Abigail Wooldridge

A systematic review of mixed methods research on human factors and ergonomics in health care

This systematic literature review provides information on the use of mixed methods research in human factors and ergonomics (HFE) research in health care. Using the PRISMA methodology, we searched four databases (PubMed, PsycInfo, Web of Science, and Engineering Village) for studies that met the following inclusion criteria: (1) field study in health care, (2) mixing of qualitative and quantitative data, (3) HFE issues, and (4) empirical evidence. Using an iterative and collaborative process supported by a structured data collection form, the six authors identified a total of 58 studies that primarily address HFE issues in health information technology (e.g., usability) and in the work of healthcare workers. About two-thirds of the mixed methods studies used the convergent parallel study design where quantitative and qualitative data were collected simultaneously. A variety of methods were used for collecting data, including interview, survey and observation. The most frequent combination involved interview for qualitative data and survey for quantitative data. The use of mixed methods in healthcare HFE research has increased over time. However, increasing attention should be paid to the formal literature on mixed methods research to enhance the depth and breadth of this research.

SEIPS-based process modeling in primary care

Process mapping, often used as part of the human factors and systems engineering approach to improve care delivery and outcomes, should be expanded to represent the complex, interconnected sociotechnical aspects of health care. Here, we propose a new sociotechnical process modeling method to describe and evaluate processes, using the SEIPS model as the conceptual framework. The method produces a process map and supplementary table, which identify work system barriers and facilitators. In this paper, we present a case study applying this method to three primary care processes. We used purposeful sampling to select staff (care managers, providers, nurses, administrators and patient access representatives) from two clinics to observe and interview. We show the proposed method can be used to understand and analyze healthcare processes systematically and identify specific areas of improvement. Future work is needed to assess usability and usefulness of the SEIPS-based process modeling method and further refine it.

Quantifying the qualitative with epistemic network analysis: A human factors case study of task-allocation communication in a primary care team

ABSTRACT Health care is fundamentally about people, and therefore, engineering approaches for studying healthcare systems must consider the perspective, concepts and methods offered by the human factors and ergonomics (HFE) discipline. HFE analysis is often qualitative to provide in-depth description of work systems and processes. To deepen our understanding of care processes, we propose the next level of analysis; i.e., quantification of qualitative data. Here, we describe epistemic network analysis (ENA) as a novel method to quantify qualitative data and present a case study applying ENA to assess communication in a primary care team. One high-performing primary care team, consisting of a physician, nurse, medical assistant and unit clerk, was observed for 15 hours. We analyzed task-allocation communications and identified the sender, receiver, synchronicity and acceptance. We used logistic regression and ENA to evaluate sender, receiver and synchronicity impact on task acceptance. The physician and unit clerk were most successful at allocating tasks. Future work should consider the role of synchronous, interruptive communication as potentially useful in time-critical tasks and further investigate the role of the unit clerk. HFE researchers should consider ENA as a tool to expand and deepen their understanding of care processes by quantifying qualitative data.

Complexity of the pediatric trauma care process: implications for multi-level awareness

Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering methods, we combine interview, archival document, and trauma registry data to describe how intra-hospital care transitions affect process and team complexity. Specifically, we identify the 53 roles directly involved in patient care in each hospital unit and describe the 3324 total transitions between hospital units and the 69 unique pathways, from arrival to discharge, experienced by pediatric trauma patients. We continue the argument to shift from eliminating complexity to coping with it and propose supporting three levels of awareness to enhance the resilience and adaptation necessary for patient safety in health care, i.e., safety in complex systems. We discuss three levels of awareness (individual, team, and organizational), and describe challenges and potential sociotechnical solutions for each. For example, one challenge to individual awareness is high time pressure. A potential solution is clinical decision support of information perception, integration, and decision-making. A challenge to team awareness is inadequate “non-technical” skills, e.g., leadership, communication, role clarity; simulation or another form of training could improve these. The complex, distributed nature of this process is a challenge to organizational awareness; a potential solution is to develop awareness of the process and the roles and interdependencies within it, using process modeling or simulation.

The hfes diversity committee: Challenges and opportunities for involvement

The Human Factors and Ergonomics Society Diversity Committee met initially in January 2017, and on a regular basis thereafter to assess and improve diversity and inclusion in the society, profession, and discipline. Charged by president Bill Marras in 2016, the Committee replaced the Diversity Task Force established in 1994, and formally became a part of the Society’s Internal Affairs Division. As part of the Committee’s initial outreach, this panel will continue the conversation with society members about diversity and inclusion. Panelists will provide an overview of the Committee’s charter, review historical trends and current status of member diversity, discuss previous successful programming for enhancing diversity and feature perspectives from students and professionals in academia, industry, government/military/aerospace and consulting. Committee members welcome feedback and input from attendees on the above topics, what inclusion and diversity means and how to balance the broader concept of diversity with focused activities for targeted groups.

Improving Care Transitions in Healthcare: A Human Factors/Ergonomics (HFE) Approach

Delivering safe healthcare often involves multi-disciplinary teams working across multiple locations. Care transitions are required to provide continuity of care and are often fail due to this type of complexity. Care transitions occur in numerous settings, for example: during shift changes, transfer between wards, or during discharge to the patient’s home (WHO Collaborating Centre for Patient Safety Solutions 2007). The aim of the panel will be to discuss different types of care transitions and how HFE can assist in improving patient safety and efficiency of the process. The panel will discuss and share lessons learnt from a range of projects involving care transitions for pediatric trauma care (Woolridge), and barriers and facilitators to follow-up care for bone marrow transplant survivors (Sesto). In addition, the work system elements for care transitions for elective orthopedic patients (Carman), elderly patients after heart failure hospitalization (Holden) and risks to elderly patients’ safe medication management (Gurses) when transitioning from hospital to home will be discussed.

Things Falling Through the Cracks: Information Loss During Pediatric Trauma Care Transitions

Pediatric trauma is one of the leading causes of morbidity and mortality in children in the USA. Several clinical teams converge to support trauma care in the Emergency Department (ED); the most severe trauma cases often need surgery in the operating room (OR) and/or are admitted to the pediatric intensive care unit (PICU). These care transitions can result in loss of information or transfer of incorrect information, We interviewed 18 clinicians about communication and coordination during care transitions between the ED, OR and PICU. Clinicians completed a short questionnaire about patient safety during transitions. Results show that, although many services and units involved in pediatric trauma work well together, important patient care information may be lost in the transitions. To safely manage transitions of this fragile, unstable, complex population, we need to better manage the information flow during these transitions.

Challenges of Disposition Decision Making for Pediatric Trauma Patients in the Emergency Department

About 9.2 million children visit the emergency department (ED) in the US annually because of trauma and 20% experience a missed injury. Upon arriving to the hospital, physicians evaluate the child and make the ED disposition decision of whether to admit, operate or discharge. The objective of this study is to report the challenges mentioned by healthcare professionals about ED disposition decision making. We conducted 11 interviews with 12 healthcare professionals and identified 2 challenges of ED disposition decision making. The first challenge was timing of the decision; e.g., an ED nurse explained that a quick decision by physicians is important for providing timely patient care to critically ill children. The second challenge was leadership and team organization; e.g., the OR nurse and surgery resident both mentioned the need to know who to listen to so that they can understand what to do. Analyzing these challenges to ED disposition decision making can help to identify sociotechnical solutions for enhancing team situation awareness.

Technology-Mediated Communication between Patients and Primary Care Clinicians and Staff Ambiguity in Secure Messaging

Health information technology, i.e. secure messaging, can support high-quality, efficient care. Secure messaging – encrypted communication between patient and clinician or staff, similar to email – can facilitate patient-reported information and communication, but its fit with clinical workflow is not understood. Fifteen primary care clinicians and staff were interviewed and observed over 35 hours to understand the impact of secure messaging on ambiguity within the care delivery workflow. We developed a general workflow diagram for secure messaging, and identified three types of ambiguity relating to workflow, content of communication, and multiple points of data entry. While the use of secure messaging can help to clarify and document patient information, it can also increase ambiguity, particularly relating to the organization of work and workflow. Understanding how to design and implement technology to support multiple stakeholders, including patients, while considering the work system is a major area for future research.