Laurie Wolf

Human factors and ergonomics and quality improvement science: integrating approaches for safety in healthcare

In this paper, we will address the important question of how quality improvement science (QIS) and human factors and ergonomics (HFE) can work together to produce safer solutions for healthcare. We suggest that there will be considerable advantages from an integrated approach between the two disciplines and professions which could be achieved in two phases. First, by identifying people trained in HFE and those trained in QIS who understand how to work together and second, by developing opportunities for integrated education and training. To develop this viewpoint we will: 1. Discuss and explore how QIS and HFE could be integrated by building on existing definitions, scope of practice, knowledge, skills, methods, research and expertise in each discipline. 2. Outline opportunities for a longer-term integration through training, and education for healthcare professionals. The disciplines and professions of QIS and HFE developed from similar origins in the 20th century to engage workers in the identification of problems and development of solutions.1 ,2 They diverged with QIS focussing more on process issues (eg, production quality control) and HFE focussing on wellbeing (occupational health and safety) and performance. Both have been used in healthcare for many years, with several recent papers discussing confusion about jargon in one or both disciplines.3–7 We will offer a simple outline of our perspectives for each before suggesting an approach for integrated working. We are using the term QIS to include both quality improvement and improvement science.8 QIS is used, defined and explained in the literature in many different ways, for example, ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’;9 ‘better patient experience and outcomes achieved through changing provider behaviour and organisation through using a systematic change method and strategies’ …

Patient Falls Focusing on Human Factors rather than Clinical Conditions

Falls have consistently been the largest single category of reported incidents for acute hospital in-patients. The number of falls and risk factors have been identified and reported since the 1950s and are mostly unchanged in the 2010s. The main response to patient falls has been to treat the physiological and psychological presenting symptoms and condition by providing nursing care (mostly through assessment and monitoring) to minimise risk with the patient as a passive care recipient. As over 70% of falls are un-witnessed (unassisted) the active role of the patient in falls has not been fully explored. The new model (DIAL-F) is proposed which reverses the traditional Human Factors / Ergonomics model by describing the system elements in terms of the level of flexibility or transience (duration of action/involvement). The patient is the most transient element of the system, represented as a series of personas (archetypal descriptions) to include physical, cognitive and behavioural changes. This allows a more stimulating, riskier environment described as the ‘horticultural model of care’.

Firefighting to innovation: using human factors and ergonomics to tackle slip, trip, and fall risks in hospitals

Objective: The aim of this study was to use a theoretical model (bench) for human factors and ergonomics (HFE) and a comparison with occupational slips, trips, and falls (STFs) risk management to discuss patient STF interventions (bedside). Background: Risk factors for patient STFs have been identified and reported since the 1950s and are mostly unchanged in the 2010s. The prevailing clinical view has been that STF events indicate underlying frailty or illness, and so many of the interventions over the past 60 years have focused on assessing and treating physiological factors (dizziness, illness, vision/hearing, medicines) rather than designing interventions to reduce risk factors at the time of the STF. Method: Three case studies are used to discuss how HFE has been, or could be, applied to STF risk management as (a) a design-based (building) approach to embed safety into the built environment, (b) a staff- (and organization-) based approach, and (c) a patient behavior–based approach to explore and understand patient perspectives of STF events. Results and Conclusion: The results from the case studies suggest taking a similar HFE integration approach to other industries, that is, a sustainable design intervention for the person who experiences the STF event—the patient. Application: This paper offers a proactive problem-solving approach to reduce STFs by patients in acute hospitals. Authors of the three case studies use HFE principles (bench/book) to understand the complex systems for facility and equipment design and include the perspective of all stakeholders (bedside).

Human factors engineering approaches to patient identification armband design

The task of patient identification is performed many times each day by nurses and other members of the care team. Armbands are used for both direct verification and barcode scanning during patient identification. Armbands and information layout are critical to reducing patient identification errors and dangerous workarounds. We report the effort at two large, integrated healthcare systems that employed human factors engineering approaches to the information layout design of new patient identification armbands. The different methods used illustrate potential pathways to obtain standardized armbands across healthcare systems that incorporate human factors principles. By extension, how the designs have been adopted provides examples of how to incorporate human factors engineering into key clinical processes.

Ending the Vicious Cycle of Patient Falls

Over the past two years Barnes-Jewish Hospital has used Lean and Six Sigma methodologies in process improvement projects to prevent inpatient falls and falls with injury. These intensive programs have validated that falls are a multifaceted, complex problem that need constant vigilance and continuous improvement to sustain patient safety. Falls that result in serious injury can be life-changing for patients and families as well as impact the caregivers with potentially severe financial and health consequences. Trends in fall rates after completion of two Case Studies show that while decreasing the number of falls continue to be a challenge; the severity of injury from a fall can be reduced with patient and staff collaboration.

Reducing inpatient falls: Human factors & ergonomics offers a novel solution by designing safety from the patients’ perspective

Patients feel safe in the hospital and perceive they are less likely to fall whereas the opposite can be true if weakness, confusion and/or altered elimination issues are experienced as a result of symptoms, medication and/or procedures. A previous editorial from Grealish and Chaboyer (2015) outlined the scale and scope of this problem with an excellent argument for improving nursing care by valuing essential needs including ambulation, hydration, nutrition and elimination. However, despite many interventions (and models of nursing care) to improve assessment, monitoring and communication (Hignett, 2010), there has been little evidence of sustained reductions in either the number of falls or severity of injuries over the last 60 years (Oliver et al., 2007).

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.’

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.

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.