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Gazza C, Marcilly R, Kovacs B, Schiro J, Pelayo S. Integration of a new technology into a work system: a case study of a smart drinking glass in French nursing homes. Disabil Rehabil Assist Technol 2024; 19:1249-1261. [PMID: 36622869 DOI: 10.1080/17483107.2022.2162612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 09/04/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE To reduce the risk of dehydration in older adults, the French company Auxivia has developed a smart drinking glass (SDG) that can measure the amount of water drunk. The present study looked at the various work systems (WSs) designed for use of the SDG in a nursing home. The study's objectives were to (i) determine the WSs' impact on the staff's ability to comply with the device's prerequisites and ensure the device's effective use and (ii) draw up guidelines on designing work systems. MATERIALS AND METHODS At three nursing homes in France, two independent observers performed 9 h of observations at each site and a total of 29 interviews. RESULTS Decisions concerning implementation and the resulting WSs have an impact on the tasks to be performed, the tasks' inherent constraints and the use of the SDG. It is essential to take account of the sociotechnical system as a whole before integrating a technology. Ideally, the introduction of an SDG will go unnoticed by staff and residents; however, our results emphasize the value of highlighting work constraints via a human factors analysis. CONCLUSIONS It is essential to take account of sociotechnical WSs as a whole when integrating a technology.
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Affiliation(s)
- Clément Gazza
- Univ. Lille, Inserm, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
- Inserm, CIC 1403 - Centre d'investigation clinique, Lille, France
- CHU Lille, CIC 1403, Lille, France
| | - Romaric Marcilly
- Univ. Lille, Inserm, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
- Inserm, CIC 1403 - Centre d'investigation clinique, Lille, France
- CHU Lille, CIC 1403, Lille, France
| | | | - Jessica Schiro
- Univ. Lille, Inserm, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
- Inserm, CIC 1403 - Centre d'investigation clinique, Lille, France
- CHU Lille, CIC 1403, Lille, France
| | - Sylvia Pelayo
- Univ. Lille, Inserm, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
- Inserm, CIC 1403 - Centre d'investigation clinique, Lille, France
- CHU Lille, CIC 1403, Lille, France
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Wust KL, Carayon P, Werner NE, Hoonakker PLT, Salwei ME, Rutkowski R, Barton HJ, Dail PVW, King B, Patterson BW, Pulia MS, Shah MN, Smith M. Older Adult Patients and Care Partners as Knowledge Brokers in Fragmented Health Care. Hum Factors 2024; 66:701-713. [PMID: 35549738 PMCID: PMC10402098 DOI: 10.1177/00187208221092847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe older adult patients' and care partners' knowledge broker roles during emergency department (ED) visits. BACKGROUND Older adult patients are vulnerable to communication and coordination challenges during an ED visit, which can be exacerbated by the time and resource constrained ED environment. Yet, as a constant throughout the patient journey, patients and care partners can act as an information conduit, or knowledge broker, between fragmented care systems to attain high-quality, safe care. METHODS Participants included 14 older adult patients (≥ 65 years old) and their care partners (e.g., spouse, adult child) who presented to the ED after having experienced a fall. Human factors researchers collected observation data from patients, care partners and clinician interactions during the patient's ED visit. We used an inductive content analysis to determine the role of patients and care partners as knowledge brokers. RESULTS We found that patients and care partners act as knowledge brokers by providing information about diagnostic testing, medications, the patient's health history, and care accommodations at the disposition location. Patients and care partners filled the role of knowledge broker proactively (i.e. offer information) and reactively (i.e. are asked to provide information by clinicians or staff), within-ED work system and across work systems (e.g., between the ED and hospital), and in anticipation of future knowledge brokering. CONCLUSION Patients and care partners, acting as knowledge brokers, often fill gaps in communication and participate in care coordination that assists in mitigating health care fragmentation.
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Affiliation(s)
| | | | | | | | - Megan E Salwei
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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Zayas-Cabán T, Valdez RS, Samarth A. Automation in health care: the need for an ergonomics-based approach. Ergonomics 2023; 66:1768-1781. [PMID: 38165841 PMCID: PMC10838176 DOI: 10.1080/00140139.2023.2286915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/17/2023] [Indexed: 01/04/2024]
Abstract
Healthcare quality and efficiency challenges degrade outcomes and burden multiple stakeholders. Workforce shortage, burnout, and complexity of workflows necessitate effective support for patients and providers. There is interest in employing automation, or the use of 'computer[s] [to] carry out… functions that the human operator would normally perform', in health care to improve delivery of services. However, unique aspects of health care require analysis of workflows across several domains and an understanding of the ways work system factors interact to shape those workflows. Ergonomics has identified key work system issues relevant to effective automation in other industries. Understanding these issues in health care can direct opportunities for the effective use of automation in health care. This article illustrates work system considerations using two example workflows; discusses how those considerations may inform solution design, implementation, and use; and provides future directions to advance the essential role of ergonomics in healthcare automation.
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Affiliation(s)
- Teresa Zayas-Cabán
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Rupa S Valdez
- Department of Public Health Sciences and Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA, USA
| | - Anita Samarth
- Clinovations Government + Health, Washington, DC, USA
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Cajander N, Reiman A, Tappura S. Occupational safety and health and temporary agency work in multiemployer restaurants. Work 2023:WOR220033. [PMID: 36710697 DOI: 10.3233/wor-220033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Current occupational safety and health (OSH) literature calls for sociotechnical, system-level approaches that increase understanding of the underlying reasons for insufficient OSH performance in non-standard employment that is associated with lower labour and social security protection when compared with traditional forms of work. OBJECTIVE This study focused on temporary agency work (TAW) which is a central form of nonstandard employment. The objective was to explore OSH issues in temporary agency work (TAW) in small and medium -sized multiemployer restaurants in Finland and discuss the issues from the perspectives of the agency worker, user company and agency. METHODS A directed content analysis method was used to examine the data obtained from semi-structured interviews (n = 20) with agency workers, restaurant managers and experts representing the temporary work agencies, a pension insurer, and a labour union. The balanced work system theory was used as a framework for this qualitative analysis. RESULTS A variety of OSH risks and hazards in TAW were identified. In addition, the complexity of OSH management was highlighted in this triangular employment relationship between the agency worker, the user company, and the agency. CONCLUSION This study reveals problems related to OSH in TAW. Restaurants are entities separate from agencies, so establishing and adhering to a common process of OSH management is not simple.
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Affiliation(s)
- Niko Cajander
- Industrial Engineering and Management, University of Oulu, Oulu, Finland
| | - A Reiman
- Industrial Engineering and Management, University of Oulu, Oulu, Finland
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5
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Jewer J. Investigating a Work System Approach to Implement an Emergency Department Surge Management System: Case Study. J Med Internet Res 2022; 24:e37472. [PMID: 36006684 PMCID: PMC9459829 DOI: 10.2196/37472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/13/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Emergency department (ED) crowding is a global health care issue. eHealth systems have the potential to reduce crowding; however, the true benefits are seldom realized because the systems are not integrated into clinicians' work. We sought a deep understanding of how an eHealth system implementation can be structured to truly integrate the system into the workflow. OBJECTIVE The specific objectives of this study were to examine whether work system theory (WST) is a good approach to structure the implementation of an eHealth system by incorporating the entire work system, and not just the eHealth system, in the implementation framework; identify the role that specific elements of WST's static framework and dynamic work system life cycle model play in the implementation; and demonstrate how WST can be applied in the health care setting to guide the implementation of an eHealth system. METHODS Through a case study of an ED in a rural hospital, we used a mixed methods approach to examine the implementation of a surge management system through the lens of WST. We conducted 14 hours of observation in the ED; 20 interviews with clinicians, management, and members of the implementation team; and a survey of 23 clinicians; reviewed related documentation; and analyzed ED data to measure wait times. We used template analysis based on WST to structure our analysis of qualitative data and descriptive statistics for quantitative data. RESULTS The surge management system helped to reduce crowding in the ED, staff was satisfied with the implementation, and wait time improvements have been maintained for several years. Although study participants indicated changes to their workflow, 72% (13/18) of survey participants were satisfied with their use of the system, and 82% (14/17) indicated that it was integrated with their workflow. Examining the implementation through the lens of WST enabled us to identify the aspects of the implementation that made it so successful. By applying the WST static framework, we saw how the implementation team incorporated the elements of the ED work system, assessed their alignment, and designed interventions to address areas of misalignment. The dynamic work system life cycle model captured how planned and unplanned changes were managed throughout the iterative implementation cycle-83% (15/18) of participants indicated that there was sufficient management support for the changes and 80% (16/20) indicated the change served an important purpose. CONCLUSIONS The broad scope and holistic approach of WST is well suited to guide eHealth system implementations as it focuses efforts on the entire work system and not just the IT artifact. We broaden the focus of WST by applying it to the implementation of an ED surge management system. These findings will guide further studies and implementations of eHealth systems using WST.
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Affiliation(s)
- Jennifer Jewer
- Faculty of Business Administration, Memorial University of Newfoundland, St. John's, NL, Canada.,Cross-appointed, Discipline of Emergency Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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6
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Edwards Iii GF, Zagarese V, Tulk Jesso S, Jesso M, Harden SM, Parker SH. Designing healthcare for human use: Human factors and practical considerations for the translational process. Front Health Serv 2022; 2:981450. [PMID: 36925891 PMCID: PMC10012824 DOI: 10.3389/frhs.2022.981450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
In recent years, the focus of implementation science (IS) shifted to emphasize the influence of contextual factors on intervention adaptations in clinical, community, and corporate settings. Each of these settings represent a unique work system with varying contexts that influence human capabilities, needs, and performance (otherwise known as "human factors"). The ease of human interaction with a work system or an intervention is imperative to IS outcomes, particularly adoption, implementation, and maintenance. Both scientific approaches consider the "big picture" when designing interventions for users and stakeholders to improve work and health outcomes. IS and human factors are therefore complementary in nature. In this paper, the authors will (1) provide perspective on the synergistic relationship between human factors and IS using two illustrative and applied cases and (2) outline practical considerations for human factors-based strategies to identify contextual factors that influence intervention adoption, implementation, and maintenance dimensions of the RE-AIM framework. This article expands on recent research that developed user- and human-centered design strategies for IS scientists to use. However, defining the complementary relationship between IS and human factors is a necessary and valuable step in maximizing the effectiveness of IS to transform healthcare. While IS can complement practitioners' identification of intervention adaptations, human interaction is a process in the work system often overlooked throughout implementation. Further work is needed to address the influence that organizational endorsement and trust have on intervention adaptations and their translation into the work system.
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Affiliation(s)
- G Franklin Edwards Iii
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Blacksburg, VA, United States
| | - Vivian Zagarese
- Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | - Stephanie Tulk Jesso
- Systems Science and Industrial Engineering, SUNY Binghamton University, Vestal, NY, United States
| | - Matthew Jesso
- Human Factors, Carilion Clinic, Roanoke, VA, United States
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Sarah Henrickson Parker
- Human Factors, Carilion Clinic, Roanoke, VA, United States.,Department of Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States.,Fralin Biomedical Research Institute at VTC, Roanoke, VA, United States
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7
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Werner NE, Ponnala S, Doutcheva N, Holden RJ. Human factors/ergonomics work system analysis of patient work: state of the science and future directions. Int J Qual Health Care 2021; 33:60-71. [PMID: 33432984 DOI: 10.1093/intqhc/mzaa099] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To demonstrate the use and value of the Human Factors/Ergonomics-based Systems Engineering Initiative for Patient Safety (SEIPS) family of work system models for studying and improving patient work. DATA SOURCES We conducted a review of the published empirical literature applying the SEIPS family of work system models for patient work. STUDY SELECTION Included studies had to apply one of the SEIPS family of work system models to study patient work; be published in a peer-reviewed journal in English and include analysis of data. We identified 16 articles that met our inclusion criteria. DATA EXTRACTION For each study, we extracted settings and situations in which models were applied; research design; study methods; model(s) used; type and number of study participants; study objective(s); whether the study included an intervention; specific aspects of the model used; knowledge generated about patient work and benefits of using the models. RESULTS OF DATA SYNTHESIS Our analysis revealed that a majority of studies were conducted in the United States, used qualitative or mixed methods and employed a variety of data collection techniques to study adult patient populations with chronic illness and their informal caregivers and healthcare providers performing patient work in the home and clinical setting. The studies resulted in a variety of useful products, demonstrating several benefits of using the models. CONCLUSION Our review has demonstrated the value of using the SEIPS family of work systems models to study and improve patient and family contributions to health-related work.
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Affiliation(s)
| | - Siddarth Ponnala
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Nadia Doutcheva
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
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8
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Fouquet SD, Fitzmaurice L, Chan YR, Palmer EM. Doctors documenting: an ethnographic and informatics approach to understanding attending physician documentation in the pediatric emergency department. J Am Med Inform Assoc 2021; 28:239-248. [PMID: 33175154 DOI: 10.1093/jamia/ocaa252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The pediatric emergency department is a highly complex and evolving environment. Despite the fact that physicians spend a majority of their time on documentation, little research has examined the role of documentation in provider workflow. The aim of this study is to examine the task of attending physician documentation workflow using a mixed-methods approach including focused ethnography, informatics, and the Systems Engineering Initiative for Patient Safety (SEIPS) model as a theoretical framework. MATERIALS AND METHODS In a 2-part study, we conducted a hierarchical task analysis of patient flow, followed by a survey of documenting ED providers. The second phase of the study included focused ethnographic observations of ED attendings which included measuring interruptions, time and motion, documentation locations, and qualitative field notes. This was followed by analysis of documentation data from the electronic medical record system. RESULTS Overall attending physicians reported low ratings of documentation satisfaction; satisfaction after each shift was associated with busyness and resident completion. Documentation occurred primarily in the provider workrooms, however strategies such as bedside documentation, dictation, and multitasking with residents were observed. Residents interrupted attendings more often but also completed more documentation actions in the electronic medical record. DISCUSSION Our findings demonstrate that complex work processes such as documentation, cannot be measured with 1 single data point or statistical analysis but rather a combination of data gathered from observations, surveys, comments, and thematic analyses. CONCLUSION Utilizing a sociotechnical systems framework and a mixed-methods approach, this study provides a holistic picture of documentation workflow. This approach provides a valuable foundation not only for researchers approaching complex healthcare systems but also for hospitals who are considering implementing large health information technology projects.
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Affiliation(s)
- Sarah D Fouquet
- Human Factors Collaborative, Children's Mercy Hospital Kansas City, Kansas City, Missouri, USA.,Department of Biomedical and Health Informatics, University of Missouri, Kansas City, Missouri, USA
| | - Laura Fitzmaurice
- Department of Emergency Medicine, Children's Mercy Hospital Kansas City, Kansas City, Missouri, USA
| | - Y Raymond Chan
- Human Factors Collaborative, Children's Mercy Hospital Kansas City, Kansas City, Missouri, USA.,Division of Hospital Medicine, Children's Mercy Hospital Kansas City, Kansas City, Missouri, USA.,Department of Pediatrics, University of Missouri, Kansas City, Missouri, USA
| | - Evan M Palmer
- Department of Psychology, San José State University, San José, California, USA
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Kekkonen P, Reiman A. Schools and kindergartens as shared workplaces: An analysis of the work ability management challenges of the meal and cleaning service employees. Work 2020; 64:161-173. [PMID: 31450528 DOI: 10.3233/wor-192966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Service organizations and their employees encounter challenges today due to an increase in the average age of employees, a decrease in recruitment, and changes in work tasks, sites, and communities. These factors give rise to physical and psychosocial burdens that can lower the work ability and productivity of the employees. OBJECTIVE The goal of this study is to find practical solutions for challenges related to the work environment and practices at a public in-house enterprise providing meal and cleaning services. Also, the design of a model for the management of these load factors at municipal workplaces, where stakeholders from different subdivisions work together, is intended. METHODS The materials comprised of documents provided by the case organization, interviews, and work observations. Root cause analysis and participatory development sessions were carried out to find causes for the observed challenges and to discover practical solutions. RESULTS A number of microergonomic solutions were found. Also, broader subjects for development, common to several target workplaces, were discovered. CONCLUSIONS The concept of a shared workplace, proved useful in exploring ways to manage work ability and productivity. A generalizable macroergonomics model for the management of load factors at shared workplaces in the public sector was proposed.
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Affiliation(s)
- Päivi Kekkonen
- Industrial Engineering and Management, University of Oulu, Finland
| | - Arto Reiman
- Industrial Engineering and Management, University of Oulu, Finland
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10
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Kekkonen P, Reiman A, Väyrynen S, Rajala HK. Occupational safety and health in shared workplaces according to workplace inspection reports. Int J Occup Saf Ergon 2019; 27:504-516. [PMID: 30932739 DOI: 10.1080/10803548.2019.1600314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to create a holistic view of shared workplaces and the ways in which these 'special situations' for organizing work take place in practice. The characteristics of shared workplaces and the associated phenomena and challenges were also points of interest. Occupational safety and health inspection reports (N = 200) from the Regional State Administrative Agency of Finland were analysed to obtain information on the deficiencies observed in shared workplaces. The observations were categorized, and the categories were linked to the elements in the work system model. Thus, observation profiles for shared workplaces in the construction, manufacturing and mining and quarrying industries were created. In the observation profiles, significant differences were identified between two or more industries in terms of deficiencies related to organization, employee, task, tools and technology as well as work environment, i.e., the elements comprising the work system model.
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Affiliation(s)
- Päivi Kekkonen
- Industrial Engineering and Management, University of Oulu, Finland
| | - Arto Reiman
- Industrial Engineering and Management, University of Oulu, Finland
| | - Seppo Väyrynen
- Industrial Engineering and Management, University of Oulu, Finland
| | - Hanna-Kaisa Rajala
- Occupational Safety and Health Section, Regional State Administrative Agency of Northern Finland, Finland
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11
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Bayramzadeh S, Portillo M, Carmel-Gilfilen C. Understanding Design Vulnerabilities in the Physical Environment Relating to Patient Fall Patterns in a Psychiatric Hospital: Seven Years of Sentinel Events. J Am Psychiatr Nurses Assoc 2019; 25:134-145. [PMID: 29788771 DOI: 10.1177/1078390318776086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The influence of the physical environment on patient falls has not been fully explored in psychiatric units, despite this patient population's vulnerability and the critical role of the physical environment in patient safety. AIMS The research objective is to describe the spatial and temporal pattern of falls occurrences and their location in relation to the levels of safety continuum model. METHOD This article presents an exploratory case study design. Seven years of retrospective data on patient falls, yielding 818 sentinel events, in an 81-bed psychiatric hospital in the United States were collected and analyzed. Data focused on extrinsic factors for falls, emphasizing the physical environment. Through a content analysis of the sentinel event narratives, recorded by the hospital staff, this study explored patient falls related to location and elements of the physical environment. RESULTS The analysis revealed that 15% of recorded falls were attributed to some aspect of or element within the physical environment. The most typical locations of falls were patient rooms (39%), patient bathrooms (22%), and dayrooms (20%). Also, the results identified patterns of environmental factors that appeared linked to increasing patients' susceptibility to falls. Risk factors included poor nighttime lighting, flooring surfaces that were uneven, and spaces that inadvertently limited visual access and supervision. CONCLUSIONS The physical environment plays an often-unexamined role in fall events and specific locations. These results are deserving of further research on design strategies and applications to reduce patient falls in psychiatric hospital settings.
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Affiliation(s)
| | - Margaret Portillo
- 2 Margaret Portillo, PhD, University of Florida, Gainesville, FL, USA
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12
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Gorman RK, Wellbeloved-Stone CA, Valdez RS. Uncovering the invisible patient work system through a case study of breast cancer self-management. Ergonomics 2018; 61:1575-1590. [PMID: 30044709 DOI: 10.1080/00140139.2018.1503339] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/11/2018] [Accepted: 07/18/2018] [Indexed: 06/08/2023]
Abstract
As patients transition from passive recipients to actors in their health management, there is an opportunity to enhance theoretical frameworks describing the patient work system. Previous macroergonomic frameworks depict how patients manage health outside the institutional healthcare system, though none formally integrate the concept of invisible work - self-management practices undervalued or unseen by healthcare providers. This article overlays invisible work onto the patient work system through a case study of breast cancer self-management. Thirty breast cancer survivors were interviewed about positive and negative experiences post-diagnosis. Invisible and visible components of participants' work systems were explicated through qualitative content analysis. The results demonstrate that all participants had invisible work system components, and based on these findings, this article theorises the existence of an 'invisible patient work system.' Future research and design to support self-management practices should explicitly address the invisible characteristics of the work systems in which patients are embedded.Practitioner Summary: This article seeks to enhance the healthcare human factors literature by integrating the concept of invisible work into preexisting patient work system models. Through a secondary analysis of an interview study with 30 breast cancer survivors, we found that all participants recalled invisible components of their respective work systems. Abbreviations CHIT Consumer Health Information Technology SEIPS Systems Engineering Initiative for Patient Safety IRB Institutional Review Board SES Socioeconomic Status mHealth Mobile Health PHR Patient Health Record ICAN Instrument for Patient Capacity Assessment HIPAA Health Insurance Portability and Accoutability Act.
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Affiliation(s)
- Ryan K Gorman
- a Department of Public Health Sciences , University of Virginia , Charlottesville , VA , USA
| | | | - Rupa S Valdez
- a Department of Public Health Sciences , University of Virginia , Charlottesville , VA , USA
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Alyousef B, Carayon P, Hoonakker P, Hundt AS, Salek D, Tomcavage J. Obstacles Experienced by Care Managers in Managing Information for the Care of Chronically Ill Patients. Int J Hum Comput Interact 2017; 33:313-321. [PMID: 31186604 PMCID: PMC6557451 DOI: 10.1080/10447318.2016.1270017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Care managers play a key role in coordinating care, especially for patients with chronic conditions. They use multiple health information technology application in order to access, process and communicate patient-related information. Using the work system model and its extension, the SEIPS model (Carayon et al., 2006a; Smith and Carayon-Sainfort, 1989), we describe obstacles experienced by care manager in managing patient-related information. A web-based questionnaire was used to collect data from 80 care managers (61% response rate) located in clinics, hospitals and a call center. Care managers were more likely to consider 'inefficiencies in access to patient-related information' and 'having to use multiple information systems' as major obstacles than 'lack of computer training and support' and 'inefficient use of case management software.' Care managers who reported inefficient use of software as an obstacle were more likely to report high workload. Future research should explore strategies used by care managers' to address obstacles, and efforts should be targeted at improving the health information technologies used by care managers.
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Affiliation(s)
| | - Pascale Carayon
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
| | - Ann Schoofs Hundt
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
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Abstract
BACKGROUND Heavy mining vehicle operators at arctic mines have a high risk of discomfort, musculoskeletal disorders and occupational accidents. There is a need for tailored approaches and safety management tools that take into account the specific characteristics of arctic work environments. OBJECTIVE The aim of this study was to develop a holistic evaluation tool for heavy mining vehicles and operator well-being in arctic mine environments. METHODS Data collection was based on design science principles and included literature review, expert observations and participatory ergonomic sessions. RESULTS As a result of this study, a systemic checklist was developed and tested by eight individuals in a 350-employee mining environment. CONCLUSIONS The checklist includes sections for evaluating vehicle specific ergonomic and safety aspects from a technological point of view and for checking if the work has been arranged so that it can be performed safely and fluently from an employee's point of view.
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Affiliation(s)
- Arto Reiman
- Finnish Institute of Occupational Health, Helsinki, Finland.,University of Oulu, Oulu, Finland
| | - Erja Sormunen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Drew Morris
- Finnish Institute of Occupational Health, Helsinki, Finland.,Clemson University, Department of Psychology, Clemson, SC, USA
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Holden RJ, Carayon P, Gurses AP, Hoonakker P, Hundt AS, Ozok AA, Rivera-Rodriguez AJ. SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics 2013; 56:1669-86. [PMID: 24088063 PMCID: PMC3835697 DOI: 10.1080/00140139.2013.838643] [Citation(s) in RCA: 572] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Healthcare practitioners, patient safety leaders, educators and researchers increasingly recognise the value of human factors/ergonomics and make use of the discipline's person-centred models of sociotechnical systems. This paper first reviews one of the most widely used healthcare human factors systems models, the Systems Engineering Initiative for Patient Safety (SEIPS) model, and then introduces an extended model, 'SEIPS 2.0'. SEIPS 2.0 incorporates three novel concepts into the original model: configuration, engagement and adaptation. The concept of configuration highlights the dynamic, hierarchical and interactive properties of sociotechnical systems, making it possible to depict how health-related performance is shaped at 'a moment in time'. Engagement conveys that various individuals and teams can perform health-related activities separately and collaboratively. Engaged individuals often include patients, family caregivers and other non-professionals. Adaptation is introduced as a feedback mechanism that explains how dynamic systems evolve in planned and unplanned ways. Key implications and future directions for human factors research in healthcare are discussed.
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Affiliation(s)
- Richard J. Holden
- Assistant Professor, Department of Medicine, Division of General Internal Medicine & Public Health, Department of Biomedical Informatics Vanderbilt University School of Medicine, Phone: +1-615-936-4343, Fax: +1-615-936-7373, Center for Research and Innovation in Systems Safety, 719 Medical Arts Building, 1211 21st Avenue S, Nashville, TN, 37212
| | - Pascale Carayon
- Procter & Gamble Bascom Professor in Total Quality, Department of Industrial and Systems Engineering, Director of the Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3126 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706 - USA, tel: +1-608-265-0503 or +1-608-263-2520, fax: +1-608-263-1425
| | - Ayse P. Gurses
- Associate Professor, Armstrong Institute for Patient Safety and Quality, Department of Anesthesiology and Critical Care Medicine, Division of Health Sciences Informatics, School of Medicine, Department of Health Policy and Management, Bloomberg School of Public Health, Department of Civil Engineering, Whiting School of Engineering, The Johns Hopkins University, 750 E. Pratt St. 15Floor, Baltimore, MD 21202, Phone: +1-410-637-4387
| | - Peter Hoonakker
- Research Scientist and Associate Director of Research, Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3132 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706 – USA, Phone: +1-608-658 0837, Fax: +1-608-263-1425
| | - Ann Schoofs Hundt
- Associate Scientist and Associate Director of Education, Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3132 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706 – USA, Phone: +1-608-262-9100, Fax: +1-608-263-1425
| | - A. Ant Ozok
- Associate Professor, Department of Information Systems, UMBC, Adjunct Associate Professor, Department of Anesthesiology, Visiting Associate Professor, The Armstrong Institute of Patient Safety and Quality, School of Medicine, The Johns Hopkins University, 1000 Hilltop Circle, Baltimore, MD 21250, Phone : +1-410-455-8627, Fax : +1-410-455-1073
| | - A. Joy Rivera-Rodriguez
- Assistant Professor, Department of Industrial Engineering, Clemson University, Phone: +1-864-656-3114, Fax: +1-864-656-0795, 130-C Freeman Hall, Box 340920 Clemson, SC 29631
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16
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Carayon P, Karsh BT, Gurses AP, Holden R, Hoonakker P, Hundt AS, Montague E, Rodriguez J, Wetterneck TB. Macroergonomics in Healthcare Quality and Patient Safety. Rev Hum Factors Ergon 2013; 8:4-54. [PMID: 24729777 PMCID: PMC3981462 DOI: 10.1177/1557234x13492976] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The US Institute of Medicine and healthcare experts have called for new approaches to manage healthcare quality problems. In this chapter, we focus on macroergonomics, a branch of human factors and ergonomics that is based on the systems approach and considers the organizational and sociotechnical context of work activities and processes. Selected macroergonomic approaches to healthcare quality and patient safety are described such as the SEIPS model of work system and patient safety and the model of healthcare professional performance. Focused reviews on job stress and burnout, workload, interruptions, patient-centered care, health IT and medical devices, violations, and care coordination provide examples of macroergonomics contributions to healthcare quality and patient safety. Healthcare systems and processes clearly need to be systematically redesigned; examples of macroergonomic approaches, principles and methods for healthcare system redesign are described. Further research linking macroergonomics and care processes/patient outcomes is needed. Other needs for macroergonomics research are highlighted, including understanding the link between worker outcomes (e.g., safety and well-being) and patient outcomes (e.g., patient safety), and macroergonomics of patient-centered care and care coordination.
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Affiliation(s)
- Pascale Carayon
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Ben-Tzion Karsh
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Ayse P Gurses
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Richard Holden
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Peter Hoonakker
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Ann Schoofs Hundt
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Enid Montague
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Joy Rodriguez
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Tosha B Wetterneck
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
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Or CK, Valdez RS, Casper GR, Carayon P, Burke LJ, Brennan PF, Karsh BT. Human factors and ergonomics in home care: Current concerns and future considerations for health information technology. Work 2009; 33:201-9. [PMID: 19713630 PMCID: PMC2819983 DOI: 10.3233/wor-2009-0867] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home dwelling patient, that can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-monitoring and self-management. Currently, a variety of health information technologies (HITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This paper reviews the HFE considerations for information access, communication, and patients self-monitoring and self-management, discusses how HIT can potentially mitigate current problems, and explains how the design and implementation of HIT itself requires careful HFE attention.
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Affiliation(s)
- Calvin K.L. Or
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
| | - Rupa S. Valdez
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
| | - Gail R. Casper
- School of Nursing, University of Wisconsin-Madison, Wisconsin, USA
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
| | | | - Patricia Flatley Brennan
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
- School of Nursing, University of Wisconsin-Madison, Wisconsin, USA
| | - Ben-Tzion Karsh
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Wisconsin, USA
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