human factors & ergonomics (hfe) in healthcare · defining human factors/ergonomics (hfe)...

NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT

Human Factors & Ergonomics (HFE) in Healthcare

Paul Bowie PhD MSc C.ErgHF FRCPEd FRCGP (Hon)

Programme Director, NHS Education for ScotlandHon Prof, University of Glasgow

Twitter: @pbnes


‘Human Factors’ OR ‘Ergonomics?


“High Level” Introduction to HFE!

• What is Human Factors & Ergonomics (HFE) / What it’s Not

• Basic principles

• Complexity

• Why things go wrong (and right)

• Systems approaches

• Human-centred design

• ‘Medical error’

• What’s happening in Scotland?

• Practical Human Factors Thinking

• Get involved!!


Defining Human Factors/Ergonomics (HFE)

• “Ergonomics (or human factors) is…concerned with the

understanding of interactions among humans and other

elements of a system…in order to optimize human well-

being and overall system performance...” (IEA, 2000)

In simpler terms:

• Applying human factors ensures that systems, products and services are designed to make them easier, safer and more effective for people to use

• Designing for people to make things easier and safer


Distinguishing features of the HFE approach:

1. It ALWAYS takes a Systems Approach (holistic)

2. It is ALWAYS Design Driven (to take account of human characteristics, needs, capabilities and preferences)

3. It focuses ALWAYS on two closely related outcomes: System Performance and Human Well-being (“Twin Aims” = “Joint Optimisation”)


Wide ranging discipline -Focus is on improving all aspects of Human Work e.g.

Reducing work-related

musculoskeletal disorders

NHS procurement of products & services

Design of care environments

/ buildings

Medical device design

& usability

New ways of working

New information technology

Safety & Improvement interventions

Supporting the ageing

clinical workforce

Learning from events & everyday

work

Design & usability of reporting systems

Reflecting on prevailing

safety culture

Wellbeing -job stress,

fatigue and burnout


Other Industries

Human factors is a scientific discipline and professional practice highly

established in other safety critical industries:• Nuclear

• Maritime

• Military

• Aviation

• Rail

• Surveillance

• Offshore industries

• Energy

In Comparison (1.5m)

A. >1000B. 750-1000C. 100-749D. 10-99E. <10


Examples of Underlying HFE PrinciplesParticipatory Design

Systems Approach

Interactions are Key(micro, meso, macro)

Closing the Gap(Work-as-Imagined v Work-As-Done)

Applying Design Knowledge(ISO…)

Mismatches(Identification & Understanding)


Human Factors – Sociotechnical System ModelSystem Engineering Initiative for Patient Safety (SEIPS) Model (Carayon, 2006)


In what ways is healthcare ‘complex’?


“Simple” Act of Taking blood

Decide to take blood

Assemble equipment

Take blood

Label blood and complete form

Send to lab

Linear? Complex?

Pickup L, Hollnagel E, Bowie P et al. Blood sampling - Two sides to the story. Applied Ergonomics. 59. 2017; 234–242


Why do things go right (and wrong) in complex healthcare systems?


• The problem with ‘Human Error’ (misnomer, not a ‘cause’ but a symptom)

• ‘Old’ and ‘New’ view of ‘Error’

• System complexity and interactions (contributory factors)

• Efficiency-Thoroughness-Trade-offs (e.g. safety Vs efficiency) - ETTOs

• Performance variability (e.g. adapting to context to get job done)

• Organisational constraints (e.g. resources, priorities, culture)

• Goal conflicts (e.g. increase productivity Vs decreased resource)

• Local rationality (i.e. decisions make sense based on available info/context at time)

Some issues to consider….! Embrace Safety-I and Safety-II thinking


The Problem with “Medical Error”

Ill-defined with no shared

understandingIt is both ambiguous and

alogical

Surely it’s now time to put

‘medical error’ to bed? Hindsight

judgement = social

construction Things going wrong is normal in a complex

system

It is not ‘medical’ – inaccurate and

misleading

Ubiquitous in media, judiciary, healthcare research, regulation,

education, wider society

Encourages focus on

individuals, not systems

Leads to error reduction strategies to minimise

human variation but this is essential

It is educationally

backward

It self-harms the profession –

why hate yourself?

It is erroneously viewed as a ‘cause’ – system induced

Error is ubiquitous, necessary and largely

inconsequential


The Blame Game

• Natural human tendency (you and others)

• Blaming is the opposite of learning

• Can’t fix problems unless we admit they exist

• System-induced issue – you’re not an idiot or bad or worse!

• When we blame, we focus on the person and not the system design

“I knew better…It was my fault”

• Not a valid analysis, doesn’t help prevent recurrence [Norman, 2013]


Importance of Human-Centred DesignHFE key to good design – focus on systems in which people interact

Design knowledge – use error –task

analysis - interactions – high risk

situations – devices – tools – drugs –

packaging – standardisation –

conventions – international design

standards – purchasing decisions – life-

cycle costing – evaluating ease of use –

usability criteria – design guidelines –

stakeholder conflicts of interest – risk

assessment training – usability heuristics


Limited Design and Usability

Poor Usability and the Risk of Mode Errors with the Lifepak 20e Defibrillator

https://www.youtube.com/watch?v=vyQ_af3CvwE&feature=youtu.be

https://www.youtube.com/watch?v=vyQ_af3CvwE&feature=youtu.be


‘Performing Well, Feeling Well’

Taking Forward Human Factors & Ergonomics (HFE) Integration in NHS Scotland


Who Are We?

• 150+ clinicians; leaders; managers; educators; risk, safety and improvement advisers; academics; human factors specialists, researchers etc

• NHS Boards, Royal Colleges and Professional Bodies, Higher Education Institutions etc

• Growing Network/Community of Practice

• Four Workshops (2017-19)


Our Vision for Health and Care

• The integration of fundamental HFE principles and approaches in priority areas of service and educational provision which will lead to joint optimisation of:

oSystem Performance (e.g. organisational safety, efficiency, effectiveness, productivity, resilience) and;

oHuman Wellbeing (e.g. improved health and safety, experience, satisfaction for patients, families and staff).


Progress – Identified Priority Areas of Integration

1. Building Workforce Capability and Capacity

2. Learning from Events

3. Integration of HFE Design Principles in National Procurement, Care Buildings / Workplaces

4. Integration of HFE Design Principles with National Programmes and Initiatives

5. Creation of a National Human Factors Advisory Board

• Integrated R&D/Evaluation agenda


What can you do?- On a Personal level

- In Teams / Organisationally- As Science & Engineering Professions


Enhance your knowledge and skills

• NES Workshops

• Entry-level e-learning

• Join national network

• Explore ideas for research, improvement, evaluation

• Advanced course, targeted training, academic route


Apply basic Human Factors thinking

‘As a way of thinking and practice’ by clinicians, scientists, engineers, managers, staff groups etc

• When something has gone wrong

• When implementing new ways of working / technology

• When looking for workplace hazards / risks

• When undertaking a quality improvement project

• Everyday problem solving, no matter where you work in healthcare.

• Selecting, buying and evaluating new equipment


5 Very Basic Principles!

1. Talk to ALL relevant frontline staff who actually do the job

2. Think about what can go wrong

3. As far as possible, simplify and standardize

4. Always take a system wide perspective

5. Focus on how we can design work to make it easier, safer and more efficient for us


Team-Based Safety Culture Discussion Cards?


Person

Technology and Tools

Tasks Physical Environment

Organisation of Work

Wanted/ UnwantedOutcomes

System Performance:

Human Wellbeing:

Worksheet - Care System Interactions and Outcomes

External Influences


Worksheet - Care System Interactions and Outcomes[As a team, use the worksheet as a prompt to highlight the various system-wide factors that contribute to the issue at hand (e.g. implementing a new way of working; managing change or learning from a safety incident);

seek to understand how these factors relate and interact to produce outcomes (desirable or undesirable)

Person Factors e.g.Physical, psychological capabilities, limitations and impacts (frustration,

stress, fatigue, burnout, musculoskeletal, satisfaction, enjoyment, experiences, job

control); personality or social issues; cognitive ; competence, skills,

knowledge, attitudes; risk perception; training issues; personal

needs and preferences; psychological safety; performance

variability; personal goals; adaptation to work conditions.Care team e.g. roles, support, communication, collaboration,

supervision, management, leadership

Patient/client e.g. complexity of clinical condition, physical, social, psychological, relationship factors

Others e.g. families and carers, and other health and social services

colleagues

Task Factors e.g. level of task complexity; time

taken; hazardous nature; capacity and demand

match/mismatch; distractions; interruptions;

variety of tasks; job content, challenge and utilization of

skills; autonomy, job control and participation; job

demands (e.g. workload, time pressure, cognitive load,

need for attention)

Tools and Technology Factors e.g.

e.g. design interaction and usability issues; positioning; availability; access; mobility;

operational/calibrated; device usability; various IT design issues; electronic

records, barcoding.

Physical Environment Factors e.g. Layout; Noise; Lighting; temperature; humidity and air

quality; design of immediate workspace or physical environment layout; location; size; clutter; standardisation,

aesthetics; crowding.

Organisation of Work Factors e.g.Coordination, collaboration and communication;

organizational culture and safety climate; work schedules and rota design; social relationships; teamwork; supervisory, management and leadership style;

performance evaluation, rewards and incentives; organisational strategy, work priorities/targets; conflicting

goals; structure and hierarchies; staffing levels; rewards and incentives; risk assessment; education, training and

development environments e.g. supervision, competence, protected time, professional development, physical and

social learning environment

External Influences e.g.Societal, government, cultural, accreditation and

regulatory influences e.g. funding, national policies and targets, professional bodies, regulatory demands,

legislation and legal influences, other risks and influences

Outcomes –System Performance

e.g.Safety; productivity; resilience; reliability;

efficiency; effectiveness; care quality; budgetary

control

Outcomes –Human Wellbeing e.g.

Health and safety; patient satisfaction and experience; enjoyment;

staff turnover; staff welfare; job satisfaction


Introducing STEW for Care Teams(Systems Thinking for Everyday Work)

• Can help care teams to:

• Better understand the current system

• Analyse incidents (with both wanted and unwanted outcomes)

• Identify improvement priorities

• Develop change ideas and their implementation into current work systems

• Monitor, evaluate and spread change.


As Professions?

• A challenge – on a par with other NHS professions?

• Interest at HEI, Professional and Regulatory levels?

• Embedded in safety & improvement training?

• Technology testing & evaluation?

• Routine team safety reviews?

• Enhancing quality improvement efforts?

• Engage with us!?

• Test our interventions?


Human Factors Scotland – National Development and Action Network [email protected]

mailto:[email protected]


Further Resources

• Entry-level e-learning

• Workshops

• Testing Interventions

https://learn.nes.nhs.scot/800/patient-safety-zone/human-factors

https://www.ergonomics.org.uk/





https://www.ergonomics.org.uk/


THANK YOU

Any Questions?

[email protected]

mailto:[email protected]

human factors & ergonomics (hfe) in healthcare · defining human factors/ergonomics (hfe)...

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