A. Joy Rivera

Occupational Macroergonomics: Principles, Scope, Value, and Methods

This year marks the 35th anniversary of Hal Hendricks (1980) report to the US Human Factors Society, considered by some as the origin of macroergonomics as a formal subdiscipline of human factors/...

Qualitative ergonomics/human factors research in health care: Current state and future directions

The objective of this systematic review was to understand the current state of Ergonomics/Human Factors (E/HF) qualitative research in health care and to draw implications for future efforts. This systematic review identified 98 qualitative research papers published between January 2005 and August 2015 in the seven journals endorsed by the International Ergonomics Association with an impact factor over 1.0. The majority of the studies were conducted in hospitals and outpatient clinics, were focused on the work of formal health care professionals, and were classified as cognitive or organizational ergonomics. Interviews, focus groups, and observations were the most prevalent forms of data collection. Triangulation and data archiving were the dominant approaches to ensuring rigor. Few studies employed a formal approach to qualitative inquiry. Significant opportunities remain to enhance the use of qualitative research to advance systems thinking within health care.

A Qualitative Observational Study in Pediatric ICUs The Use of Handsfree Device for Interruptions

Handsfree Communication Devices (HCDs) provide healthcare providers with an efficient way to communicate. However, they create new pathways for interruptions. The aim of this study is to understand how nurses use HCDs for interruptions from a systems perspective. Five Registered Nurses (RNs) in pediatric Intensive Care Units (ICU) were shadowed for a total of 15 hours. Fourteen interruptions mediated by HCDs were recorded and coded based on the identified themes. Results show that both interrupters and interruptees have to make decisions in the way of communicating with other people using HCDs. However, there is no standard way of making the choice, creating opportunities for medical errors. Based on this understanding, we propose several work system design recommendations at different levels.

Who is Drinking Our Kool-Aid? Hear Clinicians’ Perspective of their Human Factors Practitioner

Human factors (HF) has multiple domains that integrate various disciplines; and its principles and methods can be diversely applied within an organization. Healthcare organizations have started to deploy HF Practitioner (HFP) to assist in enhancing patient safety. However, the path for HFP integration into a hospital is still immature, clinical staff may be unclear of how to effectively collaborate with their HFP, and what benefits could HFP provide. This panel brings in 5 panelists from different organizations, who will share their experience in collaborating with their clinical advocate. Most importantly, audiences will hear their clinician advocates’ perceptions of the collaborations and benefits that their HFP has delivered, which encouraged them to drink our HFP ‘Kool-Aid.’

Ineradicable System Vulnerabilities in the Anesthesia Pre-Filled Syringe Medication Management Process

Pre-filled medication syringes (PFS) are injection devices that were recently introduced into the anesthesia medication management process to enhance safety, affordability, and convenience. However, it is still uncertain how well PFS integrate within the process and whether they effectively eliminate the system vulnerabilities (SV) associated with the traditional self-filled medication syringe (SFS) process. Two Human Factors Engineers conducted observations of 17 general surgery cases with either SFS or PFS. Aggregating the observation data, four ineradicable SV in the process with PFS were identified. Participants rated these ineradicable SV based on their occurrence, their severity to patients, and the disruptiveness to the operating room (OR) workflow. Results show that while PFS resolve SV to some degree, they are not panacea to all the problems in the anesthesia medication management process. Organizational-level interventions are needed for the elimination of all SV.

Real World Strategies to Achieve Human Factors Integration

Integrating human factors (HF) into organizational practices has long been one of the profession’s goals. Despite research that demonstrates the benefits of early HF integration, many organizations still resist or omit its inclusion in design and change management activities. The resistance is due to several reasons, including a lack of awareness of the field and misunderstandings about what the field encompasses. In this discussion panel, HF practitioners from different industries discuss effective as well as ineffective strategies for integrating HF into design and change management activities. The audience will gain relevant and applicable knowledge for improving HF integration into their organizations and industries.

Human Factors in the Wild: SOLUTIONS for Mitigating the Negative Impact of Interruptions in Healthcare (Discussion Panel)

This discussion panel will focus on solutions for mitigating the negative impact of interruptions in healthcare. Five human factors practitioners who work within healthcare systems will present solutions of mitigating the negative impact of interruptions on safety and quality with the acknowledgement that interruptions in and of themselves should not be viewed as purely negative (i.e. some interruptions are not only necessary but beneficial to patient care). Additionally, one panelist will focus on the difficulties in bridging the gap between research and practice in this arena. The session will lead to an interactive discussion about how human factors methods can be adapted and applied to identify and develop realistic, impactful solutions that improve safety by eliminating the negative impact of interruptions in applied healthcare settings.

Human Factors in the Wild Delivering Safety in the Pediatric World (Discussion Panel)

The pediatric healthcare environment is arguably more complex than the general, adult, healthcare settings (e.g., weight based dosing, caring for patients who cannot advocate for themselves, etc.). These complexities and the ever-changing dynamics of the pediatric patient population and their families increase risk of healthcare professionals committing errors that may result in patient harm. Moreover, due to their physiologic state, when pediatric patients incur such errors their impact is exacerbated due to the fact that children are often less capable of recovering from such events. Human Factors Engineering can help promote a culture of safety and high reliability by using proven techniques to understand human fallibility and help prevent or mitigate human error in healthcare. This panel invites six diverse healthcare HF practitioners from different organizations to share their experiences, contributions, and the impacts they have made to improve pediatric patient safety. Our panel will provide a unique lens on the application of HF approaches, and what sensitive factors toned to be considered to successfully enhance pediatric patient safety.

Using Challenges Associated Meaningful-Use Criteria to Prioritize Needed Changes in Electronic Health Records

To date, more than 30 billion dollars has been spent on the meaningful use (MU) program. While high adoption has been realized, there has been little improvement in usability of Electronic Health Records (EHRs), prompting continuous discussion. Further, very little scientific data has been provided regarding the type of challenges present for physicians when using an EHR. This study evaluates and prioritizes 6 of the most common challenges associated with EHR use by physicians during a patient encounter using meaningful use criteria as a basis. Data represents 430 physicians from across the US. Findings show all EHRs have significant challenges with organization and structure of information and the amount or method of documenting information. Analysis of the 31 MU criteria show only 1 criterion did not have any significant challenges. Alternately, 75% of criteria had 3 or more significant challenges with 9 criteria being significantly impacted by all reported challenges. Finally, individual groupings of physicians were found to have more challenges than others when considering physician’s age, computer comfort level, and the organizational type. Overall, findings show significant challenges exist for physicians when using EHRs, especially related to routine/basic patient care MU criteria. Specifically, challenges exist regarding how information is organized and the amount and/or method of EHR documentation, which must be a priority for improvement. If healthcare is to move forward and progress, EHRs must effectively support physicians in their work.

Human Factors in the Wild Getting the Human Factors Foot in the Healthcare Door. (Discussion Panel)

The Institute of Medicine (2005) identified Human Factors (HF) engineering as an approach to promote better healthcare system design. The use of HF in healthcare has evidently delivered improvement in safety, quality, and productivity. Although existing literature shows the application of HF in practice, there is limited discussion of the integration of HF into healthcare operations, and the science of HF and its mechanism to deliver improved outcomes. This gap makes it difficult for healthcare professionals and management to see how HF can benefit their organization. Even if the potential benefits of integrating HF into healthcare organizations are understood, there is a lack of guidance on how to best deploy full-time HF practitioners. Despite the vast number of hospitals and healthcare systems around the world, only a few have actively and successfully engaged HF practitioners as part of their internal operations. This panel invites four healthcare HF practitioners, with diverse backgrounds and sub-specialties (Micro-, Physical-, and Macro-Ergonomics) to share their roles and contributions to their organization, and discuss their pathway to becoming integrated into their healthcare organization. This panel will provide guidance on how healthcare organizations can deploy and achieve the full benefit of their full-time HF practitioner (e.g., which unit/functional department to position HF and proper expectations of HF). Additionally, the panel will discuss insights for educators and budding HF practitioners on what it takes to advance their career in this challenging, yet literally life-saving industry.