Design of Work for Patient Safety

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Design of Work for Patient Safety

• Pascale Carayon, Ph.D.
• Procter Gamble Bascom Professor in Total
  Quality
• Department of Industrial and Systems Engineering
• Center for Quality and Productivity Improvement
• University of Wisconsin-Madison

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

• SEIPS model of work and patient safety
• DESIGN
• What kind of research?
• Challenges and questions

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Outline

• SEIPS model of work and patient safety
• Importance of work and processes for patient
  safety
• DESIGN
• What kind of research?
• Challenges and questions

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SEIPS Model of Work System and Patient
SafetySEIPS System Engineering Initiative for
Patient Safety
Carayon et al., 2006
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An example...
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Medication Administration Technologies

• SMArTHF Project Team
• University of Wisconsin-Madison / UW Hospital
  Clinics
• Madison-Wisconsin-USA

Funding provided by the Agency for Healthcare
Research and Quality
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Work System (or a sociotechnical system)(Balance
Theory Smith and Carayon, 1989 Carayon and
Smith, 2000)
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BCMA Technology ImplementationBCMA Bar Coding
Medication Administration
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BCMA Bar Coding Medication Administration
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Organizational factors interruptions, shift
Technology automation surprises, malfunctions
Individual (nurse or patient) patient in
isolation
Environment where tasks completed, lighting,
noise
Tasks sequence of acts, handoffs, unsafe acts
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Outline

• SEIPS model of work and patient safety
• DESIGN
• What kind of research?
• Challenges and questions

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Design of

• work system
• process
• Purposeful activity
• Continuous process
• Knowledge, principles, tools
• Design principles (human factors)

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Opportunities for Design of Work

• Technology implementation (e.g., EHR, CPOE, bar
  coding medication administration)
• Renovation or new building/facility
• Any change that affects work and processes
• Can you think of a change currently going on in
  your organization that can affect the work of
  healthcare providers and processes?

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Design Principles of Human Factors and Ergonomics
(HFE)

• User-centered design
• Dimensions of HFE
• Physical ergonomics
• physical characteristics of end users
• Cognitive ergonomics
• cognitive characteristics of end users
• Organizational ergonomics
• psychosocial needs of end users

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• 51 chapters, 1,000 pages
• Human error
• Sociotechnical systems and macroergonomics
• Technology, medical devices
• Physical ergonomics
• Methods and tools
• Various care settings

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Outline

• SEIPS model of work and patient safety
• DESIGN
• What kind of research?
• Challenges and questions

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What Kind of Research?

• Probably not RCT
• Action research framework
• Collaborative multidisciplinary research
• Multiple data collection methods

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Outline

• SEIPS model of work and patient safety
• DESIGN
• What kind of research?
• Challenges and questions

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Challenges and QuestionsDesign of Work for
Patient Safety

• Complex system with interactions
• Who are the end users?
• Example medication management in ambulatory
  care
• Design for multiple groups of end users
• Who is the designer of work and processes?
• Home care
• Role of patient and family
• Transitions of care
• Design of interaction
• HIT
• Impact on work system
• Design of HIT-supported work and processes

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