Act 2 - Human factors systems approach to healthcare quality and patient safety. Applied Ergonomics

Human Factors Systems Approach to Healthcare Quality and Patient Safety

Authors and Affiliations

• Pascale Carayon: Center for Quality and Productivity Improvement, University of Wisconsin-Madison

• Tosha B. Wetterneck: Department of Medicine, University of Wisconsin School of Medicine and Public Health

• A. Joy Rivera-Rodriguez: Department of Industrial Engineering, Clemson University

• Ann Schoofs Hundt: Center for Quality and Productivity Improvement, University of Wisconsin-Madison

• Peter Hoonakker: Center for Quality and Productivity Improvement, University of Wisconsin-Madison

• Richard Holden: Vanderbilt University School of Medicine

• Ayse P. Gurses: Johns Hopkins University School of Medicine

Abstract

• Human factors systems approaches are essential for enhancing healthcare quality and patient safety.

• SEIPS model (Systems Engineering Initiative for Patient Safety) is highlighted as an effective approach in healthcare research and practices.

• Discusses the model's implications for healthcare system redesign and principles aimed at improving healthcare quality and safety.

Keywords

• Sociotechnical system

• Macroergonomics

• Healthcare

• Patient safety

• SEIPS model

• Balanced work system

• Patient-centered care

• Healthcare team

Introduction

• History of HFE Studies: The first significant study on medication safety by Chapanis and Safren (1960) identified 178 medication errors, underscoring the impact of work systems on patient safety.

• Recognition of HFE: The publication of "To Err is Human: Building a Safer Health System" by the US Institute of Medicine in 1999 emphasized the importance of human factors engineering (HFE) in patient safety.

• Role of HFE in Healthcare: HFE provides insights for the redesign of healthcare systems to enhance patient safety and quality of care.

The SEIPS Model

• Key Characteristics:

  • Describes work system elements and their interactions.

  • Integrates Donabedian’s Structure-Process-Outcome (SPO) model, which comprises:

    • Structure: Material and human resources that support healthcare delivery.

    • Process: Care processes influenced by the work system, contributing to outcomes.

    • Outcome: Measures of patient and organizational performance.

• Dynamic Nature: Any alteration in the work system leads to changes in all elements of the work system. Recognizes the influence of external environments on the work system.

• Adaptation of the Model: The model has evolved to focus on various 'persons' at the center, including healthcare teams and patients, emphasizing collective roles in care quality and safety.

Balancing Work Systems for Patient Safety

• Principles of Balance: Focus on the interaction of systems and their components to promote better healthcare delivery.

• Implications for Improvement: Identifies both positive and negative elements of work systems, requiring a balanced approach to optimize performance and patient outcomes.

Influence of the Work System on Care Processes

• Care Processes: A series of tasks performed using various tools in a specific environment, essential for patient outcomes and quality of care.

• Need for Understanding Interactions: Recognition of how work system elements interact over time to influence healthcare quality and patient safety.

Performance Obstacles and Facilitators

• Obstacles in Work Systems: Identified through various studies, including task overload, inadequate tools, and ineffective organizational structures that affect healthcare delivery.

• Impact on Outcomes: Understanding these obstacles is crucial for enhancing patient safety and the working conditions of healthcare professionals.

Healthcare Quality and the Role of Health IT

• Health IT's Role: Seen as a valuable tool for improving patient safety, yet often fails to meet expectations due to lack of HFE consideration in design and implementation.

• Research Findings: Studies illustrate the complex relationship between technology, process changes, and patient safety outcomes.

Practical Applications of the SEIPS Model

• Usage in Healthcare: The SEIPS model serves as a practical framework for identifying and addressing patient safety issues through human factors and ergonomics methodologies.

• A Systems Approach: Encourages healthcare professionals to adopt a broader strategy rather than focusing solely on individual actions.

Conclusion

• SEIPS Model's Effectiveness: Successful in promoting an understanding of human factors in healthcare systems, supporting research and practical applications.

• Future Research Directions: Emphasis on exploring work system interactions and developing assessments for balanced systems, with the aim of benefiting both patients and healthcare workers.