Mike Fray

TROPHI: development of a tool to measure complex, multi-factorial patient handling interventions.

Patient handling interventions are complex and multi-factorial. It has been difficult to make comparisons across different strategies due to the lack of a comprehensive outcome measurement method. The Tool for Risk Outstanding in Patient Handling Interventions (TROPHI) was developed to address this gap by measuring outcomes and comparing performance across interventions. Focus groups were held with expert patient handling practitioners (n = 36) in four European countries (Finland, Italy, Portugal and the UK) to identify preferred outcomes to be measured for interventions. A systematic literature review identified 598 outcome measures; these were critically appraised and the most appropriate measurement tool was selected for each outcome. TROPHI was evaluated in the four EU countries (eight sites) and by an expert panel (n = 16) from the European Panel of Patient Handling Ergonomics for usability and practical application. This final stage added external validity to the research by exploring transferability potential and presenting the data and analysis to allow respondent (participant) validation. Practitioner Summary: Patient handling interventions are complex and multi-factorial and it has been difficult to make comparisons due to the lack of a comprehensive outcome measurement method. The Tool for Risk Outstanding in Patient Handling Interventions (TROPHI) was developed to address this gap by measuring outcomes to compare performance across interventions.

More holes than cheese. What prevents the delivery of effective, high quality and safe health care in England?

Abstract What prevents the delivery of effective, high quality and safe health care in the National Health Service (NHS) in England? This paper presents 760 challenges which 330 NHS staff reported as preventing the delivery of effective, high quality and safe care. Some problems have been known for over 25 years (staff shortages, finance and patient complexity) but other challenges raise questions about the commitment of the NHS to patient and staff safety. For example, Organisational Culture leading to ‘stifling bureaucracy’, ‘odds stacked against smooth […] working’ and Workload resulting in ‘firefighting daily’ and ‘perpetual crisis mode’. The role of Human Factors/Ergonomics professional input (engagement with safety scientists) is discussed in the context of success stories and examples of Human Factors Integration from other safety critical industries (Defence, Nuclear and Rail). Practitioner Summary: 760 challenges to the quality, effectiveness and safety of health care were identified at Human Factors/Ergonomics taster workshops in England. These are used to challenge health care providers to think about a Human Factors Integration (HFI systems) approach for safety, well-being and performance for all people involved in providing and receiving health care.

Occupational safety and health and smaller organisations: research challenges and opportunities

Abstract Despite the prevalence of small and medium-sized enterprises (SMEs) and micro organisations, comparatively little is known about how such organisations approach occupational safety and health (OSH). Research has tended to present a negative picture of OSH practices in smaller organisations. This paper discusses some of the challenges to researching OSH in SMEs and micro organisations and how these challenges can be overcome. It draws lessons and experiences from a qualitative study involving 149 structured interviews, nine short-term ethnographies and 21 semi-structured interviews with owners and employees in SMEs and micro organisations from a broad cross-section of industry sectors in the UK, including construction, retail, healthcare, logistics and agriculture. Data from the study suggest that the established boundaries between micro, small and medium-sized enterprises are less meaningful in an OSH context – OSH practices are influenced more by the culture of the organisation, the type of work being undertaken and the sector that an organisation operates in. OSH practices in SMEs and micro organisations tend to reflect more informal characteristics of such organisations, with more emphasis (than many larger organisations) on tacit knowledge, learning by doing and improvisation. Such practices should not necessarily be assumed to be unsafe or incompatible with formalised OSH.

Two Case Studies Using Mock-Ups for Planning Adult and Neonatal Intensive Care Facilities

This paper describes two case studies using a 5-step protocol to determine functional space requirements for cardiac and neonatal intensive care clinical activities. Functional space experiments were conducted to determine the spatial requirements (defined as the minimumsized rectangle to encompass the Link Analysis). The data were collected with multi-directional filming and analysed frame-by-frame to plot the movements between the nurses and other components in the space. The average clinical functional space for the adult critical care unit was 22.83 m 2 (excluding family and hygiene space and in-room storage). The average functional clinical space for neonatal intensive care unit was 13.5 m 2 (excluding circulation and storage). The use of the 5-step protocol is reviewed, with limitations in case study 1 addressed in case study 2. The findings from both case studies have been incorporated into government guidance and achieved knowledge transfer by being implemented in building design.

Macro and Micro Ergonomic Outcomes in Healthcare: Unraveling the Relationship Between Patient Handling Performance and Safety Climate

OCCUPATIONAL APPLICATIONS The management of risks surrounding patient handling activities continues to be an important factor in healthcare organizations. A great deal of research has been undertaken to investigate the best practices for physical transfers and equipment provision, yet there is less research adopting an organizational systems approach to this problem. In this article we compare two methods for assessing safety climate and patient handling safety performance and argue that a multi-level (mesoergonomic) interpretation of the relationship between the two affords insights into the safety of the system as a whole. TECHNICAL ABSTRACT Background: Karsh et al. ((2014)) proposed a model for developing cross-level ergonomics investigations, which clarified the inclusion of micro, macro, and meso level factors to any organizational investigation. The growing body of research into the management of patient handling risks has not adopted these multi-level organizational systems approaches. Purpose: In this article we explore the use of this model to create a clearer understanding of the healthcare specific activities that surround the management of patient handling functions within a neurological rehabilitation setting. Methods: Six acute medical wards in a large UK teaching hospital were used to explore the relationship between patient handling, as part of a complex socio-technical healthcare system, and safety climate. Data were collected using the Tool for Risk Outstanding in Patient Handling Interventions and Safety Climate Survey and analyzed using descriptive statistics and Spearmans Rank Correlation. Results: A variety of results highlighted strengths and weaknesses in safety climate and patient handling risks. Significant correlations were found between Tool for Risk Outstanding in Patient Handling Interventions Tool for Risk Outstanding in Patient Handling Interventions Safety Climate scores and the Safety Climate Survey Overall Mean. Conclusion: These results suggest that the differences between scores across a variety of measures indicate that a wider range of data may be required to best represent a measure of safety climate in this occupational setting.

Observational study of treatment space in individual neonatal cot spaces.

Purpose: Technology developments in neonatal intensive care units have increased the spatial requirements for clinical activities. Because the effectiveness of healthcare delivery is determined in part by the design of the physical environment and the spatial organization of work, it is appropriate to apply an evidence-based approach to architectural design. This study aimed to provide empirical evidence of the spatial requirements for an individual cot or incubator space. Subjects and Methods: Observational data from 2 simulation exercises were combined with an expert review to produce a final recommendation. A validated 5-step protocol was used to collect data. Step 1 defined the clinical specialty and space. In step 2, data were collected with 28 staff members and 15 neonates to produce a simulation scenario representing the frequent and safety-critical activities. In step 3, 21 staff members participated in functional space experiments to determine the average spatial requirements. Step 4 incorporated additional data (eg, storage and circulation) to produce a spatial recommendation. Finally, the recommendation was reviewed in step 5 by a national expert clinical panel to consider alternative layouts and technology. Results and Conclusions: The average space requirement for an individual neonatal intensive care unit cot (incubator) space was 13.5 m2 (or 145.3 ft2). The circulation and storage space requirements added in step 4 increased this to 18.46 m2 (or 198.7 ft2). The expert panel reviewed the recommendation and agreed that the average individual cot space (13.5 m2/[or 145.3 ft2]) would accommodate variance in working practices. Care needs to be taken when extrapolating this recommendation to multiple cot areas to maintain the minimum spatial requirement.

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.

A Comparative Force Assessment of 4 Methods to Move a Patient Up a Bed

This study compared four different postures and positions regularly suggested for moving a patient up towards the head of the bed, using both novice and expert users. The trial was carried out in a laboratory using 21 participants (10 novices and 11 experts). All participants completed all conditions (n = 4) three times each (n = 3 repetitions). The physical force at each hand was recorded using electronic four compression/tension meters, recorded on DasyLab software. After each condition a subjective review questionnaire was completed. The data was processed with excel and SPSS to evaluate the differences between the conditions. A significant statistical reduction was found when comparing combined force for all carers (F(3,27) = 24.63, p < .05) and the load per individual (F(2.21,44.21) = 27.26, p < .05). However there was found to be no statistical difference between left and right hand or upper or lower hand. Transfers carried out with the carer pulling the patient towards them corresponded with a lower force to complete the transfer. This study suggests that a position with an oblique offset base and an action of pull and push in line with the carer could be the preferred position for a wide range of patient transfers.

An evaluation of sit to stand devices for use in rehabilitation

There are many assistive devices to help with raising a person from a seat. These devices are considered active as they require some balance, trunk control and weightbearing ability. There is concern that this movement is mostly passive due to fixation at the trunk and knee. This study explores the movement patterns in sit to stand transfers active and assisted.

Weak Signals in Healthcare: The Case Study of the Mid-Staffordshire NHS Foundation Trust

Most organisational disasters have warning signals prior to the event occurring, which are increasingly appearing in accident reports. In the case of the Mid-Staffordshire Disaster, the disaster was not as a result of component failure or human error but rather an organisation that drifted into failure with precursory warning signals being ignored. It has been estimated that between 400 and 1200 patients died as a result of poor care between 2004 and 2009. The aim of this study was to identify the precursory signals and their rationalizations that occurred during this event. Qualitative document analysis was used to analyse the independent and public inquiry reports. Signals were present on numerous system levels. At a person level, there were cases of staff trying to make management aware of the problems, as well as the campaign “Cure the NHS” started by bereaved relatives. At an organisational level, examples of missed signals included the decrease in the trust’s star rating due to failure to meet targets, the NHS care regulator voicing concern regarding the unusually high death rates and auditors’ reports highlighting concerns regarding risk management. At an external level, examples included negative peer reviews from various external organizations.