methods, adapt existing activities, proactively consider gaps in knowledge sharing, and coordinate work in complex environments to support safety.

The same type of degradation of practice can also happen on the “blunt end” of the system. The loss of organizational knowledge when leadership, administrative staff, and non-clinical teams leave can degrade productivity, system-level learning, and the collective management of risk all, adversely affecting safety. Efforts to retain and transfer this knowledge should receive the same attention as other patient safety initiatives. ¹² Mentoring, multidisciplinary teamwork, and embedding staff in different units over time are tactics that enable humans to learn from one another. These strategies can be more effective than online portals, e-learning modules, and written process documentation.^6,13

Human interaction is a powerful force for learning, engagement, and innovation. Concrete efforts to optimize humanness as a positive component of patient safety to increase knowledge sharing should not be left to chance.