Samuel J. Alper

A human factors engineering paradigm for patient safety: designing to support the performance of the healthcare professional

The goal of improving patient safety has led to a number of paradigms for directing improvement efforts. The main paradigms to date have focused on reducing injuries, reducing errors, or improving evidence based practice. In this paper a human factors engineering paradigm is proposed that focuses on designing systems to improve the performance of healthcare professionals and to reduce hazards. Both goals are necessary, but neither is sufficient to improve safety. We suggest that the road to patient and employee safety runs through the healthcare professional who delivers care. To that end, several arguments are provided to show that designing healthcare delivery systems to support healthcare professional performance and hazard reduction should yield significant patient safety benefits. The concepts of human performance and hazard reduction are explained.

A systematic review of safety violations in industry

It is widely known that intentional non-malevolent violations of safety procedures and norms occur and evidence shows that safety violations can increase the risk of accidents. However, little research about the causes of these violations in work settings exists. To help shed light on the causes, this paper systematically reviews the empirical causes of safety violations in industry. Electronic database literature searches were performed to identify relevant articles published prior to January 1, 2007. Thirteen articles met the inclusion criteria and 57 different variables were examined as predictors of safety violations. Study settings were healthcare delivery, commercial driving, aviation, mining, railroad, and construction. The predictors were categorized into individual characteristics, information/education/training, design to support worker needs, safety climate, competing goals, and problems with rules. None of the reviewed studies examined whether violations can improve system performance or safety. Methodological suggestions and a macroergonomic framework are offered for improving future studies of the epidemiology of safety violations.

A change management framework for macroergonomic field research

With the proliferation of macroergonomic field research, it is time to carefully examine how such research should be managed and implemented. We argue that the importance of attending to high-quality implementation of field research is equal to that of methodological rigor. One way to systematically manage the implementation process is to adopt a change management framework, wherein the research project is conceptualized as an instance of organization-level change. Consequently, principles for successful organization-level change from the literature on change management can be used to guide successful field research implementation. This paper briefly reviews that literature, deriving 30 principles of successful change management, covering topics such as political awareness, assembling the change team, generating buy-in, and management support. For each principle, corresponding suggestions for macroergonomic field research practice are presented. We urge other researchers to further develop and adopt frameworks that guide the implementation of field research.

PROTOCOL VIOLATIONS DURING MEDICATION ADMINISTRATION IN PEDIATRICS

The paper uses a new measure of protocol violations to explore the extent of violations in the medication administration process. 203 nurses in three units of a free-standing pediatric hospital were provided with a survey assessing violations in the medication administration process; 120 nurses responded for a response rate of 59%. Violation data were collected for three stages of the medication administration process: matching medications to the medication administration record, checking patient identification, and documenting administration. The percentage of nurses who reported violating protocol in the medication administration process ranged from 8.4% to 30.2% in routine situations, and from 32.2% to 53.0% in emergency situations. Violations in the medication administration process may lead to medication errors. To improve medication safety, efforts should be taken to discover the system deficiencies that produce such frequent violations. System redesign should then address these deficiencies.

Nursing Workload and its Effect on Patient and Employee Safety

A well accepted human factors concept is that poorly designed work systems can produce workload levels that pose a threat to safety and performance. The purpose of this study was to assess a systems model of workload and safety developed for nursing/healthcare. Using survey data from six nursing units in two pediatric hospitals, the study measured the relationship between self-reported workload at the unit, job, and task levels on the one hand and job dissatisfaction, burnout, and medication error likelihood on the other. Multiple linear and logistic regression revealed that staffing adequacy and medication administration workload strongly predicted the above patient and employee safety outcomes. Design priorities and strategies for future research are discussed, including the need for multiple-level approaches.

Do beliefs about hospital technologies predict nurses' perceptions of their ability to provide quality care?: a study in two pediatric hospitals

The purpose of this study was to test the hypothesis that nurse perceptions of technology they use in practice would affect their perception that they were able to provide high quality patient care. A survey assessing the variables was administered to 337 pediatric nurses from two academic freestanding pediatric hospitals in the US. Two separate equations were constructed, one to test whether technology perceptions affected individual quality of care and the other to test whether technology perceptions affected quality of care provided by the nursing unit. Nurse confidence in their ability to use hospital technology and their beliefs that the technologies were easy to use, useful, and fit their tasks are important predictors of nurse beliefs that they are able to provide quality care to their patients.