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Macroergonomics is the formal study of work systems.[1] In health care, the human-task/tool interface represents the microsystem. Individuals interacting as teams or organizations represent mesosystems, whereas more complex sociotechnical interactions create the macrosystem. Regardless of which sub-system is being evaluated, the systems approach to human factors and ergonomics (HFE) always clearly maps the interventions to the macrosystem.[2] A core principle of HFE is the balance of work systems to the active and adaptive roles of those who work within them.[3] Quality improvement (QI) initiatives frequently employ training to reduce human error when things have gone wrong. However, it is a common misconception that HFE strives to eliminate human error. The paradigms of HFE more accurately align with creating systems resilient to unanticipated events using a thoughtful design process. Understanding the interaction between systems and behaviors supports the goal of optimizing systems so things go as right as possible. To this end, modifying tools and techniques creates more sustainable improvements in safety than behavior modification through training alone.[4]

In addition to using QI to reduce errors, HFE principles can be used to optimize and sustain safety approaches. To optimize the impact of simulation-based training, functional task alignment can be used to meet objectives with a structured debriefing in a psychologically safe environment to facilitate reflection. Didactics and workshops can be combined with simulation-based training for human factor skills to produce the most impactful participant experience and improvements. The TEAM instrument is a promising assessment tool for evaluating human factor skills and teamwork in simulated and clinical environments. Simulation plays a crucial role in supporting a human-centered design to develop and assess clinical support tools while integrating AI into the healthcare system. Simulation-based hospital design or simulation-based clinical system testing should be used to identify latent safety threats. Latent safety threat mitigation should be prioritized using failure modes and effects analysis. Countermeasure implementation and effectiveness should be evaluated through systems integration simulations.

After completing simulation-based, interprofessional training sessions through the Training In Non-technical Skills to Enhance Levels of Medicines Safety (TINSELS) program, study participants attended focus groups to capture the richness of the human experience and explore the concepts of nontechnical skill acquisition and safety development. For effective intergroup communication to develop, intergroup anxiety must be managed—a task not adequately addressed within homogeneous professional groups. Investigators accomplished this goal by developing a cooperative goal structure, institutional or normative support for these interactions, and the complexity of scripts. Researchers highlight the simulated environment as a means to support the pedagogical approach of exposure-based interprofessional team training.[62] Leadership can foster a culture of habitual excellence through briefings and debriefings, demonstrating transparency and sharing challenges. Thoughtful crafting and facilitation of the debriefing process is shown by establishing the following essential elements—psychological safety, debriefing stance or basic assumption, debriefing rules, and a shared mental model. In a meta-analysis of factors moderating the efficiency and effectiveness of debriefing, researchers revealed that a general discussion of overall performance is enhanced when reflecting on specific past events coupled with cue-strategy associations. This intentional approach to debriefing allows participants to examine actions and their underlying cognitions more deeply. Periods of silence provide for active listening and support transitions between complex topics. This approach also allows facilitators to evaluate non-verbal communication and determine if participants are ready to learn.[63]

Leadership can foster a culture of habitual excellence through briefings and debriefings, demonstrating transparency and sharing challenges. Thoughtful crafting and facilitation of the debriefing process is shown by establishing the following essential elements—psychological safety, debriefing stance or basic assumption, debriefing rules, and a shared mental model. In a meta-analysis of factors moderating the efficiency and effectiveness of debriefing, researchers revealed that a general discussion of overall performance is enhanced when reflecting on specific past events coupled with cue-strategy associations. This intentional approach to debriefing allows participants to examine actions and their underlying cognitions more deeply. Periods of silence provide for active listening and support transitions between complex topics. This approach also allows facilitators to evaluate non-verbal communication and determine if participants are ready to learn.[63] Through the simulation design process, contextual factors are augmented to optimize workflow representation, thus promoting the natural execution of tasks.[64] Participant motivation and engagement are fueled by the gamification inherent in the simulation delivery process, thus promoting teamwork and communication skills development.[38] Functional task alignment can be confirmed by measuring participants' immersion in the simulation session.[65] Collecting performance metrics at the team level helps support methodological alignment when evaluating critical teamwork processes.[66] As previously noted, incorporating global rating or behavioral assessment tools into the debriefing session allows for discussion of roles and expectations of the team as a whole.[67] Finally, by asking open-ended questions and confirming that learning objectives have been addressed, this critical component of successful healthcare simulation delivery optimizes the reflective experience of the participants.[68] By enabling teams and individuals to experience the appropriate conceptual, emotional, and physical fidelity of high-risk situations without the potential for patient injury, high fidelity simulation is well suited to assessing HFE through crisis resource management.[47]