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?

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

• •

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
“Going solid” eg bed gridlock Tight coupling causes larger movements in operating point Compensation then decompensation

Shifting perception of boundary location

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

Levels and multiple disciplines needed for healthcare context.
Health System Government Regulators Board Health Service Admin Department Team Staff Patient and carers Roles Senior Health Adminstrators, Advisors, Academics Managers Clinicians Public with health issues Disciplines Political Science, Economics, Sociology, Epidemiology Management and organisational theory Medicine, Engineering, Human Factors, Consumer research

Use of Rasmussen’s model of risk management to analyse Walkerton E coli breakout. Woo & Vicente, Rel Eng
Sys Safety 2003;80:253-269

Complex couplings revealed between different levels of organisation Propagation of negative safety culture, ignorance of basic science.

Cognitive Engineering
The systems viewpoint
• For CREPS, Rasmussen model of risk management guides development of research programs and role of human factors engineering Extension to cycles of investigate intervene evaluate where each step occurs at one or more levels of the model.
(Re)definition of problem (Re)definition of intervention 1. Identify problem
Government Regulators Board Hlth Svc Admin Department Team Staff Patient

6. Post-translation evaluation

2. Investigate problem
Government Regulators Board Hlth Svc Admin Department Team Staff Patient

3. Propose intervention
Government Regulators Board Hlth Svc Admin Department Team Staff Patient

4. Test intervention
Government Regulators Board Hlth Svc Admin Department Team Staff Patient

5. Translate to practice
Government Regulators Board Hlth Svc Admin Department Team Staff Patient

Cognitive Engineering
The systems viewpoint
Benchmark and track Prior research outcomes (Re)definitionof problem Targeted video data (Re)definitionof intervention collection and analysis

6

Outcome measurement

Resuscitation
Government Regulators Board Hlth Svc Admin Department Team Staff Patient

1c Identify problem 1b 1a
Trauma registry data

2a Investigate problem 2b

Propose intervention 3

Test intervention 4a 4b

Translate Introduce into practice 5
Change embodied in ED

Resuscitation video records

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

Construct a framework for effective intervention Think about vertical connections while at each step.
Benchmark and track

Medication errors

6
(Re)definitionof problem In vitro study to confirm observations (Re)definitionof intervention

Prior research outcomes

Outcome measurement

1a Identify problem 1b
Incident reports (local)

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

Based partly in industrial engineering
– Task and work analysis; workflow models – Operations research and systems integration

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 Senior Health Adminstrators, Advisors, Academics Managers Clinicians Public with health issues Disciplines Political Science, Economics, Sociology, Epidemiology Management and organisational theory 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
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

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.

Design

Fidelity

$
Spartan lab Clinical

Control

Fidelity

$$

Control

Usability lab

Many further trajectories exist

Full scale simulator

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
14%


OX

TE
57% 57% 14%

21%


36%

CV
29% 27%

PF
57% 57% 21% 21%

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

IN VN
36%

PE
14%

Latent failure: overconfident identification?

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

END

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