Carla J. Alvarado

Work system design for patient safety: the SEIPS model

Models and methods of work system design need to be developed and implemented to advance research in and design for patient safety. In this paper we describe how the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety, which provides a framework for understanding the structures, processes and outcomes in health care and their relationships, can be used toward these ends. An application of the SEIPS model in one particular care setting (outpatient surgery) is presented and other practical and research applications of the model are described.

Multi-Society Guideline for Reprocessing Flexible Gastrointestinal Endoscopes

Flexible gastrointestinal endoscopy is a valuable diagnostic and therapeutic tool for the care of patients with gastrointestinal and pancreaticobiliary disorders. Compliance with accepted guidelines for the reprocessing of gastrointestinal endoscopes between patients is critical to the safety and success of their use. When these guidelines are followed, pathogen transmission can be effectively prevented. Increased efforts and resources should be directed to improve compliance with these guidelines. Further research in the area of gastrointestinal endoscope reprocessing should be encouraged. The organizations that endorsed this guideline are committed to assisting the FDA and manufacturers in addressing critical infection control issues in gastrointestinal device reprocessing.

Work design and patient safety

This paper describes the linkages between work design and patient safety. The focus is on nursing work; however, many of the concepts and methods are equally applicable to other healthcare professions. Work design relies on a large body of knowledge, including ergonomics, job stress and job/organizational design. First, a general framework of work design and patient safety is proposed. The proposed framework assumes that when designing or redesigning work one needs to examine different elements of a work system, i.e. the individual, the tasks, tools and technologies, the physical environment and organizational conditions. The second part of the report discusses the work design process, i.e. what it consists of, the ‘toolbox’ of tools and methods used to evaluate the work system and design and implement solutions, and principles for successful work (re)design projects. Finally, a number of recommendations to healthcare decision makers are proposed. §An extended version of this paper was written for the US Institute of Medicine Committee on the Work Environment for Nurses and Patient Safety (Carayon et al . 2003b). It was used by the Institute of Medicine for its report on Keeping Patients Safe – Transforming the Work Environment of Nurses (Institute of Medicine 2004).

Patient safety in outpatient surgery: The viewpoint of the healthcare providers

The objective of this study is to understand the viewpoint of healthcare providers with regard to patient safety in outpatient surgery settings. Two methods were used to gather data from the healthcare providers: (1) questionnaire with open-ended questions about six predefined stages of the patient care process; (2) survey with closed questions. With the first method, the main quality and safety of care issues concerned communication to patients, coordination of reports and forms, patient and staff time pressures and standards of care. The first two stages of the outpatient surgery process, i.e. patient work-up prior to day of surgery and patient admission and preparation on the day of surgery, yielded many more comments than the other four stages. The results of the structured questionnaire show that, overall, the healthcare providers report high quality of care provided by themselves (98%) and their surgery centre (96%). With regard to patient safety (i.e. cancellations of surgeries, patient safety problems and serious mistakes), there was a clear difference in perceptions reported by the physicians vs. the nurses and other staff. Nurses and other staff were more likely to report patient safety problems than physicians. The combination of qualitative data from the initial questionnaire and the quantitative data from the structured questionnaire provides a rather complete view of the outpatient surgery staff perceptions of quality and safety of care. This research highlights the importance of getting input from the healthcare providers regarding the quality and safety of care rather than relying only on traditional measures about patient outcomes.

Panel: The Role of Human Factors in Healthcare – 2020

What role will human factors professionals play in healthcare 2020? Health systems throughout the world face a number of common pressures, related to demography, epidemiology, science and technology developments, and medical demand. In particular, while developments in technology do not just provide health care with new possibilities for human factors engineering, medical interventions and therapies. They also produce changes the in our understanding of sickness and health, the possibilities and needs for managing the systems, for innovation, for standardization, and the political and economic relationships. The health care providers not only have to cope with these technological developments but assure their successful implementation and acceptance. The uncertainties and expectations linked to these innovations face major issues within the research and health care system, such as policies for managing scarcity of resources and changes in the relative frequency of diseases because of factors like ageing, and mobile global population and the like. A panel of both healthcare and human factors experts will discuss the role that human factors will play in healthcare in 2020.

Collecting Workers' Perceptions of Performance Obstacles in Outpatient Surgery

The aim of this study was to gather information from staff of outpatient surgery centers concerning their perception of the patient safety/quality of care issues at their Center and the performance obstacles they face when doing their work. In addition we wished to determine whether performance obstacles research (Brown & Mitchell, 1988; Peters et al, 1985) can be applied to the conceptual framework that serves as the basis for all of our patient safety research (Smith & Carayon, 1989, 1995; Carayon & Smith, 2000). We distributed open-ended surveys to all health care providers in five local outpatient surgery centers. Based on previous work conducted in the area of performance obstacles (Brown & Mitchell, 1988; Peters, et al, 1985) we asked the caregivers to identify instances when they felt their performance was challenged or below par, as well as instances when they were able to perform their job very well. Because the population we surveyed is not familiar with the totality of the work system model as defined by Smith & Carayon (1989, 1995) and Carayon & Smith, (2000), we provided the elements of the work system as examples to the respondents. The resounding themes caregivers listed as significant performance obstacles included inter-provider coordination and communication of care, equipment, work space, scheduling, time pressure and staffing issues.