design of work for patient safety pascale carayon, ph.d. procter & gamble bascom professor in...
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Design of Work for Patient Safety
Pascale Carayon, Ph.D.Procter & Gamble Bascom Professor in Total Quality
Department of Industrial and Systems Engineering
Center for Quality and Productivity Improvement
University of Wisconsin-Madison
http://www2.fpm.wisc.edu/seips/
Outline
SEIPS model of work and patient safety DESIGNDESIGN What kind of research? Challenges and questions
Outline
SEIPS model of work and patient safety Importance of work and processes for patient safety
DESIGN What kind of research? Challenges and questions
SEIPS Model of Work System and Patient SafetySEIPS = System Engineering Initiative for Patient Safety
Carayon et al., 2006
SMArTHF Project TeamUniversity of Wisconsin-Madison / UW Hospital & Clinics
Madison-Wisconsin-USA
Funding provided by the Agency for Healthcare Research and Quality
Medication Administration Technologies
Work System (or a sociotechnical system)(Balance Theory; Smith and Carayon, 1989; Carayon and Smith, 2000)
Technology and Tools
Organization
Environment Tasks
Person
BCMA Technology Implementation…BCMA = Bar Coding Medication Administration
Technology and Tools
Organization
Environment Tasks
Person
scan self
obtain meds
check med vs device
enter pt room
scan med
scan med
doc admin
double check
enter pt room
M (1)
give med to pt
scan pt ID band
doc admin
N (1)
give med to pt
scan pt ID band
enter pt room
scan med
scan pt ID band
doc admin
give med to pt
O (1)
scan med
check med vs device
enter pt room
scan ptID band
Q(1)
give med to pt
doc admin
P (1)
scan ptID band
D(22)
E (1)
docadmin
doc admin
give med to pt
give med to pt
F (17)
give medto pt
G(1)scan pt ID band
docadmin
I(1)doc
admin
H(2)
double check
scan pt ID band
give med to pt
docadmin
J(1)
enter pt room
docadmin
give med to pt
K(2)
START
obtain meds
scan pt ID band
A(1)
give med to pt
docadmin
scan self enter pt room
check med vs device
scan med enter pt room
enter ptroom
scan ptID band
give medto pt
docadmin
B(1)
scan self
check medvs device
scan med
scan pt ID band
give med to
pt
doc admin
C(2)
scan pt ID band
docadmin
enter pt room
L (1)
give med to pt
enter ptroom
scan pt ID band
doc admin
R (1)
give med to pt
1
9
3
2
5
4
7
6
8
Sequence according to policy
Potentially unsafe sequence
Most frequent workaround: documentation before medication administration
BCMA = Bar Coding Medication Administration
Organizational factors:
interruptions, shift
Environment: where tasks completed,
lighting, noise
Tasks: sequence of acts, handoffs,
unsafe acts
Technology: automation surprises, malfunctions
Technologyand Tools
Organization
EnvironmentTasks
Person
Technologyand Tools
Organization
EnvironmentTasks
Person
Individual (nurse or patient): patient
in isolation
Outline
SEIPS model of work and patient safety DESIGNDESIGN What kind of research? Challenges and questions
Design of …
… work system… processPurposeful activityContinuous processKnowledge, principles, tools
Design principles (human factors)
Opportunities for Design of Work
Technology implementation (e.g., EHR, CPOE, bar coding medication administration)
Renovation or new building/facility…Any change that affects work and
processes… Can you think of a change currently going on in
your organization that can affect the work of healthcare providers and processes?
Design Principles of Human Factors and Ergonomics (HFE)
User-centered designDimensions of HFE:
Physical ergonomics physical characteristics of end users
Cognitive ergonomics cognitive characteristics of end users
Organizational ergonomics psychosocial needs of end users
51 chapters, 1,000 pages:•Human error•Sociotechnical systems and macroergonomics•Technology, medical devices•Physical ergonomics•Methods and tools•Various care settings•…
Outline
SEIPS model of work and patient safety DESIGN What kind of research? Challenges and questions
What Kind of Research?
Probably not RCT… Action research framework
Collaborative multidisciplinary researchMultiple data collection methods
Outline
SEIPS model of work and patient safety DESIGN What kind of research? Challenges and questions
Challenges and QuestionsDesign of Work for Patient Safety
Complex system with interactions Who are the end users?
Example = medication management in ambulatory care Design for multiple groups of end users
Who is the designer of work and processes? Home care:
Role of patient and family Transitions of care:
Design of interaction
HIT Impact on work system Design of HIT-supported work and processes
