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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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
“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!!
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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”)
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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)
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
Human Factors – Sociotechnical System ModelSystem Engineering Initiative for Patient Safety (SEIPS) Model (Carayon, 2006)
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
“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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
Why do things go right (and wrong) in complex healthcare systems?
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
• 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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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]
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
‘Performing Well, Feeling Well’
Taking Forward Human Factors & Ergonomics (HFE) Integration in NHS Scotland
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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)
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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).
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
What can you do?- On a Personal level
- In Teams / Organisationally- As Science & Engineering Professions
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
Person
Technology and Tools
Tasks Physical Environment
Organisation of Work
Wanted/ UnwantedOutcomes
System Performance:
Human Wellbeing:
Worksheet - Care System Interactions and Outcomes
External Influences
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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.
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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?
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
Human Factors Scotland – National Development and Action Network [email protected]
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
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/
NHS EDUCATION FOR SCOTLAND SAFETY, SKILLS & IMPROVEMENT
THANK YOU
Any Questions?