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How Human Factors Testing Improves Healthcare Technology Procurement

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Canadian Patient Safety Institute
Canadian Patient Safety Institute

Healthcare information technology (IT) procurement is critical for healthcare organizations, as procurement decisions on medical devices and IT infrastructure will impact safety, efficiency, staff and patient experiences – impact that could last decades. Full details: https://goo.gl/HgtYHQ

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Using Human Factors in Hospital Technology Procurement Svetlena Taneva, PhD svetlena@humanfactors.ca Healthcare Human Factors University Health Network @healthcarehf @SvetlenaTaneva
WHAT IS HUMAN FACTORS?
Buxton, W. (2001). Less is More (More or Less), in P. Denning (Ed.). The Invisible Future: The seamless integration of technology in everyday life. New York: McGraw Hill, 145-179. What is Human Factors? The application of the science of human behaviour to the design of systems Engineering for human efficiency and effectiveness - accommodate the limits of the human user.
Bridging the gap between human capability and demands of the task
210,000 - 400,000 US DEATHS annually due to preventable medical error James, J.T. (2013). A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9(3), 122-128
17,300 – 23,000 CANADIAN DEATHS annually due to preventable medical error CIHI (2016). Measuring Patient Harm in Canadian Hospitals. Canadian Patient Safety Institute. Baker, Norton, et al. (2004). The Canadian Adverse Events Study.
HEALTHCARE TECHNOLOGY PROCUREMENT
The Opportunity Healthcare environments today: — Volume of technology increasing — Complexity of technology increasing — Interdependency of technologies increasing — Clinical staff busier — Increasingly concerned with errors associated with technology use
Pitfalls of Traditional Procurement • Cost and functionality • Stakeholders: lack of front line users • Vendor demos: — Very slick — Biased by how well the vendor is liked — Biased by how well the vendor organizes the demo • Financial decisions are made early on • Financial review often carries as much weight as technical and clinical review
HF goals in procurement — Objective evidence to inform the procurement decision — Identify risk and needed customizations to inform negotiations — Inform implementation strategy — Ensure best fit
Thetestmethodologycallsfor intendeduserstoperform representativeandhigh-risktasks.
Usability Testing/Simulations Elements of a usability test: — Representative users — Representative environment (physical constraints) — Representative tasks with contender products — Realistic training, realistic use — Distractions — Record video and audio — Qualitative and quantitative — Semi-structured debrief
Procurement process
CASE STUDY: INFUSION PUMPS
Pump A Pump B Case Study: Large Volume Infusion Pumps
Stakeholders — Clinical representation — Management — Infection control — Transportation — Supply and purchasing — Biomedical engineering
HF Process List of prioritized tasks • Stakeholder input via task survey Shadowing builds context Draft scenarios • Clinicians validate and provide example pt. cases Refine based on heuristic evaluation Pilot and refine Usability Testing
Usability Testing Protocol — Training — Setting up and programming the pump — Modifying the pump settings and hitting a soft limit — Modifying the pump settings and hitting a hard limit — Resolving an occlusion alarm — Resolving an empty reservoir alarm — Debrief and questionnaire
Evaluation Criteria — Task accuracy & error frequency — Impact and severity of errors — Task efficiency — Number of requests for help — User feedback and preferences
Categorization of Usability Issues Priority Definition High Issues that could have direct patient safety implications and/or prevent users from completing tasks Medium Issues that have a potential indirect patient safety impact and/or could result in considerable user frustration and inefficiencies Low Issues that affect general usability and/or the user’s overall impression of the system
Number of Usability Issues Pump A Pump B
Task Efficiency Number of Requests Pump A 18 Pump B 10 Average Time (mm:ss) Pump A 59:47 Pump B 56:35 Requests for guidance Time to complete scenarios
0 1 2 3 4 Easiest to use Best meets my clinical needs Safest Number of Participants Adult Acute Care - Exit Survey Cardinal Alaris Hospira Symbiq 0 1 2 3 4 Easiest to use Best meets my clinical needs Safest Number of Participants NICU - Exit Survey Cardinal Alaris Hospira Symbiq Questionnaires Pump A Pump B Pump A Pump B
Overall Comparison Score Overall Comparison Score Pump A 10.70 Pump B 18.99
OTHER PROJECTS
HF Informed Procurement Examples Project • Electronic medical records Outcome Current products on the market are not easy to use, resulting in use-related patient safety risks. Decision to postpone purchase until better technology is available. HF value add Saved close to $1 billion and prevented introducing preventable risk.
HF Informed Procurement Examples Project • Anesthesia Gas Machines Outcome Large variability in performance among the 4 products evaluated. Two products stood out as being significantly easier to use, with minimal patient safety implications. Investment made for the system that is both safe and best supports the specific organization's users and their workflows. HF value add
HF Informed Procurement Examples Project • Surgical Instrument Management System Outcome Systems evaluated performed similarly across assessment criteria, but one of them demonstrated a significantly lesser number of critical patient safety and usability issues. Informed the customization negotiations, training requirements, mitigations and implementation strategy for the chosen product in order to prevent any potential use-safety risk. HF value add
HF Informed Procurement Examples Project • ABG syringes Outcome Users were not able to distinguish the heparinized syringes from non- heparinized syringes. Packaging, plunger colour and labeling all contributed to safety errors, which perpetuated through supply stocking, feeds preparation and administration. The data was used to break the contract with the vendor. HF value add
Benefits: Human Factors Informed Procurement — Objective evidence to inform the procurement decision — Identify risks and push for needed customizations — Improved adoption of technology — Improved efficiency — Decreased training — Improved patient safety
Conclusions We cannot assume manufacturers test for safety Simulation takes into consideration the complexity of real healthcare environments Simulation uncovers system issues that may also be addressed through further simulation
PROCUREMENT LANDSCAPE
Value-Based Procurement
THANK YOU!
How Human Factors Testing Improves Healthcare Technology Procurement

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How Human Factors Testing Improves Healthcare Technology Procurement

  • 1. Using Human Factors in Hospital Technology Procurement Svetlena Taneva, PhD svetlena@humanfactors.ca Healthcare Human Factors University Health Network @healthcarehf @SvetlenaTaneva
  • 2. WHAT IS HUMAN FACTORS?
  • 3. Buxton, W. (2001). Less is More (More or Less), in P. Denning (Ed.). The Invisible Future: The seamless integration of technology in everyday life. New York: McGraw Hill, 145-179. What is Human Factors? The application of the science of human behaviour to the design of systems Engineering for human efficiency and effectiveness - accommodate the limits of the human user.
  • 4. Bridging the gap between human capability and demands of the task
  • 5.
  • 6. 210,000 - 400,000 US DEATHS annually due to preventable medical error James, J.T. (2013). A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9(3), 122-128
  • 7. 17,300 – 23,000 CANADIAN DEATHS annually due to preventable medical error CIHI (2016). Measuring Patient Harm in Canadian Hospitals. Canadian Patient Safety Institute. Baker, Norton, et al. (2004). The Canadian Adverse Events Study.
  • 8.
  • 10.
  • 11. The Opportunity Healthcare environments today: — Volume of technology increasing — Complexity of technology increasing — Interdependency of technologies increasing — Clinical staff busier — Increasingly concerned with errors associated with technology use
  • 12. Pitfalls of Traditional Procurement • Cost and functionality • Stakeholders: lack of front line users • Vendor demos: — Very slick — Biased by how well the vendor is liked — Biased by how well the vendor organizes the demo • Financial decisions are made early on • Financial review often carries as much weight as technical and clinical review
  • 13. HF goals in procurement — Objective evidence to inform the procurement decision — Identify risk and needed customizations to inform negotiations — Inform implementation strategy — Ensure best fit
  • 15. Usability Testing/Simulations Elements of a usability test: — Representative users — Representative environment (physical constraints) — Representative tasks with contender products — Realistic training, realistic use — Distractions — Record video and audio — Qualitative and quantitative — Semi-structured debrief
  • 18. Pump A Pump B Case Study: Large Volume Infusion Pumps
  • 19. Stakeholders — Clinical representation — Management — Infection control — Transportation — Supply and purchasing — Biomedical engineering
  • 20. HF Process List of prioritized tasks • Stakeholder input via task survey Shadowing builds context Draft scenarios • Clinicians validate and provide example pt. cases Refine based on heuristic evaluation Pilot and refine Usability Testing
  • 21. Usability Testing Protocol — Training — Setting up and programming the pump — Modifying the pump settings and hitting a soft limit — Modifying the pump settings and hitting a hard limit — Resolving an occlusion alarm — Resolving an empty reservoir alarm — Debrief and questionnaire
  • 22. Evaluation Criteria — Task accuracy & error frequency — Impact and severity of errors — Task efficiency — Number of requests for help — User feedback and preferences
  • 23. Categorization of Usability Issues Priority Definition High Issues that could have direct patient safety implications and/or prevent users from completing tasks Medium Issues that have a potential indirect patient safety impact and/or could result in considerable user frustration and inefficiencies Low Issues that affect general usability and/or the user’s overall impression of the system
  • 24. Number of Usability Issues Pump A Pump B
  • 25. Task Efficiency Number of Requests Pump A 18 Pump B 10 Average Time (mm:ss) Pump A 59:47 Pump B 56:35 Requests for guidance Time to complete scenarios
  • 26. 0 1 2 3 4 Easiest to use Best meets my clinical needs Safest Number of Participants Adult Acute Care - Exit Survey Cardinal Alaris Hospira Symbiq 0 1 2 3 4 Easiest to use Best meets my clinical needs Safest Number of Participants NICU - Exit Survey Cardinal Alaris Hospira Symbiq Questionnaires Pump A Pump B Pump A Pump B
  • 27. Overall Comparison Score Overall Comparison Score Pump A 10.70 Pump B 18.99
  • 29. HF Informed Procurement Examples Project • Electronic medical records Outcome Current products on the market are not easy to use, resulting in use-related patient safety risks. Decision to postpone purchase until better technology is available. HF value add Saved close to $1 billion and prevented introducing preventable risk.
  • 30. HF Informed Procurement Examples Project • Anesthesia Gas Machines Outcome Large variability in performance among the 4 products evaluated. Two products stood out as being significantly easier to use, with minimal patient safety implications. Investment made for the system that is both safe and best supports the specific organization's users and their workflows. HF value add
  • 31. HF Informed Procurement Examples Project • Surgical Instrument Management System Outcome Systems evaluated performed similarly across assessment criteria, but one of them demonstrated a significantly lesser number of critical patient safety and usability issues. Informed the customization negotiations, training requirements, mitigations and implementation strategy for the chosen product in order to prevent any potential use-safety risk. HF value add
  • 32. HF Informed Procurement Examples Project • ABG syringes Outcome Users were not able to distinguish the heparinized syringes from non- heparinized syringes. Packaging, plunger colour and labeling all contributed to safety errors, which perpetuated through supply stocking, feeds preparation and administration. The data was used to break the contract with the vendor. HF value add
  • 33. Benefits: Human Factors Informed Procurement — Objective evidence to inform the procurement decision — Identify risks and push for needed customizations — Improved adoption of technology — Improved efficiency — Decreased training — Improved patient safety
  • 34. Conclusions We cannot assume manufacturers test for safety Simulation takes into consideration the complexity of real healthcare environments Simulation uncovers system issues that may also be addressed through further simulation
  • 36.
  • 37.
  • 39.