human factors is vital for transforming health care

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Human Factors is Vital for Transforming Health Care Eric F Shaver, PhD ericshaver.com @ericshaver

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“The most significant factor in making the nation’s health care system safer is the human element. And that is our business.” (Salas, et al., 2006)

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Current State of U.S. Health Care

• Health care is at a crisis point.

• 2012 Health Spending (Martin, et al., 2014): • Total health expenditure: $2.8 trillion • Per person expenditure: $8,915 • Percent of GDP: 17.2%

• U.S. spends more than any other industrialized nation without achieving better outcomes.

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Changes Are Needed

• The current status and future trajectory are untenable.

• Substantial changes must be undertaken to transform health care in order to: • Reduce costs • Improve quality of care • Improve accessibility of care

• Human Factors is vital to assisting in achieving this

transformation.

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Human Factors (HF) Overview

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What is Human Factors?

• Human Factors 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 satisfaction.

• In simpler terms, Human Factors focuses on designing the world to better accommodate people.

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What is Human Factors?, cont.

• Human Factors are relevant anywhere people work with systems, whether they are social or technical in nature.

• The breadth of these sociotechnical systems include

situations and circumstances where individuals interact with other system elements including: • People • Technology • Tasks • Organizations • Environments • Rules & Regulations

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What is Human Factors?, cont.

• Health care is arguably the most complex sociotechnical system.

• Human Factors takes a people-centered, process-oriented, systems approach to understanding and solving complex problems.

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Origins of Human Factors

Human Factors

Psychology

Anthropology

Applied Physiology

Environmental Medicine

Engineering Computer Science

Statistics

Operations Research

Industrial Design

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Origins of Human Factors, cont.

• In the U.S., Human Factor is generally considered to have originated during WWII.

• But, advances that contributed to its formation can be traced to the turn of the 20th century.

• Human Factors started in the military, but expanded into most industries, including health care.

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Industries Benefiting from Human Factors

• Aerospace • Automotive • Chemical • Computer • Consumer Product • Construction • Defense • Forestry

• Health Care • Manufacturing • Mining • Nuclear • Petroleum • Telecommunication • Textile

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What Does HF Bring to the Table?

• Increased • Safety & health • Quality • Productivity • Ease of learning & use • Satisfaction, trust &

loyalty • User experience &

engagement • Sales & market share

• Decreased • Deaths, injuries &

illnesses • Accidents • Error rates • Absenteeism & turnover • Training time • Development costs • Need for redesign & recall • Support & services costs • Maintenance costs

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What Does HF Bring to the Table?, cont.

• A deep understanding of people: • Sensory

• Visual, auditory, olfactory, gustatory, & somatosensory

• Psychological • Attention, perception, decision making, memory, & motivation

• Physiological • Anthropometry & biomechanics

• Psychosocial • Behavior

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What Does HF Bring to the Table?, cont.

• How people interact with other people in: • Dyads, teams, groups, & organizations

• How people interact with technology: • Individually • Groups (e.g., teams, departments, etc.) • Organizations (e.g., hospitals, across systems, etc.)

• How systems need to be designed (or redesigned) to fit the capabilities & limitations of people.

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What Does HF Bring to the Table?, cont.

• A solid foundation, grounded in science, that includes: • Theories • Models • Principles • Guidelines • Findings • Methods • Tools

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How has Human Factors Positively Impacted Health Care?

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Brief History of HF & HC

• Early history • Medication errors (Chapanis & Safrin, 1960)

• Anesthesia (Cooper, et al., 1978)

• Human Factors came to the forefront with the

publishing of the IOM report To Err is Human in 1999. (Leape, 2004)

• Since then, a primary focus of Human Factors has

been patient safety and medical technology design.

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Human Factors has conducted research on a variety of Health Care topics, settings, & people.

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Sample of HC Topics

• Anesthesiology • Built Environment • Care Coordination • Checklists • eHealth • Health Communication • Health Information

Technology • Infection Prevention • Medical Error • Medical Products • Medication

• Needles • Organizational Culture • Patient Safety • Safety Culture • Simulation • Teamwork • Telemedicine • Training • Websites • Work Design • Work Schedules

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Sample of HC Settings & People

• Settings • Emergency Departments • Home Care • Intensive Care Units • Nursing Homes • Operating Rooms • Pharmacy Departments • Physician Offices

• People • Nurses • Patients • Pharmacists • Physicians • Technicians

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What value does Human Factors provide to Health Care?

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Human Factors Interventions Can:

• Increase patient and staff safety; • Decrease numbers of adverse events; • Minimize the potential for introduction of new hazards; • Improve staff acceptance; • Increase work efficiency; • Better integrate new technology with existing

technology; • Decrease training time needed to reach competency;

and • Minimize the need for modifications, “workarounds,”

and/or shortcuts.

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How can Human Factors assist the Health Care community?

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Technology Integration

• Medical technology has great potential, but implementation is often viewed as a mixed blessing.

• HF takes a holistic approach to understanding how people will interact with technology in a system. Doing so makes it possible to identify technological requirements that will best fulfill users’ needs, which in turn will improve quality and safety.

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Technology Integration, cont.

• Example methods to facilitate integration: • Heuristic evaluation • Task & job analysis • Structured interviews • Job shadowing

• Focus: • Prevent poorly designed technology from entering the

system. • Determine that to be acquired technology will integrate

appropriately within the system.

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Patients

• Focus: • Must understand the needs, wants, & desires of patients

to optimize their experiences and maximize their satisfaction.

• Example efforts:

• Identify how technology can be utilized to facilitate patient understanding & decision making.

• Streamline and/or redesign patient-facing processes.

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Health Care Teams

• Focus: • Developing teams that increase patient safety by

decreasing medical error. • Transitioning from a team of experts to expert teams.

• Example efforts:

• Team design • Team assessment • Team training

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Health Care Systems

• Health care delivery needs changes.

• HF can help by leading and/or collaborating in multidisciplinary teams seeking to solve system problems.

• In-house human factors expertise can be dispatched to different teams, departments, hospitals, etc.

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Health Care Systems, cont.

• HF can provide comprehensive, macroergonomics strategies, methods, and tools to assist with successful change management efforts across health care systems.

• HF can assist with appropriate integration of recently acquired hospitals into health care systems.

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Research

• HC has gotten better about collecting important financial & performance metrics electronically.

• But, it hasn’t fully leveraged the opportunity to rapidly, reliably, & repeatedly capture data from patients, family members, physicians, nurses, staff, etc. on important topics.

• HF can help overcome this challenge.

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Research, cont.

• HF uses a variety of methods to capture data from individuals, groups, & organizations: • Surveys (online & in-person) • Structured interviews • Usability evaluations • Observational studies • Video analysis • Field studies • Lab experiments • Simulation

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Human Factors has made important contributions to Health Care. But, more must be accomplished.

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What is Required from HF?

• “…take every opportunity to explain and ‘sell’ HF.” (Carayon, 2012, p. 12)

• Communicate beyond the boundaries of our

discipline.

• Continue with current health care-related efforts. • Collaborate with HC domain experts at every

opportunity.

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What is Required from HF?, cont.

• Understand and speak the language of business. • Be involved at the strategic level. • Continually demonstrate value. • Calculate ROI (e.g., internal, external, & social) for

HF interventions. (Wilson & Rosenbaum, 2005)

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What is Required from HF?, cont.

• Realize that HF is an innovation. (Carayon, 2010)

• Move beyond interventions that just “sand the

edges” of the problem. • Understand there may be barriers to entry; but the

effort is worth the challenge.

• HF should strive for positive societal change. (Vicente, 2008)

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But, Human Factors can’t tackle this challenge alone. It needs buy-in from the Health Care community.

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What is Needed from HC?

• Realizations that health care challenges are a “wicked” problem needing assistance from outside the health care community.

• Willingness to embrace and learn from HF. • Understanding that HF contributions are greater

than just patient safety.

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What is Needed from HC?, cont.

• Increased utilization of HF professionals: • Consultants

• In-house HF experts

• “Biculturals” (HC professionals trained in HF)

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References Carayon, P. (2010). Human factors in patient safety as an innovation. Applied Ergonomics, 41, 657-665. Carayon, P. (2012). Human factors and ergonomics in health care and patient safety. In P. Carayon (Ed), Handbook of Human Factors and Ergonomics in Patient Safety, 2nd Ed (pp. 3-15). Boca Raton, FL: CRC Press. Chapanis, A., & Safrin, M.A. (1960). Of misses and medicines. Journal of Chronic Diseases 12, 403–408. Cooper, J.B., Newbower, R.S., Long, C.D., & McPeek, B. (1979). Preventable anesthesia mishaps: A study of human factors. Anesthesiology, 49, 399–406.

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References, cont. Kohn, K. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (1999). To err is human: Building a safer health system. Washington, DC: National Academy Press. Leape, L.L. (2004, Summer). Human factors meets health care: The ultimate challenge. Ergonomics in Design, 6-12. Martin, A.B., Lassman, D., Washington, B., Catlin, A., & the National Health Expenditure Accounts Team (2012). Growth in US health spending remained slow in 2010; health share of gross domestic product was unchanged from 2009. Health Affairs, 31, 1, 208-219.

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References, cont. Salas, E., Baker, D., King, H., & Battles, J. (2006). Special section commentary: Opportunities and challenges for human factors and ergonomics in enhancing patient safety. Human Factors, 48, 1-4. Vicente, K.J. (2008). Human factors engineering that makes a difference: Leveraging a science of societal change. Theoretical Issues in Ergonomics Science, 9, 1-24.

Wilson, C.E., & Rosenbaum, S. (2005). Categories of return on investment and their practical implications. In R.G. Bias and D.J. Mayhew (Eds.), Cost-Justifying Usability: An Update for the Internet Age (pp. 215-263). San Francisco, CA: Morgan Kaufman Publishers.

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Additional Resources to Consult

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Additional Resources to Consult, cont.

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Dr. Shaver is the Human Factors Lead at FUJIFILM SonoSite, the world leader in bedside and point-of-care ultrasound. Dr. Shaver's work has emphasized achieving an optimal fit between people, technology, and work systems to facilitate safety, performance, and satisfaction. A specific focus has centered on bridging the research-practice gap by synthesizing and disseminating the latest scientific findings about human capabilities and limitations to the design, development, implementation, use, and evaluation of technology.