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http://www2.fpm.wisc.edu/seips/

Ergonomics in Healthcare DeliveryPascale Carayon, Ph.D.

Center for Quality and Productivity ImprovementDepartment of Industrial and Systems Engineering

University of Wisconsin-Madison

email: carayon@engr.wisc.edu / tel: 608-265-0503

June 15-16, 2006 – Healthcare Systems Engineering Workshop

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HSE at University of Wisconsin-Madison! CHESS:

" Computer support system! CHSRA:

" Measurement of quality in long-term care! CQPI/SEIPS:

" Human factors engineering and systems engineering in patient safety

! Two ISyE faculty are IOM members.! AHRQ training grant (with Population Health Sciences)! Graduate certificate in patient safety! Interdisciplinary HSE courses (pharmacy, population

health sciences, medical physics)! Mentoring of physicians

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Ergonomics in Healthcare DeliveryResearch needs! Major issues facing health care and patient

safety:"Workload of healthcare providers"Medical errors and adverse events: identification,

management, review, recovery"Reliability of systems, processes and technologies"Patient safety in a variety of settings"Transitions of care"Medical devices and healthcare information technology

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- Work system and patient safety -SEIPS model (Carayon et al., 2003)

Bar Coding Medication AdministrationSmart IV Pump

CPOEEHR

SEIPS = Systems Engineering Initiative for Patient Safetyhttp://www2.fpm.wisc.edu/seips/

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Task sequences observed – BCMA medication administration

scan self

obtain meds

check med vs device

enter pt room

scan med

scan med

doc admin

double check

enter pt room

M (1)

give med to pt

scan pt ID band

doc admin

N (1)

give med to pt

scan pt ID band

enter pt room

scan med

scan pt ID

banddoc

admin

give medto pt

O (1)

scan med

check med vs device

enter pt room

scan ptID band

Q(1)

give med to pt

doc admin

P (1)

scan ptID band

D(22)

E (1)doc

admin

doc admin

give medto pt

give medto pt

F (17)

give medto patient

G(1)scan pt ID band

docadmin

I(1)doc

admin

H(2)

double check by RN

scan pt ID band

give med to pt

docadmin

J(1)

enter pt room

docadmin

give med to pt

K(2)

START

obtain meds

scan pt ID band

A(1)

give med to pt

docadmin

scan self enter pt room

check med vsdevice

scan med enter pt room

enter ptroom

scan ptID band

give medto pt

docadmin

B(1)

scan self

check medvs device

scan med

scan pt ID band

give med to

ptdoc

admin

C(2)

scan pt ID band

docadmin

enter pt room

L (1)

give med to pt

enter ptroom

scan pt ID band

doc admin

R (1)

give medto pt

1

9

3

2

5

4

7

6

8

02/04/2006

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Work system factors observed in BCMA medication administration

! Tasks:"Potentially unsafe med. admin.

! Person:"Patient in isolation

! Environment:"Messy, insufficient light

! Technology:"Automation surprises,

malfunctions! Organization:

" interruptions

Technologyand Tools

Organization

EnvironmentTasks

Person

Technologyand Tools

Organization

EnvironmentTasks

Person

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- Work system and patient safety -SEIPS model (Carayon et al., 2003)

Outpatient surgery

SEIPS = Systems Engineering Initiative for Patient Safetyhttp://www2.fpm.wisc.edu/seips/

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Outpatient surgery - Preoperative process

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Patient shadowing

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- Work system and patient safety -SEIPS model (Carayon et al., 2003)

SEIPS = Systems Engineering Initiative for Patient Safetyhttp://www2.fpm.wisc.edu/seips/

Inpatient carePediatric hospital

Outpatient surgeryPrimary careIntensive care

Medication safetyInfection controlQuality of care

Perceived quality/safety of care

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Study of ICU nurses

! 298 nurses from 17 ICUs of 7 hospitals located in Wisconsin

! Data collection between February and August 2004

! ICUs with different specialties (trauma, medical, surgical, cardiac, cardiothoracic, neurosurgery, burn, pediatric, neonatal)

! Overall response rate: 77% (ranging from 40% to 100%)

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0

20

40

60noise

distractions family

hectic work envt

crowded work envt

delay meds pharmacy

family needs

teaching familiesequipment unavailable

pt rooms not well-stocked

inadequate workspace

searching supplies

searching pt charts

many calls from families

delay seeing new orders

Technologyand Tools

Organization

EnvironmentTasks

Person

Technologyand Tools

Organization

EnvironmentTasks

Person

298 ICU nurses – 7 Wisconsin hospitalsPerformance obstacles at end of shift

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Lucian Leape in Ergonomics in Design – Summer’2004

!“Given the complexity of health care and the formidable obstacles it presents to change, to overcome those barriers and create a safe culture does indeed seem to

be the ultimate challenge for those who specialize in human factors.”

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Human Factors and Ergonomics

IEA [International Ergonomics Association] definition (www.iea.cc):"Ergonomics (or human factors) is the scientific discipline

concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.

Physical ergonomicsCognitive ergonomicsOrganizational ergonomics

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Ergonomics expertise in healthcare organizations

Employee health:occupational safety & health, ergonomics

Purchasing of equipment:usability

Quality improvement:

process analysis

Risk management:incident reporting, event

analysis

OR and critical care:teamwork,

communication

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Ergonomics in Healthcare DeliveryResearch needs! Major issues facing health care and patient

safety:"Workload of healthcare providers"Medical errors and adverse events: identification,

management, review, recovery"Reliability of systems, processes and technologies"Patient safety in a variety of settings"Transitions of care"Medical devices and healthcare information technology

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What kind of ergonomics/HSE research?

!Collaboration with healthcare researchers, professionals and organizations

!Remember the unique characteristics of healthcare:"Complexity"Criticality"People-intensiveness

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Probably the first (modern) study on medication errors…

… was conducted by Alphonse Chapanis (1960).

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Need for ergonomics (intervention) research…

…that will contribute to care that is:"safe"effective"patient-centered"timely"efficient"equitable