Applying a Systems Approach to Human Factors in Healthcare Design and Investigations
TimeThursday, April 152:00pm - 3:00pm EDT
DescriptionThe most recent view of human factors as a discipline is that humans are an element of a sociotechnical system. Any design or review effort should consider humans in that context and not reduce complexity but rather embrace it. This presentation will discuss whether healthcare has seen the real benefits yet of systemic applications of human factors and provide some examples of such applications both in incident investigation and design.
In healthcare the colloquial term ‘the human factor’ is, unfortunately, often used to describe ‘incorrect use’ of technology or human involvement in adverse events. This view of humans and human error remains entrenched despite seminal reports such as To Err is Human (Institute of Medicine, 1999) and Patient Safety 2030 (Yu et al., 2016) calling for a systems approach and acknowledging that errors are a symptom of faulty systems, processes and conditions.
Human error is still often seen as the ‘root cause’ of accidents in healthcare. Despite the evolution of accident analysis methods, root cause analysis remains the most applied tool in healthcare investigations. Its application has led to trying to find the root cause; often resulting in blaming the healthcare worker or pointing at a faulty policy or procedure. Resulting recommendations then too often focus only on retraining workers and/or developing a new policy or procedure.
More recently, there has been an increase in the uptake of the London Protocol (Taylor-Adams and Vincent, 2004; Vincent et al., 1999). This method comes with a contributing factors taxonomy that goes beyond the patient and healthcare worker. It considers team, work environment, organisational and management and institutional context factors. A systems investigation method widely applied in other high-risk industries and by leading accident investigation agencies, Accimap (Rasmussen, 1997), is also starting to be applied in healthcare investigations.
In this presentation, we will present a de-identified case study to demonstrate how a systems approach to investigations using such methods leads to higher quality investigations and stronger recommendations. We will discuss how such methods are being used to shift the focus from blaming or retraining the person to setting people up for success through improvements in the system in which they work.
In the design of health care products and technology there has been a focus on usability; with a cross over of human factors, industrial design and UX. This has been influenced by regulatory requirements that ‘use errors’ have been addressed (the stick) and safety and commercial benefits (the carrot). These design efforts remain, unfortunately, often technology driven and focused on individual physical and/or cognitive interactions with a device, rather than considering the end user as part of a large sociotechnical system. Products and technology are often developed in isolation which has resulted in a mix of devices within health services that do not connect or share data and have unique materials and supply requirements; rather than an integrated suite of devices focusing on patient safety, quality of care and ease of use by clinicians.
Systems engineering considers a device or system over its entire lifecycle from defining requirements for design, operation and decommissioning. It also follows a structured approach starting with defining goals and needs and then identifying systems and subsystems that meet the requirements; driving design by serving a goal rather than driven by technology. In applying a systems engineering framework, the human is but one part of the system and human factors integration within the overall system is central to the process. To date applications of human factors integration based on systems engineering have been limited in healthcare design and human interaction with technology is rarely considered within the wider sociotechnical system.
In this presentation, we will present a de-identified case study of a medical device used in the home. We will demonstrate how a systems lens can help identify opportunities for holistic design improvement considering the sociotechnical system supporting the human machine interaction.