19.1 INTRODUCTION

The dental practitioner has long been regarded as highly valuable. However, managing the most personal aspects of human life inevitably involves errors, which can have consequences for patient safety and for which the dental practitioner is held accountable [1].

Many errors can be attributed to human factors [2]. Dentistry inherently involves complex manual tasks requiring a high degree of precision, which carries a significant risk of error. Failing to acknowledge the inevitability of errors not only compromises patient safety but also hampers professional performance [1]. Nevertheless, there is a growing shift in dentistry towards focusing on system analysis rather than solely blaming the practitioner [3, 4].

Human factors are an important aspect of ensuring safe and effective dental care. Human factors refer to the study of how people interact with their environment, equipment and other people, and how these interactions can affect performance, safety and well‐being. In dentistry, human factors can influence everything from the design of dental equipment to how dental procedures are performed. A critical appraisal of human factors in dentistry involves examining the ways in which human factors can impact patient safety, as well as identifying strategies for mitigating the risks associated with these factors. Some common human factors that can impact dental care include communication breakdowns, distractions, fatigue and stress. To address these issues, dental practices can implement various human factors interventions, such as team training, process improvement initiatives and the use of standardised checklists and protocols. For example, team training can help improve communication and collaboration among dental professionals, while standardised checklists and protocols can help ensure that procedures are performed consistently and safely.

A critical appraisal of human factors in dentistry can also involve evaluating the effectiveness of existing interventions and identifying areas where further improvements can be made. This may involve collecting and analysing data on safety incidents, near‐misses and other indicators of potential risk. Identifying human factors in dentistry is an important step in promoting patient safety and ensuring that dental care is delivered in a safe and effective manner. By understanding the ways in which human factors can impact dental care, dental professionals can work to mitigate these risks and provide high‐quality care to their patients.

19.2 THREAT AND ERROR MANAGEMENT

An error is an unintentional deviation from the planned course of action [1]. In contrast, faults or violations are intentional deviations from the guidelines and rules of a given system [1].

While it is acknowledged that any clinician can make an error, it is generally assumed that responsible clinicians would not deliberately deviate from established guidelines. Although there is no specific research related to dentistry, evidence suggests that 30% of medical professionals exhibit attitudes that could jeopardise patient safety [5]. These concerning attitudes include machismo, anti‐authority, impulsivity and a sense of invulnerability [5].

As clinicians, our role extends beyond merely fixing a problem; we are treating a patient. We aim to provide the highest standard of care. However, we may underestimate the risk of complications during initial assessments [6], likely due to an empathetic rather than analytical approach. Additionally, the belief held by 75–90% of dentists that they are more skilled or intelligent than their peers can foster a false sense of security and invincibility [6].

Designing systems and protocols to ensure that threats and errors are reduced to a minimum should form a key part of our practice.

19.3 TEAM RESOURCE MANAGEMENT

Errors are inherently tied to human behaviour [7–15]. The crucial first step in changing our team’s attitude towards errors is to acknowledge their inevitability and assess the risk of error associated with specific types of skilled dental performance.

Errors should not be associated with fault or punishment; instead, it is essential to analyse their causes to prevent future occurrences and improve patient safety. The International Classification for Patient Safety (ICPS) 2009 [16] aims to enhance science‐based systems and define key concepts to improve patient safety.

Research has been conducted to develop strategies for fostering a ‘patient safety culture’ [17], including the use of clinical audits [18], safety checklists [19], error reporting [20, 21], a national error database [20, 22], the NHS’ Never Events List (such as wrong‐site surgery and wrong tooth extraction) [23], calls to action for patient safety initiatives [24], novel trigger tools to detect adverse events in patient charts [25], studies on the dangers of dental devices and investigations into the causes of errors [26–27].

Despite the widespread use of clinical audits to analyse practice and identify errors, there is limited research in dentistry on the causes and frequency of errors in day‐to‐day practice. Consequently, there is little understanding of the role of human factors and their likelihood of causing adverse events.

A recent investigation by the authors of these guidelines aimed to provide insight into the risk factors contributing to errors and the link between error risk and perceived causes of adverse events in dental practice. The study found that the perceived number of daily errors is 2.016, ranging from one to four. The number of errors was unrelated to the clinician’s years of qualification and weekly work sessions. Importantly, the study found that, on average, 1.45% of errors are perceived to lead to an adverse event, ranging from zero to six.