Human Factors is Vital for Transforming Health Care in the 21st Century

Human Factors is Vital forTransforming Health Care in the 21st Century Eric F. Shaver, Ph.D. January 31, 2012 Working Presentation: 12-1

“The most significant factor inmaking the nation’s health caresystem safer is the human element.And that is our business.” (Salas, et al., 2006) 2

This slide deck is a working presentation in draft form.It is being distributed to facilitate comment anddiscussion in both the human factors & ergonomicsand health care communities.If you have questions, comments, or suggestions,please contact the author. 3

Current State of U.S. Health Care• Health care is at a crisis point.• 2010 Health Spending (Martin, et al., 2012): – Total health expenditure: $2.6 trillion – Per person expenditure: $8,402 – Percent of GDP: 17.9%• U.S. spends more than any other industrialized nation without achieving better outcomes. 4

Changes Are Needed• The current status and future trajectory are untenable.• Substantial changes must be undertaken to transform health care in order to: – Reduce costs – Improve quality of care – Improve accessibility of care• Human factors & ergonomics is vital to assisting with this transformation. 5

Overview of Human Factors& Ergonomics (HFE) 6

What is HFE?• HFE is a unique scientific discipline that systematically applies the knowledge of human abilities and limitations to the design of systems with the goal of optimizing the interaction between people and other system elements to enhance safety, performance, and satisfaction.• In simpler terms, HFE focuses on designing the world to better accommodate people. 7

What is HFE?, cont.• Human factors are relevant anywhere people work with systems, whether they are social or technical in nature .• The breadth of these sociotechnical systems include situations and circumstances where individuals interact with other system elements including: – People – Technology – Tasks – Organizations – Environments – Rules & Regulations 8

What is HFE?, cont.• Health care is arguably the most complex sociotechnical system.• HFE takes a people-centered, process-oriented, systems approach to understanding and solving complex problems. 9

Origins of HFE Psychology Industrial Anthropology Design Operations Applied Research Physiology Human Factors & Ergonomics Environmental Statistics Medicine Computer Engineering Science 10

Origins of HFE, cont.• In the U.S., HFE is generally considered to have originated during WWII.• But, advances that contributed to its formation can be traced to the turn of the 20th century.• HFE started in the military, but expanded into most industries, including health care. 11

Industries Benefiting from HFE• Aerospace • Health Care• Automotive • Manufacturing• Chemical • Mining• Computer • Nuclear• Consumer Product • Petroleum• Construction • Telecommunication• Defense • Textile• Forestry 12

What Value Does HFE Add?• Increased • Decreased – Safety & health – Deaths, injuries & illnesses – Quality – Accidents – Productivity – Error rates – Ease of learning & use – Absenteeism & turnover – Satisfaction, trust & – Training time loyalty – Development costs – User experience & – Need for redesign & recall engagement – Support & services costs – Sales & market share – Maintenance costs 13

What Does HFE Bring to the Table?• A deep understanding of people: – Sensory • Visual, auditory, olfactory, gustatory, & somatosensory – Psychological • Attention, perception, decision making, memory, & motivation – Physiological • Anthropometry & biomechanics – Psychosocial – Behavior 14

What Does HFE Bring to the Table?, cont.• How people interact with other people in: – Dyads, teams, groups, & organizations• How people interact with technology: – Individually – Groups (e.g., teams, departments, etc.) – Organizations (e.g., hospitals, across systems, etc.)• How systems need to be designed to fit the capabilities & limitations of people. 15

What Does HFE Bring to the Table?, cont.• A solid foundation, grounded in science, that includes: – Theories – Models – Principles – Guidelines – Findings – Methods – Tools 16

How has HFE PositivelyImpacted Health Care? 17

Brief History of HFE & HC• Early history – Medication errors (Chapanis & Safrin, 1960) – Anesthesia (Cooper, et al., 1978)• HFE came to the forefront with the publishing of the IOM report To Err is Human in 1999. (Leape, 2004)• Since then, a primary focus of HFE has been patient safety. 18

HFE has performed research ona variety of HC topics, settings,and people. They include… 19

Sample of HC Topics• Anesthesiology • Needles• Built Environment • Organizational Culture• Care Coordination • Patient Safety• Checklists • Safety Culture• eHealth • Simulation• Health Communication • Teamwork• Health Information • Telemedicine Technology • Training• Infection Prevention • Websites• Medical Error • Work Design• Medical Products • Work Schedules• Medication 20

Sample of HC Settings & People• Settings • People – Emergency Departments – Nurses – Home Care – Patients – Intensive Care Units – Pharmacists – Nursing Homes – Physicians – Operating Rooms – Technicians – Pharmacy Departments – Physician Offices 21

What value does HFE provideto HC? 22

HFE Interventions Can:• Increase patient and staff safety;• Decrease numbers of adverse events;• Minimize the potential for introduction of new hazards;• Improve staff acceptance;• Increase work efficiency;• Better integrate with existing technology;• Decrease training time needed to reach competency; and• Minimize the need for modifications, “workarounds,” and/or shortcuts. 23

How can HFE assist the HCcommunity? Examples include… 24

Technology Integration• Medical technology has great potential, but implementation is often viewed as a mixed blessing.• HFE takes a holistic approach to understanding how people will interact with technology in a system. Doing so makes it possible to identify technological requirements that will best fulfill users’ needs, which in turn will improve quality and safety. 25

Technology Integration, cont.• Example methods to facilitate integration: – Heuristic evaluation – Task & job analysis – Structured interviews – Job shadowing• Focus: – Prevent poorly designed technology from entering the system. – Determine that to be acquired technology will integrate appropriately within the system. 26

Patients• Focus: – Must understand the needs, wants, & desires of patients to optimize their experiences and maximize their satisfaction.• Example efforts: – Identify how technology can be utilized to facilitate patient understanding & decision making. – Streamline and/or redesign patient-facing processes. 27

Health Care Teams• Focus: – Developing teams that increase patient safety by decreasing medical error. – Transitioning from a team of experts to expert teams.• Example efforts: – Team design – Team assessment – Team training 28

Health Care Systems• Health care delivery needs changes.• HFE can help by leading and/or collaborating in multidisciplinary teams seeking to solve system problems.• In-house human factors expertise can be dispatched to different teams, departments, hospitals, etc. 29

Health Care Systems, cont.• HFE can provide comprehensive, macroergonomics strategies, methods, and tools to assist with successful change management efforts across health care systems.• HFE can assist with appropriate integration of recently acquired hospitals into health care systems. 30

Research• HC has gotten better about collecting important financial & performance metrics electronically.• But, it hasn’t fully leveraged the opportunity to rapidly, reliably, & repeatedly capture data from patients, family members, physicians, nurses, staff, etc. on important topics.• HFE can help overcome this challenge. 31

Research, cont.• HFE uses a variety of methods to capture data from individuals, groups, & organizations: – Surveys (online & in-person) – Structured interviews – Usability evaluations – Observational studies – Video analysis – Field studies – Lab experiments – Simulation 32

HFE has made importantcontributions to HC …but more must be accomplished 33

What is Required from HFE?• “…take every opportunity to explain and ‘sell’ HFE” (Carayon, 2012, p. 12).• Communicate beyond the boundaries of our discipline.• Continue with current health care-related efforts.• Collaborate with HC domain experts at every opportunity. 34

What is Required from HFE?, cont.• Understand and speak the language of business.• Be involved at the strategic level.• Continually demonstrate value.• Calculate ROI (e.g., internal, external, & social) for HFE interventions (Wilson & Rosenbaum, 2005). 35

What is Required from HFE?, cont.• Realize that HFE is an innovation (Carayon, 2010).• Move beyond interventions that just “sand the edges” of the problem.• Understand there may be barriers to entry; but the effort is worth the challenge.• HFE should strive for positive societal change (Vicente, 2008). 36

But, HFE can’t tackle this challengealone. It needs buy-in from the HCcommunity… 37

What is Needed from HC?• Realizations that health care challenges are a “wicked” problem needing assistance from outside the health care community.• Willingness to embrace and learn from HFE.• Understanding that HFE contributions are greater than just patient safety. 38

What is Needed from HC?, cont.• Increased utilization of HFE professionals: – Consultants – In-house HFE experts – “Biculturals” (HC professionals trained in HFE) 39

ReferencesCarayon, P. (2010). Human factors in patient safety as an innovation.Applied Ergonomics, 41, 657-665.Carayon, P. (2012). Human factors and ergonomics in health care andpatient safety. In P. Carayon (Ed), Handbook of Human Factors andErgonomics in Patient Safety, 2nd Ed (pp. 3-15). Boca Raton, FL: CRCPress.Chapanis, A., & Safrin, M.A. (1960). Of misses and medicines. Journalof Chronic Diseases 12, 403–408.Cooper, J.B., Newbower, R.S., Long, C.D., & McPeek, B. (1979).Preventable anesthesia mishaps: A study of human factors.Anesthesiology, 49, 399–406. 40

References, cont.Kohn, K. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (1999). To err ishuman: Building a safer health system. Washington, DC: NationalAcademy Press.Leape, L.L. (2004, Summer). Human factors meets health care: Theultimate challenge. Ergonomics in Design, 6-12.Martin, A.B., Lassman, D., Washington, B., Catlin, A., & the NationalHealth Expenditure Accounts Team (2012). Growth in US healthspending remained slow in 2010; health share of gross domesticproduct was unchanged from 2009. Health Affairs, 31, 1, 208-219. 41

References, cont.Salas, E., Baker, D., King, H., & Battles, J. (2006). Special sectioncommentary: Opportunities and challenges for human factors andergonomics in enhancing patient safety. Human Factors, 48, 1-4.Vicente, K.J. (2008). Human factors engineering that makes adifference: Leveraging a science of societal change. Theoretical Issuesin Ergonomics Science, 9, 1-24.Wilson, C.E., & Rosenbaum, S. (2005). Categories of return oninvestment and their practical implications. In R.G. Bias and D.J.Mayhew (Eds.), Cost-Justifying Usability: An Update for the InternetAge (pp. 215-263). San Francisco, CA: Morgan Kaufman Publishers. 42

Additional Resources to Consult 43

Author Biography Dr. Shaver is a senior consultant with Benchmark Research & Safety, Inc., where he specializes in human factors & ergonomics, safety, organizational behavior, leadership development, user research, and training. Dr. Shavers work has emphasized achieving an optimal fit between people, technology, and work systems to facilitate safety, performance, and satisfaction. A specific focus has centered on bridging the research-practice gap by synthesizing and disseminating the latest scientific findings about human capabilities and limitations to the design, development, implementation, use, and evaluation of technology. 44

Contact Information• Eric F. Shaver, Ph.D. Email: eric.shaver@gmail.com Blog: www.thehumanfactorblog.com LinkedIn: www.linkedin.com/in/ericshaver SlideShare: www.slideshare.net/ericfshaver Twitter: @ericshaver 45

Human Factors is Vital for Transforming Health Care in the 21st Century

by Eric Shaver on Jan 31, 2012

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