Thursday, February 14, 2013

Next up: Training in Human Factors Engineering

This question from a nurse patient safety specialist in the Midwest US showed up on a patient safety list-serve run by the National Patient Safety Foundation:

We do not currently have any solidly trained human factors engineering employees in our team.  I have enough knowledge of human factors (and enough clinical experience) to recognize how easy it is to make a bad decision. How did you get your training in human factors? I do have some training, but would not consider myself an expert by any means. I know enough to be concerned that I know so little!

Eric Streicher at MedStar, which has a strong program in this area through its affiliated National Center for Human Factors in Healthcare, graciously answered:  "See the University of Wisconsin Center for Quality and Productivity Improvement course on human factors and patient safety." This made me curious, and I found an excellent short course described:

Today, CQPI’s Systems Engineering Initiative for Patient Safety (SEIPS) is the foremost leader in applying Human Factors and Systems Engineering to the patient safety challenge.

The SEIPS Human Factors and Patient Safety short course is designed to provide an understanding of human factors and systems engineering and how these patient safety approaches can improve performance, prevent harm when error does occur, help systems recover from error, and mitigate further harm.

This course is designed for all physicians, nurses, physician assistants, pharmacists, engineers, patient safety officers, chief information officers, and other professionals interested in human factors engineering and patient safety.

This is an area that deserves greater attention.  As the folks at MedStar note:

Human Factors is applied to healthcare to design processes, devices, and systems that support the work of care givers in medicine. Specific benefits of Human Factors  and System Safety Engineering applied to healthcare include:
  • Efficient care processes in medical care
  • Effective communication between medical care providers
  • Better understanding of a patient’s current medical condition
  • Implementation of effective and sustainable RCA solutions
  • Reduced risk of medical device use error
  • Easier to use (or more intuitive) devices
  • Reduced risk of health IT-related Use error
  • Easier to use (or more intuitive) health IT
  • Reduced need for training
  • Easier repair and maintenance
  • Cost savings through prevention and mitigation of adverse events
  • Safer working conditions in medicine
  • Improved patient outcomes
Human Factors evaluations and interventions should take place early in the design and system development process. It should include tools such as work domain analysis, function allocation, probabilistic risk assessment, usability testing, among others.


Unknown said...

As a burned-out old Med Onc guy, I'm seeing an elaborate mock-up of what was routine for some of us decades ago.

We did this 30 years ago. A 32 bed Oncology Unit, an 8 hour workday for nurses, a pre-NP NP and me. And it was based on continuity, ongoing communication, commitment, dedication and some grit.

Most of the nurses were not RN's; but their dedication was incredible. The shorter work day meant that there was greater continuity of care.

Central lines? I placed up to 5 a day. Patients went home with the old angiocath. Our infection rate for in, and outpatients was 3%. Families were taught to change dressings. If a patient became febrile, he got cultures and a full examination. If he couldn't come to the office, I visited him at home.

Those were whirlwind days. But our basic precept was attention to detail, communication, and alertness. And because we talked every day, we learned from each other. And our survival stats were proof of our excellence.

Now, in the new era, we're searching to somehow reinvent and codify human values, talents and commitment. Would that it could be done
Peter S. Kennedy, M.S., M.D.

Anonymous said...

I attended your session on leadership at the IHI conference in Orlando last December. I've been trying to connect with you to follow up on your experience soliciting input of employees to reduce costs as a way to avert potentially devastating layoffs. My organization is facing a similar situation and I was wondering if you would be willing to share how you went about this. Would you provide your email address or a good way to contact you regarding this issue?

Paul Levy said...

Please leave name and email and I will get back to you and not publish it.

Unknown said...

If this is addressed to me, it's not me. I haven't addressed anybody regarding leadership in the last 3 years. But I dare say, those in medicine who care about people, both patient and personnel, are looking over the same cliff. (And it is, indeed, a cliff this time.) Without doubt, I am one of those.

The view is most frightening to those whose concern is not only the bottom line, and not the stats & algorithms, but patient comfort, well-being, and survival.

The answers lie among those who can not only talk with erudition, but can listen with real humility and patience.

Those included in this new conversation must be techies, councillors, home care personnel, administrators & purse holders. All must agree somehow on the goals and means in that order.

But they REALLY have to agree. If they can't, everyone around the table deserves to know the real reason why.

The task is excruciatingly more painful and complex than it was decades ago. And recalling old standards and values may be impossible to effect.

But in the end, the oath we took as physicians is the same one to which all support personnel gave tacit acceptance, whether they recognize it or not. Our goal is unchanging. The current challenge is to not forget it as we move forward.

Peter Kennedy, M.S., M.D.

Mark Williams said...

WHO website and report on Human Factors