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Single pilot operation (SPO) is now coming into focus, as advances in automation and artificial intelligence may allow the implementation of certain SPO concepts in commercial aviation within the upcoming years. At the same time, commercial aviation is facing a rising demand, increasing operating costs, and an enduring shortage of pilots. SPO implies far-reaching changes to the pilot positions and brings up questions regarding the inevitable guarantee of today’s safety standards, also related to the job requirements of SPO. Therefore, this study aimed to determine the requirements of the future SPO positions in comparison to today’s dual pilot (DP) position. The Fleishman Job Analysis Survey was administered to 40 airline pilots to evaluate the required levels of 75 different abilities and skills from five domains: cognitive, psychomotor, physical, sensory and interactive. Beforehand, participants were introduced to a reference SPO concept comprising two human roles – onboard pilot (OBP) and remote pilot (RP) – assisted by AI. Statistical analyses revealed high similarity between DP and OBP in terms of their requirement profile, whereas RP’s requirement profile diverged significantly at a predominantly lower level. On three cognitive and five important interactive requirements, the OBP position demands a higher level than the DP position. The results suggest that personnel selection concepts require no major but some minor adjustments when selecting personnel for SPOs. However, future technical developments have to consider these results to strive for maximum safety.
Core literature presented on concepts and evidence in multi-professional teamworking needed to enable competent management of all obstetric emergencies. Key theories and principles are presented with diagrams and worked examples. Key learning points: Effective teamworking is important because poorly functioning teams are associated with preventable harm. National reports recommend that teams that work together should also train together. Multi-professional training locally for all staff has been associated with improved teamwork, improved safety attitudes and, most importantly, improved perinatal outcomes. The most efficient teams state the emergency earlier, use structured communication and closed-loop communication. Effective teams appreciate the different roles and responsibilities of team members and the importance of shared decision making. The use of structured communication tools such as SBAR (situation, background, assessment, recommendations) can aid the transfer of information to the team in an emergency. When communicating with women and their birth partners in an emergency, allocate one health care professional to be the key communicator.
In Europe, rulemaking on single pilot operations (SPO) and its transitional stage of extended minimum crew operations (eMCO) has fuelled pilot unions in activism opposing them worldwide. Two officially unnamed aircraft manufacturers approached the European Union Aviation Safety Agency (EASA) to assess their operational flight safety for certification. The International Civil Aviation Organisation (ICAO) successfully mitigated the developments by setting the flight safety imperative to demonstrating equivalence. As part of rulemaking, a questionnaire on retrospectively disclosing health reports and physiological need preferences involved thousands of pilots, while a response rate of only 30.08% (n = 1,999) fully committed to being involved. A methodological and ethical critique identified several issues compromising the study’s integrity. This rulemaking project has reached appropriate conclusions that eMCO and SPO were unequal in safety to current flight operations, although their data from the questionnaire and flight simulations methodologically never allowed for interpretation with regards to risk and contemporary flight safety levels. However, the specific European organisational and industrial environment provided the requirements to ensure research quality and its integrity, but suffered from several shortcomings during business conduct across hierarchies. The consortium excelled in documentation of group dynamics and complete availability of reports enabling organisational psychology to take up investigations. The next time rulemaking is externally contracted, it should be justified on contemporary technology readiness levels with respect to interdisciplinary research, method, design, and development capabilities in the application domain, their standards, guidelines, and specialities.
Although many factors influence the incidence of medical error and adverse patient outcome, this chapter focuses on human and system performance and its impact on patient safety in the delivery room. First, we review general concepts and models of patient safety. Second, approaches taken by high-risk industries other than healthcare to improve human and system performance will be explored. Next, how those approaches can be adapted and adopted to address similar safety problems in healthcare will be discussed. Finally, we underscore how human factors research in healthcare can be used to improve patient safety. Healthcare must incorporate objective performance data, briefing, debriefing, simulation, and human factors science to identify and remediate human and system weaknesses inherent in patient care. Only then will we be able to improve performance, reduce error, and minimize risk.
This study utilises low-cost 2D pose tracking to analyse individual technique differences in elite rowers. We established key biomechanical metrics, revealing variations linked to anthropometrics, training style and flexibility. A technique mapping tool was developed, providing objective insights that supplemented expert opinion. A pilot demonstrated the utility of this analysis to generate actionable insights for equipment personalisation. This showcases that low-cost automated methods can provide proactive and meaningful insights suitable for individualized training strategies.
Human Factors and Ergonomics (HFE) is a discipline concerned with designing interactions in sociotechnical systems to improve both system performance and human well-being. This Element introduces the core principles of HFE, tracing its development from multidisciplinary efforts to solve practical problems in military operations during the Second World War to its current application in healthcare improvement. The Element acknowledges the growing role of HFE in areas such as the design of the physical environment, medical device design, learning from patient safety incidents, and safety investigations. A critical reflection highlights persistent challenges, including conceptual ambiguity, structural and practical barriers to HFE integration, and the need both for a stronger evidence base and a compelling business case. The Element concludes by identifying future priorities for advancing HFE in healthcare, including continuing professional development and career pathways, embedding HFE in regulation and policy, and adopting evaluation approaches suited to complex systems. This title is also available as open access on Cambridge Core.
Despite remarkable surgical advances, knowledge, and training, the reliability of patient care needs to be more robust, and affordable. Surgical teams struggle to design, implement, and maintain processes that optimize human performance, reduce risk, and ensure highly reliable, safe outcomes. Solutions for caregivers, especially those on the frontlines, remain elusive. This chapter helps to demystify the complex reality of our surgical processes, exploring how disruptions impact outcomes. It provides the tools to empower people and teams to provide the most effective, safe, and reliable care by improving process flow.
Healthcare provision involves humans (clinicians and non-clinicians) working in a complex environment consisting of equipment, technology, organizational culture and attitudes and behaviours of fellow team members as well as their patients and families. Human factors refer to the intricate link between knowledge, skills and competencies, the environment in which clinicians work, their personal circumstances, and the nature of communication between team members. Possession of individual knowledge, skills and competencies alone will not lead to the desired clinical outcomes if all other aspects of human factors are not understood and rectified. Pereira et al. identified 12 key aspects of human factors that may contribute to poor outcomes relating to CTG interpretation, based on ‘Du Pont’s dirty dozen’ from the airline industry. Addressing these key areas where ‘human factors’ is essential to optimize perinatal outcomes. Four consecutive ‘Each Baby Counts’ (EBC) Reports have reported that >50% of all cases of severe intrapartum hypoxia-related brain injury and perinatal deaths in the UK was due to CTG misinterpretation/fetal scalp blood sampling.
The impact of guideline-directed medical therapy (GDMT) has not fully translated to decreases in the disproportionate rates of hospitalization and lengths of stay in African Americans with congestive heart failure (CHF). GDMT is optimized by registered nurses (RNs) and their use of clinical information. Yet, there are no instruments for measuring the influence of clinical information use and nursing care. The study assessed an instrument’s ability to measure the influence of RN performance of social, technical, and socio-technical care tasks on length of stay in the CHF hospitalizations of African Americans.
Methods:
A sample of 200 RNs, who cared for 5060 African Americans with 14,123 heart failure hospitalizations, were surveyed. Descriptive statistics, Cronbach’s alpha, and a generalized linear regression assessed the instrument’s reliability and predictive validity.
Results:
The Cronbach’s alpha was 0.95 (95% CI: 0.94–0.96). The corrected item-total correlations for the 22 items ranged from 0.44 to 0.80. For an increase of one to four points per item in a RN’s performance, the estimated reductions in the patient’s length of stay were 3.34% (6.11,0.5), 6.58% (11.84,1), 9.70% (17.22,1.49), and 12.72% (22.28,1.99), respectively (P = 0.004).
Conclusions:
Increases in a RN’s performance of social, technical, and socio-technical care tasks were significantly associated with clinically meaningful decreases in their patients’ length of stay. The instrument has strong potential for addressing the disproportionate impact of CHF by measuring and tailoring interventions to optimize nursing care and the use of clinical information in the provision and receipt of GDMT.
This study evaluates the effectiveness of high-fidelity maritime simulators in improving seafarer training, focusing on navigation and emergency response skills. Using Kongsberg Polaris full-mission simulators, 98 participants (students, professionals and instructors) completed structured simulator exercises and were assessed using customised post-exercise questionnaires. Results indicate improved practical skills, with professionals reporting higher confidence and perceived control than students. Emotional engagement was also important: professionals showed more balanced responses, whereas students exhibited higher arousal and more variable perceptions of control. Instructors emphasised real-time feedback and scenario customisation as key to effective training. Limitations included challenges with certain manoeuvres, lack of integrated assessment tools and high simulator costs limiting wider adoption. The study concludes that high-fidelity simulators are valuable in maritime education, although further technological development and adaptation for less experienced trainees are needed.
Despite technological and scientific improvements in maternity care, mothers and babies continue to come to harm. As with other safety-critical industries, mistakes occur as a result of ‘human’ and ‘system’ errors. A sound understanding of non-technical skills can help explain past errors and prevent future errors; these skills include cognitive (situation awareness and decision-making) and social (teamwork, leadership and communication) aspects. Caring for mothers and babies is compromised by individuals and teams feeling stressed and exhausted, and it is increasingly recognised that a focus on individual/team human factors may be both ineffective and punitive. Improvements in safety culture therefore require both system redesign and compassionate leadership.
Unstable approaches contribute significantly to accidents during the critical approach and landing phases of flight, many of which could have been prevented by executing a go-around. This review investigates cognitive lockup, a tendency to adhere to task completion despite shifting priorities, and its role in aviation incidents. Specifically, we explore the psychological underpinnings of cognitive lockup, the influence on pilot decision-making and potential mitigation strategies. We examine factors such as task completion bias, framing effects and the perceived cost of task switching, and provide recommendations for training and policy modifications to reduce cognitive lockup. Aviation safety in critical flight phases can be improved through enhanced pilot training, mindfulness techniques, positive policy framing and AI-based alert systems.
Positive human–wildlife coexistence, especially in contexts of rewilding and the reintroduction of large carnivores, partially depends on communication between stakeholders. The media, and in particular local journalism, can play a crucial role in determining people’s knowledge of and attitudes towards wildlife. In this article, we analyse the online coverage of bears produced by the most widely circulated local newspaper in Trentino (Italy), where bears have been reintroduced thanks to a rewilding project funded by the European Union. Employing quantitative and qualitative content analysis of 375 articles, we look into the main features of the media coverage of bears over one year (2024). We find that articles tend to focus on controversial and uncommon events, such as culls and interactions. The most prevalent sources of quotations in the articles are politicians and activists, while experts, local residents, and individuals in the farming sector are less often quoted. The majority of articles are framed through the lens of the socio-political struggle generated by bear presence. Micro-dynamics of the online media coverage include high polarisation, fragmentation of narratives, and the marginalisation of relevant stakeholders (i.e., local communities, experts, European institutions).
Sixty uncrewed aerial vehicle (UAV) accident reports were analysed to identify causal and contributory factors leading to loss of control in flight – the most prominent category of UAV accident (36%). Design and manufacturing errors were dominant causal factors (22 events, 34%) and contributory factors (18 events, 22%). Recovery was not attempted in the majority of events (35 events, 55%). The relationship between operator age, total hours of experience, experience on type and recovery attempts were analysed. The number of accidents decreased as total hours of experience increased as well as attempted recovery. Using this data, existing accident analysis frameworks HFACS, AcciMap and Accident Route Matrix were applied to a sample of accidents and suitability compared. An adapted version of the Accident Route Matrix – Uncrewed Aerial Vehicle is proposed to assist current and future operators to understand causal and contributory factors to mitigate future loss of control in flight accidents and improve the likelihood of recovery. Using the results of the statistical analysis and the data gathered, a new definition for LOC-I for UAVs was defined by considering the different operating environment of UAVs.
The Aerospace Integration Research Centre (AIRC) at Cranfield University offers industry and academia an open environment to explore the opportunities for efficient integration of aircraft systems. As a part of the centre, Cranfield University, Rolls-Royce, and DCA Design International jointly have developed the Future Systems Simulator (FSS) for the purpose of research and development in areas such as human factors in aviation, single-pilot operations, future cockpit design, aircraft electrification, and alternative control approaches. Utilising the state-of-the-art modularity principles in simulation technology, the FSS is built to simulate a diverse range of current and novel aircraft, enabling researchers and industry partners to conduct experiments rapidly and efficiently. Central to the requirement, a unique, user-experience-centred development and design process is implemented for the development of the FSS. This paper presents the development process of such a flight simulator with an innovative flight deck. Furthermore, the paper demonstrates the FSS’s capabilities through case studies. The cutting-edge versatility and flexibility of the FSS are demonstrated through the diverse example research case studies. In the final section, the authors provide guidance for the development of an engineering flight simulator based on lessons learned in this project.
Aviation employees operate in a dynamic, complex safety-critical system that is filled with uncertainty, requiring quick and correct expert decision-making. The purpose of this study is to investigate the decision-making indicators among aviation employees. Fifty-five technical engineers and air traffic controllers participated in this study by completing the Cambridge Gambling Task (CGT) at one of Iran’s airports. The CGT provides one of the most reliable and widely used decision-making assessment tasks and related indicators, including decision-making quality, risk-taking, delay aversion, deliberation time, risk adjustment and overall bet ratio. Higher risk adjustment, less deliberation time, and a lower delay aversion index resulted in better decision-making quality. Higher risk-taking does not necessarily mean lower self-control. No significant differences were observed between the studied groups, including between air traffic controllers (both Ground and Tower vs. RADAR and Approach) and between air traffic controllers and technical engineers in the CGT performance. The decision-making quality increased with age and work experience, which has important implications for training and selection processes.
Edited by
Richard Williams, University of South Wales,Verity Kemp, Independent Health Emergency Planning Consultant,Keith Porter, University of Birmingham,Tim Healing, Worshipful Society of Apothecaries of London,John Drury, University of Sussex
This chapter explores the moral dimensions of work in emergency and pre-hospital medicine, with an emphasis on protecting the workforce and maintaining optimal functioning of teams. It explores the concepts of moral distress and moral injury from the literature and as they apply to emergency and pre-hospital medicine, but also in the light of the COVID-19 pandemic. It includes reference to the experience of one helicopter emergency medical service (HEMS) organisation attempting to make changes to its culture.
Occupational back-support exoskeletons, categorized as active or passive, hold promise for mitigating work-related musculoskeletal disorders. However, their impact on combined physical and cognitive aspects of industrial work performance remains inadequately understood, especially regarding potential differences between exoskeleton categories. A randomized, counterbalanced cross-over study was conducted, comparing the active CrayX, passive Paexo Back, and a no exoskeleton condition. A 15-min dual task was used to simulate both cognitive and physical aspects of industrial work performance. Cognitive workload parameters included reaction time, accuracy, and subjective measures. Physical workload included movement duration, segmented in three phases: (1) walking to and grabbing the box, (2) picking up, carrying, and putting down the box, and (3) returning to the starting point. Comfort of both devices was also surveyed. The Paexo significantly increased movement duration in the first segment compared to NoExo (Paexo = 1.55 ± 0.19 s; NoExo = 1.32 ± 0.17 s; p < .01). Moreover, both the Paexo and CrayX increased movement duration for the third segment compared to NoExo (CrayX = 1.70 ± 0.27 s; Paexo = 1.74 ± 0.27 s, NoExo = 1.54 ± 0.23 s; p < .01). No significant impact on cognitive outcomes was observed. Movement Time 2 was not significantly affected by both exoskeletons. Results of the first movement segment suggest the Paexo may hinder trunk bending, favoring the active device for dynamic movements. Both devices may have contributed to a higher workload as the movement duration in the third segment increased compared to NoExo.
The main purpose of crew resource management (CRM) is to ensure safe flights by preventing possible errors with the effective use of non-technical skills. The aim of the current study is to examine the effects of CRM on flight safety culture (FSC) with the help of the structural equation model with 451 airline pilots. As a result of the analysis, it was determined that there was a significant correlation between CRM and FSC and that CRM has a significant positive effect on FSC. It has been demonstrated that if CRM awareness and skills are used effectively, the perception of FSC will also improve. Furthermore, these findings indicate that there is a need to progress to the corporate CRM phase, i.e., CRM 7.0, to ensure that organisation-wide FSC awareness is established through CRM awareness.
The relevant growth of human-machine interaction (HMI) systems in recent years is leading to the necessity of being constantly aware of the cognitive workload level of an operator, especially in a safety-critical context such as aviation. Since the confusion in the definition of this concept, this paper clarifies this terminology and also highlights its relationship with stress. Thus, we analysed the state-of-the-art of cognitive workload evaluations, showing three up-to-date methodologies: subjective, behavioural and physiological. In particular, the physiological approach is increasingly gaining attention in the literature due to today’s exponential growth of biomedical sensors. Therefore, a review of the most adopted physiological signals in the workload evaluation is provided, focusing on the aeronautical field. We conclude by highlighting the necessity of a multimodal approach for mental workload assessment as a result of this analysis.