Case Report: A novel human factors and professional boundaries workbook to support patient safety in complex mental health settings

‘Human factors’ are the intrinsic physical, cognitive and psychological limitations that impact on the implementation of human tasks and activities. These limitations necessarily influence the quality of care in mental healthcare settings. Whilst a large body of research explores the effect of human factors in physical healthcare (i.e. mitigating human error in surgery), comparatively minimal research exists in mental healthcare. On key human factor related issue in mental health care is the construct of professional boundaries. These are the interpersonal constraints required in staff /patient relationships. Systematic errors, or a breakdown in adherence, to professional boundary policies has been noted as a key driver of abuse and neglect in inpatient mental healthcare services. Improved policies and training around both human factors and the human factors underpinning professional boundary management s are likely significant drivers of quality and safety in mental health settings. A human factors and professional boundaries workbook was developed and deployed across 5 Iris Care Group services for a trial period, with the aim of training staff on research derived psychologically intrinsic human factors that may impact their work/interaction with service users. Subsequently, questionnaire data, interview data and quantitative patient safety metrics were analysed to determine workbook effectiveness. Qualitative feedback was positive, suggesting the workbook corrected misconceptions around professional boundaries, encouraged staff self-reflection, improved general understanding of cognitive and psychological limitations, and had high understandability. Improvements in patient safety metrics in the months following workbook distribution supported positive initial conclusions and suggest the workbook effectively promoted patient safety. Unresolved questions and areas for future research are discussed.