A Framework for Systematic Human Error Assessment in Healthcare Settings: The Case of Laparoscopic Surgery Publisher



Olyaei M ; Omidi L ; Zakerian S A ; Salehi V ; Ghasemi F
Source: Perioperative Care and Operating Room Management Published:2026

Abstract

Human error is a major issue in healthcare settings, significantly threatening patient health and safety. The aim of this study is to develop and apply a comprehensive framework to analyze and manage human errors in healthcare settings. The recommended framework comprises three major parts, including task analysis using Hierarchical Task Analysis (HTA), qualitative human error assessment to single out high-risk errors, and quantitative human reliability assessment using the extended Cognitive Reliability and Error Analysis Method (CREAM) to determine critical errors with the highest probabilities and to discern important, influential factors contributing to them. We conducted a case study on the laparoscopic cholecystectomy process to demonstrate the applicability of the framework. HTA, conducted by interviewing relevant persons and observing the activities in the operating room, identified 166 subtasks in three main phases preparing for the surgery, conducting the surgery, and bringing the patient back to consciousness. Systematic Human Error Reduction and Prediction Approach (SHERPA) reveals that 47 subtasks are high risk, and CREAM revealed that time pressure (available time), and teamwork (crew collaboration quality) are the most important contributory factors to human errors. The implementation of the method is easy to implement and affordable, guiding healthcare settings to manage human errors efficiently. © 2026 Elsevier Inc.