Understanding human performance improvement

What is human performance improvement?

Human performance improvement (HPI) is a systematic and scientific approach to identifying and analysing organisational and individual performance gaps or deficiencies in order to determine solutions that will effectively and efficiently enhance performance. Improving human performance involves analysing and understanding the specific factors that contribute to performance issues such as employee knowledge or skills, organisational systems or processes, and environmental or external factors.

To understand this, it is useful to distinguish between human factors and human performance. Human performance is all about how and why people do what they do. Human factors is the science which applies what we know about that ‘how and why’ to the design of machines, equipment, work environments, procedures and anything else involving human interaction.

The solutions developed through human performance improvement are focused on continuous improvement and a commitment to performance excellence which may include training, coaching, process improvement, technology implementation, and other interventions designed to promote improved performance and achieve desired outcomes.

3 factors which affect human performance

There are three critical factors which shape our performance. Motivation, capability and limitations. Different people may approach the same task with very different motivations – it may be money or praise or personal satisfaction, or a combination of these and others. It is important to know, to the extent it is possible, what is motivating an individual, because if for some reason that particular input is withdrawn, the motivation may simply cease and the task be abandoned. Abraham Maslow’s hierarchy of human needs gives some insight into the spectrum of desires, and hence motivations, we humans share.

The next performance factor is capability. If, for example, we were motivated to swim across a river, the ability to swim would be an essential capability if we are to succeed. Therefore, when assigning someone to a task, no matter how keen and motivated they may be, we must be sure they possess the requisite capabilities. Humans really only have access to two capability channels. One is cognitive, requiring active thought, while the other is learned from repetition, failure and practice. Mental calculation is a cognitive process for example, whereas standing up or driving a car are largely learned.

Sadly, both human capability channels have vulnerabilities and can fail us suddenly and unpredictably. These limitations can impact otherwise sound capabilities and significantly hamper performance. Cognitive thought can be prone to distraction, complacency or overload, whereas learned capabilities can be eroded by lack of practice or mis-applied in an unfamiliar environment.

Human performance in healthcare

There are many parallels which can be drawn between human performance in aviation and healthcare. In the late 1940s there were two significant influences on commercial cockpit culture which changed aviation safety forever and would eventually inform our understanding of how to improve patient safety in healthcare.

The first was a result of the massive wartime technology spike, taking planes higher and faster than before but also making the design, test and manufacture processes more reliable. The second was the transfer of military-style rank from warplanes to airliner cockpits. Aircraft captains assumed the mantle of complete command and more junior members of the crew (there were still several in the cockpit in those days) would think very carefully before challenging it.

The introduction of the flight data recorder and cockpit voice recorder technology revealed that while the total accident rate may have been decreasing, the proportion of those accidents attributable to human performance failures was increasing as technical reliability improved. It also proved that the precursors of many accidents had actually been recognised by crew members at the time but their cautionary input had either been too timid or the captain had simply dismissed it. Pilot behaviours, as with those of any team member, will be strongly influenced by management and organisational culture.

Years of training in the aviation industry has embedded a safety culture in which speaking up and reporting concerns are celebrated. There is an understanding that ‘to err is human’ and that the responsibility is to learn and mitigate future risk. Voice recordings from the cockpit reveal the nature of teamwork, leadership and decision making.

Rhona Flin is Professor of Applied Psychology at the University of Aberdeen. She leads a team of psychologists conducting research on human performance improvement in high-risk industries including healthcare. She describes another effect of power gradients. There is compelling evidence that witnessing or experiencing bad behaviour can seriously impair our judgement and performance.

As with aviation, the first step in a healthcare environment is to establish if there is a problem or not. Then, we need to identify and quantify the problem using robust evidence and data – is it technical and the equipment not good enough; is it procedural and we need to find a better way; or is it behavioural? If the latter, then it is the enhancement of non-technical skills within the team which offers the greatest opportunities for human performance improvement. Thereafter, an examination of the wider organisational culture could facilitate and promote an environment in which front line teams can perform at their best, without fear of criticism or sanction.

How cognitive dissonance affects human performance

Human performance can also be affected by cognitive dissonance, which is the the disparity between aspiration and reality during the conduct of a task. Humans harbour a compelling desire to complete a task once we have commenced it. This can be so compelling that we may press on although all of the indications, our instincts and maybe even our own colleagues are telling us to stop and rethink the strategy. This situation yields an ability to ignore evidence that suggests failure is imminent, which has clear consequences for the safety of patients in a healthcare organisation.

So, understanding how well we should expect human performance to improve requires that we first understand their motivations, their cognitive and learned capabilities and finally what limitations they might encounter. Understanding the importance of learning about human characteristics and behaviours and designing processes to be as resilient to human error as possible is fundamental to reducing patient safety incidents in healthcare.

Verita has been running a programme of workshops and training in human performance in the healthcare sector since 2017. If you would like to know more about human performance improvement, book a free consultation or email [email protected].