Human Factors & Ergonomics: A J ourney in Improving Care

1. Human Factors & Ergonomics:A Journey in Improving Care Professor Sue Hignett S.M.Hignett@lboro.ac.uk

2. Alternative title….Patient Handling Silos or Systems?

3. Ergonomics in Healthcare • Occupational Ergonomics - Risks relating to Musculoskeletal Disorder (MSD) exposure • Design for Patient Safety - Ergonomics principles in medical device development • Organisational and socio-technical systems - Integrating safety for EVERYONE (workers and patients)

4. Ergonomics in Healthcare • Occupational Ergonomics - Risks relating to Musculoskeletal Disorder (MSD) exposure • Design for Patient Safety - Ergonomics principles in medical device development • Organisational and socio-technical systems - Integrating safety for EVERYONE (workers and patients)

5. 1. Occupational Ergonomics Patient handling: What works??? • In the 1980s and 1990s the focus of research was mostly epidemiological with repeated studies finding that nurses were at risk of back pain • Hignett S (1996) Work-related back pain in nurses Journal of Advanced Nursing. 23, 1238-1246 • The main response to this finding from the healthcare industry was technique training, with many programmes being developed and marketed • Hignett, S. and Crumpton, E. (2007) Competency-based education for patient handling Applied Ergonomics, 38, 7-17

6. Patient handling: 2000s • A systematic review on patient handling in 2003 found that interventions based on technique training had NO impact on working practices or injury rates • Hignett, S., Crumpton, E., Alexander, P., Ruszala, S., Fray, M. and Fletcher, B. (2003). Evidence-Based Patient Handling: Tasks, Equipment and Interventions. London: Routledge Apply Ergonomics principles to change the work, not the worker……

7. Hospital Ergonomics: does it work? Multi-factorial • Strategy for Manual Handling risk management • Problem solving training (assess and reduce the risk) • Ergonomic advice on equipment purchase & building design Outcome measures • Incident Reports • Sickness Absence • Risk Reduction Hignett S. (2001). Embedding ergonomics in hospital culture: top-down and bottom-up strategies. Applied Ergonomics. 32, 61-69 Hignett S. (2001). Embedding ergonomics in hospital culture: top-down and bottom-up strategies. Applied Ergonomics. 32, 61-69

8. Organisational Outcome Measures Manual Handling Incident Reports Completed Risk Actions Musculoskeletal Sickness Absence Savings over 3 years £3.5 million

9. Ergonomics in Healthcare • Occupational Ergonomics - Risks relating to Musculoskeletal Disorder (MSD) exposure • Design for Patient Safety - Ergonomics principles in medical device development • Organisational and socio-technical systems - Integrating safety for EVERYONE (workers and patients)

10. 2. Safety for Patients (Leape, 2012) USA How has healthcare gone so wrong??? At least 10% of patient admissions may result in some form of harm

11. ‘First, do no NET harm’ (Sokol, 2013)

12. Reflections of a Patient Safety Expert (Wears, 2016) After 15 years of patient safety… • Most of the discourses about safety have been‘how to do it’ or ‘we need to do it harder’. • Very little engagement with Safety Scientists • Suitably Qualified and Experienced Person (SQEP) e.g. C.Erg.HF or CPE

13. Are you in the SAME department as Patient Safety?

14. Design for Patient Safety: Falls • “Patient stated that she stood up and started to walk with her frame to the toilet without asking for help. She said she slipped and fell onto the floor”. • “because there's lots of furniture (around) they tend to use it to walk rather than the walking aids, so they're leaning on the tables which are unstable and can move away…’

15. Older person’s perceptionOld Lady and Ballerina http://themetapicture.com Older person’s perception of what constitutes good health or frailty often very different to the clinician’s perspective http://www.telegraph.co.uk/news/health/elder/11755913/Branding-elderly-frail-harming-their-health-study.html

16. Incident Analysis: NRLS data 2005-2008 (3 years) • 646,357 reports of falls • 72% not witnessed • 67% experienced no harm • Location • 67% in bed space (19% toilet) • Falls in bed space significantly more likely to be associated with obstacles Hignett, S., Sands, G., Griffiths, P. (2013) In-Patient Falls: What can we learn from incident reports? Age & Ageing. 42, 527-531

17. Go to the Toilet in Hospital:Hierarchical Task Analysis HTA developed iteratively with visits to: • Coronary Care Unit • Medical Ward (Older People) • Orthopaedic (Trauma) Hignett, S. (2012) Can inclusive environmental design be achieved in acute hospitals? Achieving quality outputs in a complex industry. Proceedings of the 2nd International Conference on Human Factors and Ergonomics in Healthcare / 4th International Conference on Applied Human Factors and Ergonomics. San Francisco, 21-25 July. p577-584

18. Step 1: Decide to go to the toilet

19. Call light issues (Wolf, 2015)

20. Understanding human limitations • How long will patients wait for a response to the call bell before mobilising independently? • Two examples from other industrial sectors provide insights for waiting behaviour: • Waiting for a response to a business call 60% of callers will hang up within60 seconds, which reduces to 40 secsif an automatic message tells the caller that they are being placed on hold (OnHold, 2015) • To manage public incursions onto railway tracks after automatic barriers are lowered over the road/ track intersection, trains are scheduled to arrive within 27–75 secsand the barrier lifts 4–10 secsafter the train has passed (Office of Rail Regulation, 2011)

21. Ergonomics Design for Patients PATIENT: ‘The biggest danger of current bed/table design is catching your feet on the bed/table feet’

22. Ergonomics in Healthcare • Occupational Ergonomics - Risks relating to Musculoskeletal Disorder (MSD) exposure • Design for Patient Safety - Ergonomics principles in medical device development • Organisational and socio-technical systems - Integrating safety for EVERYONE (workers and patients)

23. Error models: Swiss Cheese Are the holes in each slice the same size and location? (Reason, 2000)

24. More holes than cheese? ‘materials inaccessible or difficult to locate in a timely-fashion’ (D69) • ‘inability of staff to make small incremental challenges to own and local practice’ (D330) ‘systems design i.e. interconnectivity between people, care providers, technologies’ (D129)

25. System of systems… • Wilson (2014) described a ‘systems of systems’ • Nested and overlapping (parent/sibling) systems; • ‘bed in a hospital is a system, • the patient monitoring equipment is a sibling system, • the two together plus the patient’s room comprise another system, • the radiology or scanning equipment, the drugs dispensary, the beds, the ambulances are all systems, • together can be seen as a system of systems Healthcare needs Human Factors Integration

26. HFI Principles Can This Person (worker, team, patient)… ..With This Training (or information)… ……Do These Tasks… ……..Using This Equipment or Service… ……….To These Standards (performance)… ………….Under These Conditions?

27. Detailed HFI Guidance Mandatory

28. Route Map for HFI in Healthcare for UK (Collaboration with HFE colleagues in Ministry of Defence)

29. Year 20 • HFI mandatory in processes for audit, procurement etc. • HFI as uniform approach across all Trusts, sectors (primary, secondary, mental health, ambulance, community & home care) • HFI competency matrix – clear, embedded and audited • HFI capacity to deliver improved safetywith a resilient system for safety culture and work load

30. My Challenge to you….Patient Handling initiatives?Silo or System?

31. PG Courses @ Loughborough University http://www.lboro.ac.uk/departments/design-school/study/pg-taught/