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

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

Shifting perception of
Knowledge of
boundary location
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 Roles Disciplines

Government Senior Health Political Science,
Regulators Adminstrators, Advisors, Economics, Sociology,
Board Academics Epidemiology
Health Service Admin Management and
Managers organisational theory
Department
Team Medicine, Engineering,
Clinicians
Staff Human Factors,
Patient and carers Public with health issues 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 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 2. Investigate 3. Propose 4. Test 5. Translate

problem problem intervention intervention to practice
Government Government Government Government Government
Regulators Regulators Regulators Regulators Regulators
Board Board Board Board Board
Hlth Svc Admin Hlth Svc Admin Hlth Svc Admin Hlth Svc Admin Hlth Svc Admin
Department Department Department Department Department
Team Team Team Team Team
Staff Staff Staff Staff Staff
Patient Patient Patient Patient Patient
 Cognitive Engineering
The systems viewpoint
Benchmark and track
(Re)definitionof problem 6 Outcome
Prior research Targeted video data (Re)definitionof intervention measurement
outcomes collection and
analysis
1c 2a
Resuscitation Identify Investigate Propose Test Translate
Introduce
problem problem intervention intervention into practice
1a 1b 2b 3 4a 4b 5
Government
Trauma Resuscitation Controlled simulated Design intervention(s) Change tested Change tested Change
Regulators
registry data video records resuscitations to to address causal in controlled in clinical embodied in
Board isolate causal factors factors simulated resuscitations ED
Hlth Svc Admin resuscitations
Department
Team
Staff
Patient Construct a framework for effective intervention
Think about vertical connections while at each step.
Benchmark and track
6
Medication Prior research
(Re)definitionof problem Outcome
measurement
In vitro study to (Re)definitionof intervention
errors outcomes confirm observations
1a 2b
Identify Investigate Propose Test Translate
Introduce
problem problem intervention intervention into practice
1b 2a 3 4a 4b 5
Incident Observations of Change(s) that might In vitro study to Clinical trials Change implemented
reports (local) infusion pump solve problem, and test effect of of intervention in ICU
management and their location on risk proposed
effects of distraction management model 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 Roles Disciplines

Government Senior Health Political Science,
Regulators Adminstrators, Advisors, Economics, Sociology,
Board Academics Epidemiology
Health Service Admin Management and
Managers organisational theory
Department
Team Medicine, Engineering,
Clinicians
Staff Human Factors,
Patient and carers Public with health issues Consumer research
 Human factors engineering
Focus and skills

Device design and

• Design of behavioural experiments evaluation (PDAs,
– Narrow or broad focus HMDs, syringes,
– Laboratory, field, simulator contexts pumps, checklists…)

– Counterbalancing, control, non-reactive

measurement, etc
• 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, Video-
Cued 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

Fidelity
$

Spartan
Clinical
Control lab Control

Usability Full scale

lab Many further simulator
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 • IEC 60601-1-8 (Aug 2005)

14%

TE 21% OX melodic alarms

57% • Proportion of nurses who
57% 36%
14%
showed a confusion more
CV PF than 25% of the time
29% Lacherez et al 2005; submitted
57%
27% 57% • Latent failure: overconfident
IN 21% PE identification?
21%

VN 14%
36%

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