Human Factors in health care
Human Factors in Health Care
Human Factors (HF):
There are many definitions of HF, but the definition by Eric Shaver of the humanfactorblog.com succinctly sums it up. ”Human factors and ergonomics 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 satisfaction1. HF&E is employed to fulfill the goals of health and safety and productivity, where they are used most of the time to design alert systems. Alerts are meant to serve as a safety net for providers, but have one key problem which is the large numbers of alerts, many of which disrupt workflow and are ignored”1.
Terms associated with "human factors" include "human characteristics," "human factors engineering," "ergonomics," "human engineering," and "the human element."
As a scientist, the human factors specialist or engineer does not attempt to judge human factors as right or wrong, correct or incorrect. Rather, the human factors scientist merely attempts to understand and define these factors, or human characteristics, so that their strengths and weaknesses, and their capabilities and limitations might be taken into account when designing systems where persons are to be an essential component, in the same way that a mechanical engineer must understand, define, and take into account the characteristics of physical materials included in a structural design2. ROLE OF HUMAN FACTORS IN HEALTH CARE Computerized clinical decision support (CDS) systems have become increasingly important in rapid rate of electronic health record (EHR) fueled somehow by the HITECH act. A lot of attention is being directed to HF principles in building efficient support systems that help health professionals make good clinical decisions. One type of CDS is designed to generate alerts that warn healthcare staff about potential errors, enabling them to make better therapeutic decisions and focus on safety. The majority of the alerts are related to medication decision support for errors: - Drug-drug interaction alerts, - Therapeutic duplication alerts, etc.
Other types of alerts available in clinical information systems include: - Blood product alerts - Laboratory results alerts - Alerts related to the absence of allergy information.
In building these systems factors determining whether human engineering inputs will be accepted include: the specification (or lack thereof) of personnel performance requirements; the advantages supplied by the human engineering recommendation; the costs involved in implementing it; the funding supplied by the customer for the new system; and his oversight of human engineering efforts. The downside of a health care system that does not take into consideration these conditions or factors is the reluctance of practitioners to heed and respond to these alerts leading to “alert fatigue”, a condition that enhances medical errors and decreases productivity3
ROLE OF HUMAN FACTORS IN AVIATION
Human error (instead of mechanical failure) has been documented as a primary contributor to more than 70 percent of commercial airplane hull-loss accidents. It is associated with flight operations, maintenance practices and air traffic management. Boeing human factors professionals work with engineers, pilots, and mechanics to apply the latest knowledge about the interface between human performance and commercial airplanes to help operators improve safety and efficiency in their daily operations.4
ROLE OF HUMAN FACTORS IN HOME HEALTH CARE
The rapid growth of home health care has raised many unsolved issues and will have consequences that are far too broad for any one group to analyze in their entirety. Yet a major influence on the safety, quality, and effectiveness of home health care will be the set of issues encompassed by the field of human factors research--the discipline of applying what is known about human capabilities and limitations to the design of products, processes, systems, and work environments. On October 1 and 2, 2009, a group of human factors and other experts met to consider a diverse range of behavioral and human factors issues associated with the increasing migration of medical devices, technologies, and care practices into the home.5
COMPONENTS OF HF
Several models of Human Factors in health care exist but they all basically use the following components in different proportions to execute and secure patient safety. Human factors are multidisciplinary in nature.
- External environment
- Physical environment, Human-system interface, Organizational/Social environment
- Nature of work
- Individual characteristics
A basic tenet of any systems approach to adverse events is that changes in one part of the system will surely have repercussions on another part of the system. Hence, it is important to focus on the way these components can interact and influence one another and not just the components themselves. When these components are functioning well together, they serve collectively as a set of barriers or system of defenses to the occurrence of preventable adverse events. However, it is when weaknesses or vulnerabilities exist within these components and they interact or align themselves in such a way that the weaknesses overlap that preventable adverse events occur.6
OVERVIEW OF HF
Human factors is the application of scientific knowledge about human strengths and limitations to the design of systems in the work environment to ensure safe and satisfying performance. A human factors framework helps us become aware of the salient components and their relationships that shape and influence the quality of care that is provided to patients. The clinical environment can be made a bit more understandable and easier in delivering care by accounting for a wide range of human factors concerns that directly and indirectly impact human performance.
HISTORY OF HF
The foundations of the science of ergonomics appear to have been laid within the context of the culture of Ancient Greece and archaeological record shows that the early Egyptian dynasties made tools and household equipment that illustrated ergonomic principles. In the 19th century, Frederick Winslow Taylor pioneered the "scientific management” method, which Frank and Lillian Gilbreth expanded in the early 1900s to develop the "time and motion study". They aimed to improve efficiency by eliminating unnecessary steps and actions. Prior to World War I the focus of aviation psychology was on the aviator himself, but the war shifted the focus onto the aircraft, in particular, the design of controls and displays, the effects of altitude and environmental factors on the pilot, and saw the emergence of aeromedical research and the need for testing and measurement methods. Henceforth, the aviation world played a major role in HF engineering as a way to reduce casualties. World War II marked the development of new and complex machines and weaponry with new demands on operators' cognition focusing on the design of equipment that took into account human limitations and take advantage of human capabilities. The beginning of The Cold War led to a major expansion of Defense supported research laboratories. The focus shifted from research to participation through advice to engineers in the design of equipment. After 1965, the period saw a maturation of the discipline. The field has expanded with the development of the computer and computer applications. The Space Age created new human factors issues such as weightlessness and extreme g-forces. Tolerance of the harsh environment of space and its effects on the mind and body were widely studied The dawn of the Information Age has resulted in the related field of human–computer interaction (HCI). Likewise, the growing demand for and competition among consumer goods and electronics has resulted in more companies including human factors in product design.7
- Eric Shaver. The many definitions of human factors and ergonomics. http://www.thehumanfactorblog.com/2009/03/16/the-many-definitions-of-human-factors-and-ergonomics
- David Meister. The role of Human Factors in system development. Applied Ergonomics Vol 13, Issue 2
- Shobha Phansalkar et al. A review of human factors principles for design and implementation of medication safety alerts in clinical information systems. JAMIA 2010 17:493-501
- Kerm Henriksen et al. Understanding adverse events: A human factor Frame work
- Human factors and ergonomics - Wikipedia, the free encyclopedia en.wikipedia.org/wiki/Human_factors_and_ergonomics
Submitted by Okunola Oluola