Paulo Victor Rodrigues de Carvalho

Designing for patient risk assessment in primary health care: a case study for ergonomic work analysis

In this paper, we study the importance of a consistent description of real work in patient risk assessment in the primary healthcare domain. Through a case study in the context of primary health care, we address the research problem of finding ways to build consistent real work descriptions of the patient risk assessment system in the primary healthcare domain, in order to foster the design of improved work situations and support devices. This is a qualitative field study based on ethnographic observation and semi-structured interviews carried out among professionals involved in the risk assessment process in a primary healthcare facility. The objects of ergonomic work analysis were work places and work situations with focus on human activity, as well as surrounding aspects. The analysis identified elements in the work domain with high cognitive demand and operations that could increase mental workload, providing elements for the earlier stages of the design of work situations and support devices to improve the risk assessment in primary health care. This paper shows the usefulness of real work descriptions in the design for complex situations like the risk assessment in health care, as well the impact of poor descriptions in generating harmful situations for both the patient and healthcare practitioners in the explored domain.

Análise de microincidentes na operação de usinas nucleares: estudo de caso sobre o uso de procedimentos em organizações que lidam com tecnologias perigosas

Organizations that work with hazardous materials, such as nuclear power plants, offshore installations, and chemical and petrochemical plants, have risk management systems involving accident control and mitigation to ensure the safety of their facilities. These systems are based on physical devices, such as protective barriers, equipment and systems aimed at preventing the occurrence and propagation of accidents, and on human aspects such as regulations and procedures. This paper analyzes the use of a variety of procedures by nuclear power plant control room operators. The methodology consisted of analyzing the work of control room operators during the normal operations, shutdown, and startup of a nuclear power plant, and in full scale simulator training. This survey revealed that routine noncompliance to procedures was considered normal according to the operating rationale, which is based on technical, organizational and cultural factors. These findings indicate that the competencies nuclear power plant operators must possess far exceed proper technical training and the ability to follow written instructions.

A necessidade de novos métodos para análise de acidentes de trabalho na perícia judicial

Our goal is to demonstrate the need to change the work accident analysis methods in judicial expertise. We propose abandoning the easy model of unsafe acts committed by an employee, which has been used to blame the workers and not to avoid new accidents. The method we propose starts with a comprehensive and careful analysis of the activity undertaken and the socio-cultural environment where the event occurred. Ergonomic work analysis is used to understand the actual work situation. This article uses a real case to show how an expert, based on the proposed method, argued the case in the Labor Court.

Supporting decision-making in patient risk assessment using a hierarchical fuzzy model

In this paper, we present a hierarchical fuzzy model to support patient triage in primary health care. In developing countries like Brazil, public health must usually cover degraded territories; thus, allocating patients to health services is very hard due low availability, enormous demands, and the complexity of assessing patient conditions—which must account for more then physical aspects of patients, but their social conditions as well. This approach combines the fuzzy set theory under the AHP framework in order to illustrate the inherent imprecision in the evaluation of patient risk. Fieldwork was conducted in a primary healthcare facility in Brazil to demonstrate the applicability of the proposed approach. The proposed approach represents criterion in the formation of patients’ risk scores encompassing important aspects of primary care triage such as the structure of families, the conditions of residences, exposure to urban violence, and other aspects of patients’ lives, taking the risk assessment beyond the simple evaluation of symptoms and physiological conditions. Our approach focuses on enforcing decisions of public health workers by improving the awareness of patients’ conditions, which we believe will make the employment of triage criteria uniform and capable of showing tendencies on patients’ risks, as well as avoiding bias in patient triage.