Human Factors and Safety

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Human Factors and Safety

• Matt Scanlon MD
• Associate Professor of Pediatrics- Medical
  College of Wisconsin
• Associate Medical Director of IS- Childrens
  Hospital of Wisconsin
• Presentation to Great Ormond Street Hospital
• 21 April, 2008

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Objectives

• Define Human Factors
• Describe key concepts of human factors
• Identify specific pediatric considerations

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What is human factors engineering?
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What isnt human factors engineering (HFE)?

• Team training
• Communication skills (SBAR)
• Analysis (FMEA, RCA or PRA)
• A discipline focused on safety

• A way to fix patient safety
• Engineering focused on aviation
• Methods to make people less likely make mistakes
• Device safety

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Human factors engineering (ergonomics)

• The science of improving human performance
• Designing the fit between people and products,
  equipment, facilities, procedures and
  environments

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What is it really?

• Discovers and applies information about human
  behavior, abilities, limitations and other
  characteristics to the design of tools, machines,
  systems, tasks, jobs, and environments for
  productive, safe, comfortable and effective human
  use

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What are the objectives of HFE?

• Reduce errors, fatigue, stress and injuries at
  work, while at the same time
• Improving productivity, ease of use, safety,
  comfort, acceptance, job satisfaction, and
  quality of life

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If we put that all together.

• Human factors engineering is the scientific
  discipline concerned with designing systems to
  make the people in them safer, happier, and more
  productive
• Bentzi Karsh, PhD
• University of Wisconsin

Who would object to this?
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What does HFE focus on to meet the objectives?

• Designing systems to meet human requirements
• Physical requirements (e.g. safe lifting)
• Behavioral requirements (e.g. training)
• Psychological requirements (e.g. job
  satisfaction)
• Cognitive requirements (e.g. memory limits)

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Human factors engineering uses

• Cognition
• Physiology
• Sensory input
• Human-tool interface
• Communication
• Psychology

• Organizational management
• Decision Science
• Environmental Design
• Among others

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How are safety goals achieved?

• Person approach
• Focus on individuals
• Blaming individuals for forgetfulness,
  inattention, or carelessness, poor production
• Methods poster campaigns, writing another
  procedure, disciplinary measures, threat of
  litigation, retraining, blaming and shaming
• Target Individuals

• System approach
• Focus on the conditions under which individuals
  work
• Building defenses to avert errors/poor
  productivity or mitigate their effects
• Methods creating better systems
• Targets System (team, tasks, workplace,
  organization)

X
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Features of HFE 1

• A belief in the idea that technologies (e.g.
  computerized physician order entry), tools (e.g.
  scalpels), machines (e.g. ventilators) are built
  to serve people and therefore must be built with
  the user in mind

Adapted from Sanders, M. S., McCormick, E. J.
Human Factors Engineering and Design (7th ed.).
New York McGraw-Hill 1993
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Features of HFE 2

• An understanding that individual differences in
  physical (e.g. hand size, height, weight,
  dexterity) and cognitive (e.g. memory, learning)
  capabilities and limitations exist and a further
  understanding that designs must accommodate these
  differences

Adapted from Sanders, M. S., McCormick, E. J.
Human Factors Engineering and Design (7th ed.).
New York McGraw-Hill 1993
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Monitors in hospitals

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Features of HFE 3

• Knowledge that the design of all things,
  including technologies, environments, and
  processes influence human behavior and well-being

Adapted from Sanders, M. S., McCormick, E. J.
Human Factors Engineering and Design (7th ed.).
New York McGraw-Hill 1993
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Who has gardened or farmed?
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Features of HFE 4

• Emphasis on evaluation and on empirical data
  during the design process

Adapted from Sanders, M. S., McCormick, E. J.
Human Factors Engineering and Design (7th ed.).
New York McGraw-Hill 1993
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Features of HFE 5

• Use of the scientific method and objective data
  to test hypotheses and generate data about human
  behavior and performance

Adapted from Sanders, M. S., McCormick, E. J.
Human Factors Engineering and Design (7th ed.).
New York McGraw-Hill 1993
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Features of HFE 6

• A systems orientation and recognition that
  technologies, cultures, procedures, processes,
  environments, and people do not exist in
  isolation and that effective design must take
  into account the implication of their
  interactions

Adapted from Sanders, M. S., McCormick, E. J.
Human Factors Engineering and Design (7th ed.).
New York McGraw-Hill 1993
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What is human factors?

• A different way to view the world
• A potential resource for improving health care
• A framework to understand failed improvement
  efforts

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Implications

• HFE is a rich science
• It is tempting to dabble with HFE tools and
  methods without knowing what you are doing right
  or wrong

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Safety science view of systems
Safety is an EMERGENT property of systems Safety
depends on more than any one part but on their
interactions
Environment
Tools and Technology
Providers And Patients
Tasks
Organization
If you change any component or components you
will influence the other components and the
outcome of the system
University of Wisconsin-Madison SEIPS Systems
Model Redrawn with Permission
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Pediatric Implications of HFE

• Technologies and tools built with end user in
  mind
• Designs must accommodate individual difference
  and range of users
• Systems based approach
• Pediatric systems are indisputably different than
  adult systems

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Pediatric Implications of HFE

• Tools and technologies
• CPOE
• Bar coding
• Catheters and tubes
• Surgical Equipment
• Monitors

• Accommodate range of users
• Neonates to adults with pediatric diseases
• 500 grams to 100 Kg
• Weight-based dosing
• Bariatric surgery in a pediatric environment

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Pediatric Implications of HFE

• Remember the 5 elements of a system
• People (providers, patients)
• Tools and technology
• Tasks
• Environment
• Organization

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Final Thoughts

• HFE is a science with a rich evidence base which
  may help patient safety
• Challenge is learning and applying this science

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Questions and Comments

• Mscanlon_at_mcw.edu