Pascale Carayon

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.

A strategy for human factors/ergonomics: developing the discipline and profession

Human factors/ergonomics (HFE) has great potential to contribute to the design of all kinds of systems with people (work systems, product/service systems), but faces challenges in the readiness of its market and in the supply of high-quality applications. HFE has a unique combination of three fundamental characteristics: (1) it takes a systems approach (2) it is design driven and (3) it focuses on two closely related outcomes: performance and well-being. In order to contribute to future system design, HFE must demonstrate its value more successfully to the main stakeholders of system design. HFE already has a strong value proposition (mainly well-being) and interactivity with the stakeholder group of ‘system actors’ (employees and product/service users). However, the value proposition (mainly performance) and relationships with the stakeholder groups of ‘system experts’ (experts fromtechnical and social sciences involved in system design), and ‘system decision makers’ (managers and other decision makers involved in system design, purchase, implementation and use), who have a strong power to influence system design, need to be developed. Therefore, the first main strategic direction is to strengthen the demand for high-quality HFE by increasing awareness among powerful stakeholders of the value of high-quality HFE by communicating with stakeholders, by building partnerships and by educating stakeholders. The second main strategic direction is to strengthen the application of high-quality HFE by promoting the education of HFE specialists, by ensuring high-quality standards of HFE applications and HFE specialists, and by promoting HFE research excellence at universities and other organisations. This strategy requires cooperation between the HFE community at large, consisting of the International Ergonomics Association (IEA), local (national and regional) HFE societies, and HFE specialists. We propose a joint world-wide HFE development plan, in which the IEA takes a leadership role. Practitioner Summary: Human factors/ergonomics (HFE) has much to offer by addressing major business and societal challenges regarding work and product/service systems. HFE potential, however, is underexploited. This paper presents a strategy for the HFE community to strengthen demand and application of high-quality HFE, emphasising its key elements: systems approach, design driven, and performance and well-being goals.

Work organization and ergonomics

This paper examines the impact of sociotechnical and business trends on work organization and ergonomics. This analysis is performed with the use of Balance Theory (Smith and Carayon-Sainfort, Int. J. Ind. Ergon. 1989, 4, 67-79). The impact on work organization and the work system of the following sociotechnical and business trends is discussed: re-structuring and re-organizing of companies, new forms of work organization, workforce diversity, and information and communication technology. An expansion of Balance Theory, from the design of work systems to the design of organizations, is discussed. Finally, the issue of change is examined. Several elements and methods are discussed for the design of change processes.

SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients

Healthcare practitioners, patient safety leaders, educators and researchers increasingly recognise the value of human factors/ergonomics and make use of the disciplines person-centred models of sociotechnical systems. This paper first reviews one of the most widely used healthcare human factors systems models, the Systems Engineering Initiative for Patient Safety (SEIPS) model, and then introduces an extended model, ‘SEIPS 2.0’. SEIPS 2.0 incorporates three novel concepts into the original model: configuration, engagement and adaptation. The concept of configuration highlights the dynamic, hierarchical and interactive properties of sociotechnical systems, making it possible to depict how health-related performance is shaped at ‘a moment in time’. Engagement conveys that various individuals and teams can perform health-related activities separately and collaboratively. Engaged individuals often include patients, family caregivers and other non-professionals. Adaptation is introduced as a feedback mechanism that explains how dynamic systems evolve in planned and unplanned ways. Key implications and future directions for human factors research in healthcare are discussed. Practitioner Summary: SEIPS 2.0 is a new human factors/ergonomics framework for studying and improving health and healthcare. It describes how sociotechnical systems shape health-related work done by professionals and non-professionals, independently and collaboratively. Work processes, in turn, shape patient, professional and organisational outcomes. Work systems and processes undergo planned and unplanned adaptations.

Handbook of Human Factors and Ergonomics in Health Care and Patient Safety

Introduction Human Factors and Ergonomics in Health Care and Patient Safety Human Factors and Patient Safety: Continuing Challenges Macroergonomics and Systems A Historical Perspective and Overview of Macroergonomics Work System Design in Health Care Sociotechnical System Design in Health Care Clinical Microsystems in Health Care: The Role of Human Factors in Shaping the Microsystem The Artichoke Systems Approach for Identifying the Why of Error Organizational Learning in Health Care The Relationship Between Physician Professionalism and Health Care Systems Change Collaborative Initiatives for Patient Safety Job and Organizational Design Job Stress in Health Care Workers Effect of Workplace Stress on Patient Outcomes Safety Culture in Health Care Burnout in Health Care Human Factors of Transition of Care Reliability Enhancement and Demise at Back Bay Medical Centers Childrens Hospital The Relation Between Teamwork and Patient Safety Physical Ergonomics Human Factors in Hospital Safety Design Physical Environment in Health Care Physical Ergonomics in Health Care Evidence-Based Interventions for Patient Care Ergonomics Ergonomics: Noise and Alarms in Health Care An Ergonomic Dilemma Technology Human Factors Engineering and the Design of Medical Devices Patient Safety and Technology: A Two-Edged Sword New Technology Implementation in Health Care Robotics in Health Care: HF Issues in Surgery Human Computer Interaction in Health Care Re-Presenting Reality: The Human Factors of Health Care Information Human Error Behind Human Error: Taming Complexity to Improve Patient Safety Human Error Reduction Strategies in Health Care Medical Failure Taxonomies Human Factors of Health Care Reporting Systems Communicating About Unexpected Outcomes and Errors Human Factors and Ergonomics Methodologies Cognitive Work Analysis in Health Care Human Factors Risk Management in Medical Products Work Systems and Process Analysis in Health Care Video Analysis in Health Care Usability Evaluation in Health Care Assessing Safety Culture and Climate in Health Care Incident Analysis in Health Care Human Factors and Ergonomics Interventions Ergonomics Programs and Effective Interventions Quality Improvement in Health Care Work Organization Interventions in Health Care Teamwork Training for Patient Safety: Best Practices and Guiding Principles Tilting the Culture in Health Care: Using Cultural Strengths to Transform Organizations Specific Applications Human Factors and Ergonomics in Intensive Care A Process-Oriented Approach Human Factors and Ergonomics in the Emergency Department Human Factors and Ergonomics in Pediatrics Human Factors and Ergonomics in Home Care Human Factors and Ergonomics in Nursing Home Care Human Factors and Ergonomics in Primary Care

The Top Patient Safety Strategies That Can Be Encouraged for Adoption Now

Over the past 12 years, since the publication of the Institute of Medicines report, “To Err is Human: Building a Safer Health System,” improving patient safety has been the focus of considerable public and professional interest. Although such efforts required changes in policies; education; workforce; and health care financing, organization, and delivery, the most important gap has arguably been in research. Specifically, to improve patient safety we needed to identify hazards, determine how to measure them accurately, and identify solutions that work to reduce patient harm. A 2001 report commissioned by the Agency for Healthcare Research and Quality, “Making Health Care Safer: A Critical Analysis of Patient Safety Practices” (1), helped identify some early evidence-based safety practices, but it also highlighted an enormous gap between what was known and what needed to be known.

Human factors systems approach to healthcare quality and patient safety

Human factors systems approaches are critical for improving healthcare quality and patient safety. The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is a human factors systems approach that has been successfully applied in healthcare research and practice. Several research and practical applications of the SEIPS model are described. Important implications of the SEIPS model for healthcare system and process redesign are highlighted. Principles for redesigning healthcare systems using the SEIPS model are described. Balancing the work system and encouraging the active and adaptive role of workers are key principles for improving healthcare quality and patient safety.

Employee stress and health complaints in jobs with and without electronic performance monitoring.

Current applications of electronic performance monitoring based on job design theories that consider worker performance rather than stress issues are likely to generate unsatisfying and stressful jobs (Smith et al, 1986). This study examines critical job design elements that could influence worker stress responses in an electronic monitoring context. A questionnaire survey of employees in telecommunications companies representative of each region in the United States examined job stress in directory assistance, service representative and clerical jobs with specific emphasis on the influence of electronic monitoring of job performance, satisfaction and employee health. Useable surveys were received from 745 employees representing seven operating companies and AT & T; a response rate of about 25%. The results of this survey indicated that employees who had their performance electronically monitored perceived their working conditions as more stressful, and reported higher levels of job boredom, psychological tension, anxiety, depression, anger, health complaints and fatigue. It is postulated that these effects may be related to changes in job design due to electronic performance monitoring.

Advancing the science of patient safety

Despite a decades worth of effort, patient safety has improved slowly, in part because of the limited evidence base for the development and widespread dissemination of successful patient safety practices. The Agency for Healthcare Research and Quality sponsored an international group of experts in patient safety and evaluation methods to develop criteria to improve the design, evaluation, and reporting of practice research in patient safety. This article reports the findings and recommendations of this group, which include greater use of theory and logic models, more detailed descriptions of interventions and their implementation, enhanced explanation of desired and unintended outcomes, and better description and measurement of context and of how context influences interventions. Using these criteria and measuring and reporting contexts will improve the science of patient safety.

Questionnaire Survey Nonresponse: A Comparison of Postal Mail and Internet Surveys

Rapid advances in computer technology, and more specifically the Internet, have spurred the use of the Internet surveys for data collection. However, there are some concerns about low response rates in studies that use the Internet as a medium. The question is whether the lessons learned in the past decades to improve rates in postal mail surveys can also be applied to increase response rates in Internet surveys. After all, the Internet is a completely new medium with its own “rules” and even its own (n)etiquette. This article examines 29 studies that directly compared different survey modes (postal mail, fax, e-mail, and Web-based surveys) with more than 15,000 respondents. Factors that can increase response rates and response quality when using Internet surveys, compared to mail surveys, are discussed. Finally, the research that can contribute to increase response rates in Internet surveys is examined.