Human Reliability Analysis (HRA) for Surgery: A Modified HEART Application to Robotic Surgery

HRA studies in healthcare highlight that PSF (or Influencing Factors-IFs) taxonomies in HRA techniques have been developed and validated in industrial contexts, and as such are not fully applicable to healthcare contexts. In this paper, a modified version of Human Error Assessment and Reduction Technique (HEART), has been developed and tested through an application to the robotic surgical Radical Prostatectomy procedure. Personal and organizational factors were modeled and assessed through an IFs taxonomy validated in the surgical domain, and then systematically translated into the corresponding Error Producing Conditions (EPCs), typical of the HEART method. The results confirmed the importance of adapting HRA methods to the healthcare sector, and added detailed information on what are the most relevant factors that should be captured by an HRA method when applied to surgery. Additionally, the analysis revealed that team related factors have the highest influence on surgeons' performance (i.e. increase of Human Unreliability Rate) in the context of different surgical tasks.