Integrating Human Factors into Health and Social Care · Integrating Human Factors into Health and...
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Integrating Human Factors into Health and Social Care Professor Sue Hignett E: [email protected] W: www.lboro.ac.uk/design/hfehub
Transcript of Integrating Human Factors into Health and Social Care · Integrating Human Factors into Health and...
Integrating Human Factorsinto Health and Social Care
Professor Sue HignettE: [email protected]
W: www.lboro.ac.uk/design/hfehub
Integration of what?
Safety for Clinical Practice ANDSafety for Health & Social Care systems
➢ Integrating safety across macro systems
• Investigation of patient safety incidents
• Design protocols and guidelines (work as imagined)
➢ Integrating HFE and Quality Improvement
➢ Integrating safety for micro systems (work as done)
• Improve the work environment and technologies to care for patients safely and effectively
How Human Factors/Ergonomics could, and should, be implemented in Health & Social Care
• Authoritative guide for HFE in Health & Social Care
• Clarifies HFE competence and experience needed
• Launched at Royal Society of Medicine (Oct. 2018)
• Widely disseminated including ISQua Global Webinar – watched in 37 countries
CIEHF White Paper
“the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data, and other methods to design in order to optimize human well-being andoverall system performance” (International Ergonomics Association, 2000)
What is Human Factors/Ergonomics?
Extensive Alumni networkChartered HF Specialists
NHS-based LU alumniNational Leaders in HF Healthcare
Health Education England
NHS England & NHS Improvement
NHS Education for Scotland
Healthcare SafetyInvestigation Branch
InternationalWHO Patient Safety
HFE in HSC with colleagues in Mexico, Peru, China,
USA (Mayo Clinic)Australia, South Africa New Zealand, Ireland
Human Factors @Lboro for 50 years
Human Factors/Ergonomics at Lboro
WHO Declaration on Patient Safety 2019
• Maintain a high level of political momentum on “Global action on Patient Safety” worldwide • strengthen capability through collaboration and learning
• prioritize patient safety in health sector policies and programmes
• Pledge to support and enable implementation of changes in systems and practices to improve patient safety
• Commit to building capacity in leadership and management • implement and strengthen patient safety systems and processes
• educate and train the health workforce in patient safety, • increase efficiency and minimize harm by sharing knowledge on risks, best practices and successful models
• Work collaboratively with patients and families to increase visibility and work towards global action
• Establish an annual World Patient Safety Day on 17 September each yearhttp://www.congre.co.jp/psgms2018/
Understanding how to use Human Factors
To investigate incidents
• HFE approach takes a wider view to encompass root causes such as poor product design
To think about systems
• HFE may focus on optimisation of a micro-system, but there will be clear mapping of the relationship of the micro-system with the larger systems
To think about design
• HFE is relevant to all stages of the life-cycle from early stages of planning and design, right through to implementation and evaluation
1. Working space
2. Tasks
3. Cognitive interfaces (workload, information processing etc.)
4. Physical interfaces with equipment and other objects (e.g. furniture, medical devices)
5. Physical activity, lifting and carrying
6. Environment (e.g. lighting, thermal, acoustic)
7. Systems (e.g. job, team work, organisation)
HFE assessment could include…
From micro…..
…..to macro.
Integration of what?
Safety for Clinical Practice ANDSafety for Health & Social Care systems
➢ Integrating safety across macro systems
• Investigation of patient safety incidents
• Design protocols and guidelines (work as imagined)
➢ Integrating HFE and Quality Improvement
➢ Integrating safety for micro systems (work as done)
• Improve the work environment and technologies to care for patients safely and effectively
1. Working space
2. Tasks3. Cognitive interfaces
(workload, information processing etc.)
4. Physical interfaces with equipment and other objects (e.g. furniture, medical devices)
5. Physical activity, lifting and carrying 6. Environment
(e.g. lighting, thermal, acoustic)
7. Systems(e.g. operating procedures, guidance and instructions)
HFE assessment could include…Space to care and work: Task Analysis
Space to care and work: Task Analysis
Link Analysis: Transferring a patient from bed to wheelchair
Observations in general medical and surgical wards,
toilet/shower facilities and Intensive Care Units
Space to care and work
• Acute medical/surgical ward bed space = 10.84m2 (Ave. width 3.41m x length 3.18m)• Hignett, S. Lu, J. (2008) Ensuring bed space is right first time. Health Estate Journal, February. 29-31
• Toilet/shower = 5.03m2 (Ave. width 2.6m x length 2.01m) • Hignett, S. Lu, J. (2008) Ensuring bed space is right first time. Health Estate Journal, February. 29-31
• ICU bed space = 22.83m2 (Ave. width 4.68m x length 4.71m) • Hignett, S. Lu, J. (2007). Minimum Space Requirements to Prevent Injuries in Critical Care Nurses: An Evaluation of Three High Risk Tasks
Critical Care Clinics of North America 19, 167-175
• Neonatal Intensive Care cot space = 13.5m2 (Ave. width 4.13m x length 3.27m)• Neonatal Health Building Note. Department of Health, Estates and Facilities Management Directorate
• Bariatric bed space = 16.61m2 (Ave. width 3.93m x length 4.23m)• Hignett, S. Griffiths, P., Chipchase, S., Tetley, A. (2007). Risk assessment and process planning for bariatric patient handling pathways. Health
and Safety Executive Research Report RR573 http://www.hse.gov.uk/research/rrhtm/rr573.htm Accessed 17th July 2007
Prof. Sue Hignett [email protected]
HFE approach to safety
1. Eliminate – the hazard through DESIGNForced function e.g. the easiest option is the safest
2. Barriers – between the hazard and the userChild resistant containers, controlled drug cupboards
3. Mitigate – the consequences of the hazardAntidote drugs, limited dose infusions
4. Educate – to change behaviourRely on (hope) users to prevent or avoid the hazard
(adapted by Pickup (2018) from Hale and Glendon, 1987)
Most effective
Least effective
Integration of what?
Safety for Clinical Practice ANDSafety for Health & Social Care systems
➢ Integrating safety across macro systems
• Investigation of patient safety incidents
• Design protocols and guidelines (work as imagined)
➢ Integrating HFE and Quality Improvement
➢ Integrating safety for micro systems (work as done)
• Improve the work environment and technologies to care for patients safely and effectively
Organisational and socio-technical systems
Holden RJ, et al 2013. SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics. 56:1669–1686.
SEIPS: Systems Engineering Initiative for Patient Safety
DIAL-F modelHignett, S. (2013) Why Design Starts with People. The Health Foundation: Patient Safety Resource Centre. http://patientsafety.health.org.uk/sites/default/files/resources/why_design_starts_with_people.pdf
HFE Integration of Safety Risk Assessment Components (reproduced with permission of The Center for Health Design)
Building Design
Use at different phases of design process:
• Pre-design
• Design (schematic)
• construction
• Occupancy
• Post-occupancy
Integration of what?
Safety for Clinical Practice ANDSafety for Health & Social Care systems
➢ Integrating safety across macro systems
• Investigation of patient safety incidents
• Design protocols and guidelines (work as imagined)
➢ Integrating HFE and Quality Improvement
➢ Integrating safety for micro systems (work as done)
• Improve the work environment and technologies to care for patients safely and effectively
Integrating QIS and HFE: 4-step model
1. Explore and define a problem by looking at the humans and the rest of the system (HFE and QIS)
2. Re-design the tasks, interfaces and system (HFE > QIS)
3. Define the elements of the intervention and process measures (QIS > HFE)
4. Implement the change using expertise in improvement methodology, facilitation and coaching skills, and reworking of barriers (HFE and QIS)
• EnvironmentEffect on
Performance Influencing Factors
Task Analysis (Cognitive, Hierarchical)
Performance
Capacity, Capability
OrganisationArtefacts/ Values/
Behaviours
Learning
Tools (Evidence, checklists, equipment)
Technologies(devices, software, hardware,) Care
providers Patients
Funders
RegulatorsCarers
How will we know a change is an improvement
Define the problemDefine the improvementStakeholder perspectiveQualitative & Quantitative• Task analysis• Data/ charts/ variation
What change can we make that will result in an improvement?
PDSA:Data/chartsTask redesignDevice redesignEnvironmental adaptationsTechnological adaptationSimulation techniquesTools and checklists
Facilitate CoachAction learning setsSurveys
Plan / ANTICIPATE
Do / RESPOND
Study / MONITOR
Act / LEARN
Case studies
Increasing HFE competence and capacity
Our vision is to increase HFE competence so that:
• HFE is included in clinical curricula (UG and CPD)
• Professional bodies and regulators seek qualified support for the delivery of HFE training
• Sufficient HFE capability exists to deliver a resilient system including safety culture and acceptable workloads for all healthcare providers
• Every Health and Social Care organisation has an identified HFE advisor
Ask these questions for every procedure, task, device, building design etc.
Can This Person (worker, team, patient)…
..With This Training (or information)…
……Do These Tasks…
……..Using This Equipment or Service…
……….To These Standards (performance)…
………….Under These Conditions?
HFE Principles
• for Patients AND Staff (and other humans in the system)
• across all safety risks in micro, meso and macro systems
• ‘bird’s eye (global) view of implementation by building on
existing systems and structures
Step change over the next 30 years to
reach out into all areas of clinical practice
Hignett, S. (2015) Plenary: Healthcare Ergonomics: Reaching out into all areas of Clinical Practice or ‘Touching and Analysing the Elephant’ Proceedings of the 19th Triennial Conference of the International Ergonomics Association. Melbourne, Australia, 11-15 August.
HFE Integration
