What is human factors engineering? How can human factors engineering help deliver safer care? Professor Penelope Sanderson Professor of Cognitive Engineering and Human Factors The University of Queensland St Lucia Qld
Overview • Human factors engineering and cognitive engineering • Cognitive engineering – Ways of thinking about systems – Integration into the CREPS research program
• Human factors engineering focus and skills
Human factors engineering and cognitive engineering •
Cognitive engineering—a systems view on designing human-system integration for complex safety-critical systems – What are the parts and wholes of the system—why does it exist, what does it do, how does it work, how does it adapt, how might it fail? – What issues does the system face at different points in its lifecycle? – What human-system integration problems is it subject to?
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Human factors engineering—the science and practice of achieving the best fit between people and the engineered worlds within which they live and work – – – –
Physical, cognitive, and social ergonomics Analysis of physical and cognitive work (“cognitive task analysis”) Field, simulator, and laboratory behavioural research techniques Resolving selection, training, and equipment design issues.
Cognitive Engineering The systems viewpoint
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Descriptive model of safety envelope for any mission-critical or safety-critical system Cook & Rasmussen QSHC 2005;14:130-134 Location of operating point(s) compared with economic success/failure and acceptable/unacceptable workload .
Cognitive Engineering The systems viewpoint • Adfgv
Shifting perception of boundary location
“Going solid” eg bed gridlock Tight coupling causes larger movements in operating point Compensation then decompensation
Knowledge of operating point location
Cognitive Engineering The systems viewpoint • •
Safety envelope operates at multiple levels of organisation Multilevel model of risk management Rasmussen, Saf Sci 1997;27:183-213, Vicente, QSHC 2002;11:302-304
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Levels and multiple disciplines needed for healthcare context. Health System Government Regulators Board Health Service Admin Department Team Staff Patient and carers
Roles
Disciplines
Senior Health Adminstrators, Advisors, Academics
Political Science, Economics, Sociology, Epidemiology
Managers
Management and organisational theory
Clinicians Public with health issues
Medicine, Engineering, Human Factors, Consumer research
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Use of Rasmussen’s model of risk management to analyse Walkerton E coli breakout. Woo & Vicente, Rel Eng Sys Safety 2003;80:253-269
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Complex couplings revealed between different levels of organisation Propagation of negative safety culture, ignorance of basic science.
Cognitive Engineering The systems viewpoint •
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For CREPS, Rasmussen model of risk management guides development of research programs and role of human factors engineering Extension to cycles of investigate Æ intervene Æ evaluate where each step occurs at one or more levels of the model.
6. Post-translation evaluation (Re)definition of problem (Re)definition of intervention 1. Identify problem
2. Investigate problem
3. Propose intervention
4. Test intervention
5. Translate to practice
Government Regulators Board Hlth Svc Admin Department Team Staff Patient
Government Regulators Board Hlth Svc Admin Department Team Staff Patient
Government Regulators Board Hlth Svc Admin Department Team Staff Patient
Government Regulators Board Hlth Svc Admin Department Team Staff Patient
Government Regulators Board Hlth Svc Admin Department Team Staff Patient
Cognitive Engineering The systems viewpoint Benchmark and track Prior research outcomes
Resuscitation Government Regulators Board Hlth Svc Admin Department Team Staff Patient
1c Identify problem 1b 1a Trauma registry data
6
Outcome measurement
(Re)definitionof problem Targeted video data (Re)definitionof intervention collection and analysis
2a Investigate problem 2b
Resuscitation video records
Propose intervention 3
Test intervention 4a 4b
Controlled simulated Design intervention(s) Change tested Change tested resuscitations to in clinical to address causal in controlled resuscitations isolate causal factors factors simulated resuscitations
Change embodied in ED
Construct a framework for effective intervention Think about vertical connections while at each step. Benchmark and track
Medication errors
Translate Introduce into practice 5
6
Outcome measurement
(Re)definitionof problem Prior research outcomes
1a Identify problem 1b Incident reports (local)
(Re)definitionof intervention In vitro study to confirm observations
2b Investigate problem 2a Observations of infusion pump management and effects of distraction
Propose intervention 3 Change(s) that might solve problem, and their location on risk management model
Test intervention 4a 4b
Translate Introduce into practice 5
Change implemented In vitro study to Clinical trials of intervention in ICU test effect of proposed intervention
Human factors engineering Focus and skills •
Based partly in scientific psychology – Perception, attention, memory, decisionmaking, etc – Individuals and teams
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Based partly in industrial engineering – Task and work analysis; workflow models – Operations research and systems integration
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Most useful HF models analyse human(s) and world/system as a unit, not separately Health System Government Regulators Board Health Service Admin Department Team Staff Patient and carers
Roles
Disciplines
Senior Health Adminstrators, Advisors, Academics
Political Science, Economics, Sociology, Epidemiology
Managers
Management and organisational theory
Clinicians Public with health issues
Medicine, Engineering, Human Factors, Consumer research
Human factors engineering Focus and skills •
Design of behavioural experiments – Narrow or broad focus – Laboratory, field, simulator contexts – Counterbalancing, control, non-reactive measurement, etc
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Device design and evaluation (PDAs, HMDs, syringes, pumps, checklists…)
Data collection and management – Real-time data capture (video, electronic) – Analysis of integrated video/data records
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Analysis – Quantitative—inferential and descriptive statistics – Qualitative analysis—classificatory, interpretive Process investigation (HeadCam, VideoCued Recall)
Human factors engineering Focus and skills • •
Strategic planning and management of multi-modal research programs for research and development Balance of fidelity, control, generality, cost.
$
Control
Spartan lab
Clinical
Usability lab
Full scale simulator
Fidelity
Fidelity
Design
$$
Control
Many further trajectories exist
Human factors engineering Focus and skills Anticipating areas of possible problems (eg Abbott Lifecare, Lin et al J Biomed Inform 2001;34:274-284). GE
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14%
TE
OX
21%
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57% 57%
36% 14%
CV
PF
IEC 60601-1-8 (Aug 2005) melodic alarms Proportion of nurses who showed a confusion more than 25% of the time Lacherez et al 2005; submitted
29%
57%
27%
57%
IN
21%
PE
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Latent failure: overconfident identification?
21%
VN 36%
14%
GE=general, OX=oxygenation, PF=power failure, PE=perfusion, VN=ventilation, IN=infusion, CV=cardiovascular, TE=temperature.
Conclusions • Human factors engineering and cognitive engineering are related areas that work together to promote patient safety – Cognitive engineering—systems perspectives and models – Human factors engineering—theories, techniques and tools for discovery and investigation
• Find human factors/cognitive engineering people to collaborate on your patient safety projects
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