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Written by: Bob Habasevich, PT on Tuesday, May 29, 2012 Posted in: Inpatient Rehab

Consider Ned, the first human who invented the wheel (more like a log that Ned rolled things over), bringing his new invention into the camp and explaining to the clan of Cro-Magnons gathered how revolutionary this technology was and how it was about to change life on the planet forever.  While some looked bewildered and asked “What’s a planet?” other early humans questioned the wisdom of investing such effort into making wheels when there were more important things to do like hunting and gathering. There must have been quite a disturbance as those gathered began to debate the pros and cons of this new technology; it was beginning to disrupt the system’s usual workflow and routine. Every member of the clan had an opinion readily supporting his or her position in the social structure and what skills or tasks could be affected by this wheel thing. Ned and his enthusiasm to make life better for all took every opportunity to get the wheel adopted by the clan. He worked with small groups with specific focused tasks demonstrating how these tasks could be accomplished more safely and effectively if things were rolled rather than carried. Ned showed them how to change traditional work habits and use the wheel. Eventually, the systems of hunting and gathering deployed, rolling as a cost-effective solution for getting tasks done. These actions, perceptions and social behaviors are the characteristic human factors that influence technology and the human-environment equilibrium.

The healthcare literature states that cost and effectiveness issues are the result of systems problems, require systems analyses and can only be addressed with systems solutions. Within that same body of literature is a growing recognition that human factors engineering methods and design principles are needed to reduce medical errors, increase patient safety and care effectiveness. Work system analysis methods, which are based on industrial and human factor engineering tools, have much to contribute to patient care because of their focus on systems. They offer principles and methods for analyzing systems, which, if followed, could help health care administrators and clinicians properly analyze their units or facilities, and should lead to more robust patient safety interventions.

Wikipedia describes “human factor science” as the study of the way humans relate to the world around them, with the purpose of improving operational performance and safety, through experience of the end user. Today, human factor science influences most aspects of our lives and economy. From product design to building systems, to manufacture and deliver goods and services, the human-technology interface is a major consideration in optimizing effectiveness. Human Factor Engineering (HFE) applies what is known about human capabilities and limitations to the design of products, processes, systems and work environments. It can be applied to the design of all systems having a human interface, including hardware and software. HFE is defined by the Human Factors and Ergonomics Society as 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 other methods to design in order to optimize human well-being and overall system performance.”

Technology and the adoption of electronic health and clinical records face many of the same human-environment challenges that Ned experienced with his wheel. Disruption of workflow, challenge to the status quo, learning and people adapting to new ways in order to accomplish old tasks still present considerable barriers to improvement. However, unlike Ned, we can benefit by the history of lessons learned about the way people interact with machines, technology and each other.

Human factor science is increasing its influence in healthcare delivery with the potential to improve both the process and effectiveness of patient care delivery. Human factors can be the difference between systems that function well in the clinical environment and systems that function poorly. These are the same reasons that health care is thought to have problems. Most conspicuous is the expectation that health care professionals will perform perfectly, which has resulted in a substantial focus on individual performance versus system design. The expectation that health care is safe and effective by design and its problems are the result of failure of its human components is no longer valid.

The value of HFE has been demonstrated to improve patient safety and reduce accidents by improving how humans interact with machines, from infusion pumps to patient lifts to telemetry monitors. Recently, the application of these engineering practices to the process of how healthcare teams interact has given evidence of improved team functioning and resultant care delivery efficiency and effectiveness.

HFE task analysis techniques provide information about the cognitive demands of work and how clinicians adapt to efficiently achieve the goals of patient care. New technology or different processes require more than training for successful adoption. Understanding what makes a task easy or difficult is the first step to developing better procedures, policies and tools to support a clinician’s work. The study of the human, technological and system process factors is becoming prerequisite for success.

Improving healthcare is a primary concern of all practitioners. New technology is outpacing its adoption. Reform must include consideration of the human factors that influence the human-environment equilibrium. Studying human-technology interactions can yield important information about the design of health care systems. Human factor science is an important element in a provider’s quality improvement initiative.

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