Sarah Atkinson

Perceptions of the impact of depression and anxiety and the medication for these conditions on safety in the workplace

Background: The number of people taking prescribed medication for anxiety and depression has increased greatly, but little is known of how this medication impacts on safety at work. Aims: To examine the relation between anxiety and depression, prescribed medication, performance, and safety in the workplace. Methods: The research involved nine focus groups with sufferers of anxiety and depression to investigate experiences of mental health problems and the impact of psychotropic drugs. A further three focus groups were conducted with staff in human resources, personnel, occupational health, and health and safety departments, to explore organisational perspectives. The sample comprised 74 individuals drawn from a wide range of occupational sectors. Finally, the results were presented to a panel of experts from occupational medicine, general practice, psychology, health and safety, and psychiatry, to consider the implications for practice. Results: Workers reported that both the symptoms and the medication impaired work performance. Participants described accidents which they attributed to their condition or to the medication. Workers with responsibilities for others, such as teachers, healthcare workers, and managers appeared to present a particular safety risk. Healthcare workers believed that they placed themselves and their patients at risk when carrying out medical procedures. Conclusions: Respondents in this study felt that their symptoms of anxiety and depression and the medication they took to treat these conditions placed them at risk with respect to safety in the workplace. Drawing on the results, the authors outline areas for improvement in the management of mental health problems at work.

Effect of a contact monitoring system with immediate visual feedback on hand hygiene compliance

BACKGROUNDnHand hygiene compliance is traditionally monitored by visual methods that are open to bias and strictly limited in time and place. Automatic monitoring may be more effective for infection control as well as performance management.nnnAIMnTo establish accuracy and acceptability of an automatic contact monitoring system for hand hygiene.nnnMETHODSnMonitoring equipment was installed across 55 beds in three wards, and included modified identity badges, bedside furniture, sinks and alcohol gel dispensers. Badges were in near-skin contact (through uniform) and could detect alcohol vapour. All devices were linked by wi-fi. A traffic light system on the badge provided immediate feedback to staff and patients on the hand hygiene status of a member of staff on approach to a patient. Compliance was logged automatically. Following a period of immediate feedback, no visual feedback was given for two weeks. Subsequently, feedback was given using red/green lights for 10 days, followed by retrospective feedback to the ward. Hand hygiene was verified independently by an observer.nnnFINDINGSnHand hygiene compliance increased from 21% of 97 opportunities to 66% of 197 opportunities during active immediate feedback. Compliance decreased when feedback was provided to wards retrospectively. Six staff (26%) avoided wearing a badge, saying that it was too heavy or they were not on the ward all day. Only three of 30 patients stated that they would challenge staff who had not performed hand hygiene.nnnCONCLUSIONSnAutomatic contact monitoring with immediate feedback was effective in increasing hand hygiene compliance, but feedback given retrospectively did not prevent a decrease in compliance.

Construction tools and equipment – their influence on accident causality

This paper presents tools and equipment aspects of the results from a three‐year United Kingdom Government funded research project investigating accident causality (ConCA). The project has used focus groups and studied in detail 100 construction accidents site audits, interviews with involved persons and follow‐up along the causal chain. This paper concentrates on the influence of construction tools and equipment which were found to be important contributory factors identified by the research. They have largely been overlooked by previous studies and are not typically acknowledged as accident contributors. This paper argues for further work to confirm these links and for the inclusion of tools and equipment in the list of categories in statutory reporting procedures. This would also require an increased acknowledgement by construction managers of their influence, leading to better design and management of their supply and care on site.

Participatory design of a preliminary safety checklist for general practice

BACKGROUNDnThe use of checklists to minimise errors is well established in high reliability, safety-critical industries. In health care there is growing interest in checklists to standardise checking processes and ensure task completion, and so provide further systemic defences against error and patient harm. However, in UK general practice there is limited experience of safety checklist use.nnnAIMnTo identify workplace hazards that impact on safety, health and wellbeing, and performance, and codesign a standardised checklist process.nnnDESIGN AND SETTINGnApplication of mixed methods to identify system hazards in Scottish general practices and develop a safety checklist based on human factors design principles.nnnMETHODnA multiprofessional expert group (n = 7) and experienced front-line GPs, nurses, and practice managers (n = 18) identified system hazards and developed and validated a preliminary checklist using a combination of literature review, documentation review, consensus building workshops using a mini-Delphi process, and completion of content validity index exercise.nnnRESULTSnA prototype safety checklist was developed and validated consisting of six safety domains (for example, medicines management), 22 sub-categories (for example, emergency drug supplies) and 78 related items (for example, stock balancing, secure drug storage, and cold chain temperature recording).nnnCONCLUSIONnHazards in the general practice work system were prioritised that can potentially impact on the safety, health and wellbeing of patients, GP team members, and practice performance, and a necessary safety checklist prototype was designed. However, checklist efficacy in improving safety processes and outcomes is dependent on user commitment, and support from leaders and promotional champions. Although further usability development and testing is necessary, the concept should be of interest in the UK and internationally.

Ward assessment of SmartIdeas Project: bringing source isolation to the patient

Most UK hospitals lack enough single rooms to provide source isolation for all infected patients. The aim of this study was to test prototype isolation systems on general wards together with specifically designed portable sink units and toilets. Questionnaires were offered to staff, patients and visitors covering ease of use and acceptability. A total of 53 patients were isolated, with concurrent collection of environmental samples and staff hand hygiene audit. Blocking of beds next to infected patients was avoided but patients and staff were concerned about limited space and communication. Hand hygiene compliance on entry or exit to/from an isolated bed space significantly improved [43/76 (56.6%) to 107/147 (72.8%), P<0.05]. Although popular, the toilets were mechanically unreliable. Low levels of microbial contamination (<1-3.4cfu/cm(2)) were present within all isolated bed spaces. The highest colony counts were obtained from high contact sites (e.g. remote controls). Meticillin-resistant Staphylococcus aureus (MRSA) was present at similar levels inside all systems. Although one system was designed to provide airborne as well as contact isolation, MRSA was isolated from air inside and outside the system suggesting poor efficiency of the air door. The finding was confirmed by aerobiology tests at the Health Protection Agency Laboratory, Porton Down, UK. A trial of redesigned units is required to establish efficacy (Trial Identifier: ISRCTN02681602).

Blood sampling - two sides to the story

This study aimed to investigate why there is variability in taking blood. A multi method Pilot study was completed in four National Health Service Scotland hospitals. Human Factors/Ergonomics principles were applied to analyse data from 50 observations, 15 interviews and 12-months of incident data from all Scottish hospitals. The Functional Resonance Analysis Method (FRAM) was used to understand why variability may influence blood sampling functions. The analysis of the 61 pre blood transfusion sampling incidents highlighted limitations in the data collected to understand factors influencing performance. FRAM highlighted how variability in the sequence of blood sampling functions and the number of practitioners involved in a single blood sampling activity was influenced by the working environment, equipment, clinical context, work demands and staff resources. This pilot study proposes a realistic view of why blood sampling activities vary and proposes the need to consider the systems resilience in future safety management strategies.

The dichotomy of the application of a systems approach in UK healthcare: the challenges and priorities for implementation

Abstract There is increasing demand for a systems approach within national healthcare guidelines to provide a systematic and sustainable framework for improvements in patient safety. Supported by this is the growing body of evidence within Human Factors/Ergonomics (HFE) healthcare literature for the inclusion of this approach in health service design, provision and evaluation. This paper considers the current interpretation of this within UK healthcare systems and the dichotomy which exists in the challenge to implement a systems approach. Three case studies, from primary and secondary care, present a systems approach, offering a novel perspective of primary care and blood sampling. These provide practical illustrations of how HFE methods have been used in collaboration with healthcare staff to understand the system for the purpose of professional education, design and safety of clinical activities. The paper concludes with the challenge for implementation and proposes five roles for systems HFE to support patient safety. Practitioner Summary: healthcare is classified as a complex and dynamic system within this paper and as such HFE system methods are presented as desirable to understand the system, to develop HFE tools, to deliver education and integrate HFE within healthcare systems.

Can People Finger-draw Color-sketches from Memory for Painting Search on Mobile Phone?

For the case of people desire to find the previously-seen painting but only have vague memory of the painting, we designed and built a mobile phone application to enable people to search for paintings by drawing rough color sketches. Three-phase memory studies -- with 15-minute delay, 1-week delay and 1-month delay -were conducted to explore if people could draw from their visual memory and the resulting drawing were useful for search. Seventeen participants were involved in three memory studies. The experiment results implied that most of participants could draw usable rough color sketches from their memory as painting queries even one month after viewing. Our research also demonstrated that users could improve their performance if they got more familiar with the functions and usage of our application.

Human factors multi-technique approach to teenage engagement in digital technologies health research

This chapter explores the use of multi-techniques for teenage HCI health research. Through four case studies we present information about adolescents as users of healthcare services and technologies, adolescent personal development and the human factors approaches through which teenagers have been involved in healthcare research projects. In each case study comprising of the design or evaluation of a new digital technology for supporting health or well-being, the techniques used by researchers to involve teenagers are explored and analysed. The case studies examine various aspects of technology design and use including but not limited to usability, acceptability and learnability. The penultimate section of the chapter presents a ‘Schema for Multi-technique HCI Health Research with Teenagers’ and provides the supporting case for a multi-method approach. The conclusions of the chapter reinforce the benefits that are specific to the implementation of multi-technique research with teenage participants. Consideration of the eight factors outlined in the ‘Schema’ within study designs should serve to unlock the potential of teenagers, ensuring reliable elicitation of their views and needs.

Human factors in general practice – early thoughts on the educational focus for specialty training and beyond

In the third article in the series, we describe the outputs from a series of roundtable discussions by Human Factors experts and General Practice (GP) Educational Supervisors tasked with examining the GP (family medicine) training and work environments through the lens of the systems and designed-centred discipline of Human Factors and Ergonomics (HFE). A prominent issue agreed upon proposes that the GP setting should be viewed as a complex sociotechnical system from a care service and specialty training perspective. Additionally, while the existing GP specialty training curriculum in the United Kingdom (UK) touches on some important HFE concepts, we argue that there are also significant educational gaps that could be addressed (e.g. physical workplace design, work organisation, the design of procedures, decision-making and human reliability) to increase knowledge and skills that are key to understanding workplace complexity and interactions, and supporting everyday efforts to improve the performance and wellbeing of people and organisations. Altogether we propose and illustrate how future HFE content could be enhanced, contexualised and integrated within existing training arrangements, which also serves as a tentative guide in this area for continuing professional development for the wider GP and primary care teams.