T he relevance of a motivational speaker from the rich sport of Formula One racing to an NHS safety conference is not obvious.

Mark Gallacher, former head of commercial affairs at Red Bull and marketing director at Jordan Grand Prix usually gives talks on "the Business of Winning".

But the audience at the recent event was quickly nodding in agreement as he discussed the need to change systems to make drivers safer, according to Dr Shelly Jeffcott, improvement advisor at NHS Healthcare Improvement Scotland.

Gallacher's topic was the human factors approach taken in F1, which has cut the number of drivers killed and injured, by taking a zero tolerance approach to unnecessary safety risks.

"The sport used to accept huge driver fatalities and long term life limiting illnesses. They took a human factors approach to the design of the car, the design of the track, and the crew and made safety everybody's business," she explains.

There had been 47 drivers killed between 1950 and 1994, Gallacher told the Scottish audience. There have been none since.

Human factors is Dr Jeffcott's speciality. The term refers to work looking not at individual errors, but how any system can 'design in' safety. Rather than focusing on the errors of individuals - doctors or nurses, say, it looks at reducing the chances that they will make errors. When they do inevitably make mistakes - because humans are fallible - it aims to reduce the risk these will lead to harm.

"We need to start learning the lessons of how other industries are reducing accident rates and limiting harm," Dr Jeffcott explains. She is an international expert on the issue, although she baulks at the term. It is hard to be an expert in something which combines computing science, education, anthropology, psychology and many other disciplines. But with seven years training in the field and a decade's working experience, she concedes she is as much an expert as anyone else.

Trained as a psychologist, she has worked in industry, looking at safety culture in the UK railways, but most recently worked at the Alfred teaching hospital at Monash University, Melbourne, Australia.

A native Aussie, she was lured back to Scotland because of the patient safety advances taking place here. "Human factors is so exciting because it is all about learning between industries," she says.

It is also about the intricacies of human behaviour and the psychological barriers that can prevent, for example, NHS staff from doing something a certain way, even though they know it would be safer.

"An aeroplane would never take off without doing a full checklist that incorporates the whole crew and cockpit team," Dr Jeffcott explains.

However some doctors and nurses sometimes resist the use of such checklists in healthcare. "There is an old culture of professional autonomy and some people fear a checklist involves dumbing down, undermining all the expertise they have through their training." Instead, she would encourage staff to see a checklist as a way of keeping everyone safer.

With the national handwashing campaign, few staff can be unaware of the importance of simple cleanliness for improving safety, but a human factors approach can shed light on why some still resist it, Dr Jeffcott adds. "If you don't have enough soap dispensers and sinks in all the patient bays, or if a nurse has to cross a room and leave a patient to wash their hands, all of those environmental factors have an effect."

She is keen to emphasise that her work, which sees her going out and shadowing staff in a bid to understand how the systems round them could support safer care, is not about scapegoating.

Quite the opposite, she says. "It is not about the person standing in front of a patient who makes an error. Human factors is about understanding and limiting conditions in the system that predispose that individual to make that error. This is not about bad nurses, or about retraining people. It is about a system that is imperfect and people that are doing their bloody damndest in the best interests of patients."

While some people are initially suspicious of being shadowed by someone who doesn't have a clinical background, they soften when they realise that their competence is not being critiqued. Instead, they are being offered support to do their job as well as possible, she says.

"In my experience people are incredible, especially on the front line and they welcome the human factors approach.

"There is a perception that there is increasing litigation and complaints from the public, but I don't think that is true. I think people understand that humans are fallible and doing their best, and that there are always going to be mistakes." However patients want to know that systems are as robust as possible and when things go wrong they want to see open communication about why, she says.

This applies to a framework for reporting so-called adverse events, which is currently being developed by NHS Healthcare Improvement Scotland. A culture of openness is being encouraged, rather than the secrecy witnessed in scandals over NHS Lothian's waiting time failures or the NHS Ayrshire and Arran serious incident figures.

"Human factors advocates learning not just from where things went catastrophically wrong, but also the near miss," Jeffcott adds. "A lot of safety critical industries have tried to introduce near-miss reporting, but nobody has really cracked it. I'm pretty fired up about it all," she says.

Changing the way new staff are trained is one approach being strongly encouraged. Junior doctors can be more open to an approach which regularly examines safety and re-assesses practices. "Sometimes we have normalised things in organisational culture that are wrong, with the idea that 'that's the way we do things around here'," Jeffcott explains.

"Junior doctors provide fresh eyes. The are the future and a huge source of strength."