Outputs & outcomes: human factors issues

Outputs & outcomes: human factors issues

Human factors issues already appear at the level of outputs and outcomes. Outputs are more observable, achievable, and manageable. They provide more immediate feedback and are, thus, more informative as well. In contrast, outcomes are more opaque and correlative. As they depend on previous outputs, there is a need to be more cognizant of causation paths and be more aware of potential ill consequences. A focus on controllable outputs is more predictable and less taxing than on correlative outcomes.

Examples of outputs and outcomes for different specialties / activities
Specialty Main focus
Nurses outcomes (eg, recovered health)
Surgeons outputs (eg, effective operation)
Anaesthetists outcomes (eg, well induced amnesia, analgesia and paralysis)
Lab technicians outputs (eg, good quality X-ray image)
Dietitians outcomes (eg, appropriate nutrition)
Doctors outputs (eg, good diagnosis and prescription )
Pharmacists outputs (eg, good drug preparation and information)
Admin outputs (eg, good filing, timetabling and accountability)

Because of above differences between outputs and outcomes, the following human factor issues may appear:

  • Professionals for whom outputs are of greater relevance (eg, clinicians, surgeons, pharmacists, etc) may have a more objective and inflexible understanding of healthcare. Good healthcare depends on good procedures and professionalism. They probably perceive outcome-focused professionals as being less knowledgeable and decisive. They may also fail to perceive human factors as highly relevant, thus proving less supportive of human factors training.
  • Professionals for whom outcomes are of greater relevance (eg, nurses, anesthetists, dietitians, etc) may have a more subjective and flexible understanding of healthcare. Good healthcare depends not only on good procedures and professionalism but also on good monitoring and situation awareness. They probably perceive output-focused professionals as failing to appreciate the "whole picture". They may also prove more supportive of human factors training, as human factors will help reduce the uncertainty existing between outputs and outcomes.
  • As a focus on outcomes is more complex and cognitively taxing than a focus on outputs, even professionals for whom outcomes are of greater relevance may feel more comfortable and rewarded when focusing on outputs (ie, doing their tasks efficiently and professionally) than when focusing on outcomes (ie, recovery of health). Thus, there is a risk they will end up focusing too much on 'care' and less on 'health', without realizing that it may be more difficult for them to achieve both at the same time. This shift in focus may accentuate itself with increasing workload, increasing pressure, and decreasing situation awareness.
  • Outcome-based professionals may also take errors more personally than output-based professionals. And especially those who interact highly with patients and families (such as nurses) may "burn out" quicker and more frequently, as well.

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Outputs & outcomes in healthcare Other outputs & outcomes MRSA as outcome


Jose D PEREZGONZALEZ (2011). Massey University, New Zealand (JDPerezgonzalezJDPerezgonzalez).

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