Human Factors
The People layer of the operating lens. Every other discipline in this framework arrives with a model — queueing theory, institutional economics, labor markets. This discipline arrives with a method: ethnography. Sustained, situated observation of how people actually behave inside the systems that the other layers describe.
Core principle: The gap between what a system says it does and what the people inside it actually do is not noise. It is the most important signal the system produces. The metrics that make systems visible to administrators render invisible the knowledge that makes systems functional.
Modules
Foundations
The anthropological and cognitive groundwork. Ethnography as a method for seeing what metrics cannot, legibility and local knowledge, how organizations behave under regime change, what the People layer uniquely explains, cognitive architecture, and situation awareness as lived experience.
Module 2Performance
How humans perform under real conditions. Cognitive load theory, the fatigue-performance curve, how information degrades across handoffs, and the specific cognitive costs of shift work in clinical settings.
Module 3Signal Detection
The science of noticing what matters. Signal detection theory applied to clinical alerts, how expert recognition differs from novice pattern-matching, and why alert fatigue is a system design problem, not a user compliance problem.
Module 4Decision Science
How clinicians actually make decisions. Heuristics and biases in clinical reasoning, debiasing strategies that work in practice, escalation of commitment and sunk cost dynamics, and loss aversion in treatment decisions.
Module 5Error Systems
How errors happen and propagate. Error taxonomy beyond "human error," the Swiss cheese model of system failure, handoff failure mechanics, and resilience engineering as an alternative to blame-based safety culture.
Module 6Product Design
Human factors applied to healthcare technology. Trust calibration in AI-assisted decisions, cognitive load in interface design, human-in-the-loop system architecture, and alert design that respects cognitive limits.
Module 7Team Dynamics
How clinical teams function and fail. Team cognition and shared mental models, communication failure patterns, high-reliability organization principles, and psychological safety as infrastructure for error reporting and learning.
Module 8Adversarial
When the system is being gamed. Incentive gaming patterns, fraud detection workflows, adversarial design thinking, and the behavioral economics of non-compliance in healthcare programs.
The Anthropological Foundation
The foundations module establishes why ethnographic observation is necessary for healthcare operating intelligence. Four documents build the argument:
- Ethnography as Method — What anthropology sees that operations research, public finance, and workforce economics cannot: the gap between official and actual practice, tacit knowledge, power and resistance, communities of practice.
- Legibility, Local Knowledge, and Institutional Power — How administrative systems (compliance frameworks, metrics, audit cultures) systematically destroy the situated knowledge they cannot see. Scott’s Seeing Like a State applied to healthcare.
- Organizations Under Regime Change — What happens to the humans when institutional ground shifts: liminality, categorical displacement, sensemaking under radical uncertainty, narrative and organizational identity.
- What the People Layer Explains — The seams between layers. Where OR, public finance, and workforce economics go silent, and why only ethnographic observation can explain what happens at those boundaries.
The cognitive science modules (cognitive architecture, situation awareness, and beyond) are repositioned within this anthropological frame — not displaced but contextualized. Cognitive limits are real and measurable. They are also experienced by people who inhabit specific institutional contexts, carry specific professional identities, and make sense of their work through culturally shared narratives.
Integration Points
- Operations Research — OR models throughput, but throughput is determined by how workers actually behave: workarounds, deliberate slow-downs, informal networks that the model cannot represent. The People layer provides the local knowledge that makes OR predictions accurate for specific systems.
- Public Finance — Identical compliance rules produce different organizational behaviors because interpretation, compliance culture, and trust relationships are cultural products. The People layer explains how rules are lived, not just written.
- Workforce — Workers stay or leave based on meaning, identity recognition, and trust — not wage optimization alone. Turnover cascades follow trust violations, and community bonds hold workers in positions the economic model predicts they should leave.
- Emergent Systems — Organizational narratives, sensemaking, and informal practices are emergent properties — arising from local interactions, not prescribed from above. The People layer observes emergence as it happens inside inhabited institutions.