Manual Handbook of Human Factors and Ergonomics in Health Care and Patient Safety

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Even after the product or system is marketed, it is useful to solicit and analyze feedback on it from users to inform updates or new designs. The user-needs analysis usually includes such characteristics as age, education, gender, culture and ethnicity, physical and cognitive abilities, relevant skills, language, and literacy, among others. Gathering this information might involve conducting interviews with potential users to understand their goals and objectives with respect to a particular system or system component, such as a device, where it will be used, how often it will be used, experiences with similar devices, etc.

It is important to recognize that, for health care in the home, the users are heterogeneous and include people who engage in self-care or receive care and both lay and professional caregivers who vary widely in their skills, abilities, and characteristics see Chapter 2. As noted in Figure , the environment is multifaceted and not restricted to its physical characteristics. It is also used in the evaluation of existing systems to help identify design problems and sources of mismatches between system demands and user-group capabilities.

These demands are then compared with the capabilities of the planned user population to determine where errors and inefficiencies are likely to arise. The result is a list of potential mismatches keyed to each task and subtask, which is the basis for deriving design requirements for a usable system. The current standard task analysis methodology is hierarchical task analysis HTA , although many methods are available. HTA starts from system goals and uses a systematic goal decomposition methodology until a sufficient level of detail is reached to solve the problem at hand.

The result of the analysis is generally a hierarchical structure that can be represented either graphically or in an outline-like formatted table that organizes tasks as sets of actions used to accomplish higher level goals. Chapter 4 presents several examples of this methodology. In health care, many tasks, especially those relying on the use of technology, draw heavily on cognitive capabilities with users required to receive, understand, evaluate, and act on information.

For these, one might perform a cognitive task analysis, which can be conceptualized as task analysis applied to the cognitive domain. In this case the demands focus on the knowledge structures e.

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Often, the analysis is performed by assuming a computational model of the relevant cognitive processes, and the specific analysis approaches depend on the model adopted. Many techniques are used for the collection of task data, including observation, interviews, questionnaires, and review of instruction manuals. The human factors literature is often used to find the range of capabilities in the appropriate population to compare with the task demands. A critical human factors method that is particularly appropriate for the design of components of health care systems is user testing.

These tests may take the form of focus groups or usability testing with early mock-ups or mid-stage prototypes or final system components. Often in usability testing, a variety of prototypes or mock-ups are used. For example, in the early stages of usability testing, two-dimensional representations of a device or user interface a graphical, nonfunctioning version of a system or storyboards that describe in a series of images the steps involved in execution of a task may be used, whereas working prototype devices or fully interactive systems may be used in later stages of testing.

Frequently, especially in software engineering, human factors specialists use iterative prototyping, involving a series of tests with rough prototypes and short revision cycles National Research Council, In usability testing it is important to ensure that the participants are representative of the anticipated user groups and that the data collection techniques capture both the demands associated with the activities they will be performing and the relevant environmental contexts.

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This is especially important with respect to health care systems for the home, for which the potential user groups are broad and diverse. Usability metrics include measures of effectiveness e. Human factors specialists rely on a variety of sources of information to guide their involvement in the design process.

This may initially include review of the existing literature, data compendiums, and design standards and guidelines. Databases that contain information on human capabilities are also available e. The document provides human dimension data and explains proper techniques for applying these data, which may vary depending on the complexity of the population to be accommodated. The guide includes a long list of resources and references Human Factors and Ergonomics Society, In addition, a number of design standards and guidelines are available to guide the design process of medical devices and systems see Chapter 5.

Human factors methods and knowledge can be applied to any stage of design or implementation of a system.

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This includes the initial design of systems and system components to avoid problems and deficiencies, as well as the diagnosis and identification of problems with existing systems. Thus, the concepts and methods of human factors have broad applicability to health care in the home. For example, human factors techniques can be applied to the design of health care equipment and technologies, such as medication dispensers, glucometers, nebulizers, blood pressure monitors, telemedicine technologies, and software interfaces for Internet health applications.

These techniques can also be applied to the design of instruction manuals and training programs to ensure that individuals or their caregivers have the information and skills they need to operate equipment and perform health care tasks. Human factors techniques can be used to inform the design of a home environment to ensure that lighting, layout, and space are adequate for the tasks being performed or the design of a neighborhood to help ensure that there is adequate and effective signage.

Human factors approaches are also relevant to the design of jobs for health care workers. For example, human factors methods can be used to determine workflow, to coordinate work, to maintain scheduling and communication protocols, and to determine work requirements to ensure worker productivity, safety, and health.

Handbook of Human Factors and Ergonomics in Health Care and Patient Safety

Human factors can have input into the broader organizational environment to help design and implement safety programs, certification protocols, or program evaluation methods. Human factors techniques can also be used to help understand the sources of human errors and safety violations in the health care domain. In fact, the goals of human factors are commensurate with the goals stated in the report Crossing the Quality Chasm Institute of Medicine, for health system reform: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equality. There are numerous examples in the health care domain in which the application of human factors has resulted in reduced errors and cost, increased safety, efficiency, and effectiveness, and personal satisfaction.

These examples include efforts to enhance safety and reduce medical errors e. Human factors methods have also been applied to the design of medical equipment and devices e. This is in contrast to a more traditional reductionist approach, which focuses on one component of a system in isolation from the other components. Using a traditional approach, the focus is typically on the physical or technical components of a system, with little regard for the human. For example, glucometer or medication instructions may be designed without considering how the persons using these instructions might vary in terms of age, cognitive and sensory capabilities, English literacy, health literacy, or stage of illness acceptance.

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For example, such errors could include lapses in performing health promotion and disease prevention behaviors, not adhering to a prescribed treatment, ignoring warning signs of complications, and not sharing important information about health history, symptoms, or response to treatment with caregivers. Other examples include potentially life-threatening events, such as misreading output from health monitoring equipment, altering equipment settings, turning off alarms, sustaining injuries due to poor body mechanics during lifting and transfers, or continuing intravenous IV antibiotic infusion in a person who is showing signs of allergic reaction.

There are many types of human error, and the causes and consequences of these errors vary. Although some errors may be inconsequential, others. Some errors and their consequences are preventable via good device or environmental design, whereas others must be handled through procedural or administrative solutions or through user education and training. They also require knowledge of whether the fit among these system elements is adequate. In summary, applying human factors knowledge and techniques to the design of health care systems intended for use in the home can make the systems safer, more effective, and more efficient.

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Handbook of Human Factors and Ergonomics in Health Care and Patient Safety. 2nd ed.

Volume II. Cognitive processes and performance. New York: John Wiley and Sons. Engineering data compendium of human perception and performance. Volume 1. Carayon, P. Nursing workload and patient safety in intensive care units: A human factors engineering evaluation of the literature. Intensive and Critical Care Nursing , 21, Casey, S.

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Human Factors training video (SHELL Model) - Trent Simulation

It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends. They carry out research and in-depth policy analysis on healthcare quality.

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