Human Factors Engineering HFE and Patient Safety

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Human Factors Engineering (HFE) and Patient Safety

• With thanks to John Gosbee

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Whats HFE?

• Designing things or processes to fit human
  abilities and limitations
• Designing the glove to fit the hand, not the hand
  to fit the glove (supporting/improving human
  performance by as little as 3-10 will make
  things much safer)
• Using specific ways to uncover hidden needs,
  assumptions and unexpected interactions
  (heuristic evaluation, usability testing)
• Taking advantage of knowledge about human
  capabilities (5 senses, communication styles,
  ranges in physical size and strength, etc.)

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Human Factors Model
Psychomotor - Hand - Eye
movements

• Input Devices
• Keyboard - Voice recognition

INTERFACE
Senses - Vision - Hearing
Output - CRT - Sound
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HFE and Healthcare

• Academia
• University of Wisconsin (BME-IE)
• Catholic University in DC (BME)
• Government
• FDA-CDRH (great web site)
• NIH-NCI usability for patient information
  (www.usability.gov)
• Industry
• Medtronic (over 8 years)
• Baxter and Abbott (more recently)

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How good are we at vigilance/paying attention?
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Performance Graph
100
90
80
70
Performance
1
2
3
4
Time (hours)
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Performance Graph
100
90
80
70
Performance
1
2
3
4
Time (hours)
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How can we move the curve up (improve
performance)?
100
90
80
70
Performance
1
2
3
4
Time (hours)
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How fast can we learn things?

• When I say up, everyone raise your hand as
  quickly as you can

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This was not an aerobic exercise

• Demonstrates paired associate learning
• Case Study
• Frequently used pharmacy computer used ENTER
  button for data entry
• Pharmacy computer used 10 of time SPACE BAR
  for data entry

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What assumptions do we make?

• For example Do we make important decisions based
  on equipment color?

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What is the content of these gas cylinders?

• Write your answer down on paper.

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What is the content of this gas cylinder?

• Write your answer down on paper

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What is the content of these gas cylinders?

• Write your
• answer down
• on paper

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What is this regulator used for?

• Write your answer down on paper

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What is this regulator used for?

• Write your answer down on paper

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Demonstration Stroop Test
Row 1
Row 2
Row 3
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Now, State the Color of the Text as Fast as You
Can
Yellow
Green
Red
Blue
Row 1
Green
Red
Blue
Yellow
Row 2
Red
Blue
Yellow
Green
Row 3
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Again, State the Color of the Text as Fast as
You Can
Red
Blue
Green
Yellow
Row 1
Yellow
Green
Red
Blue
Row 2
Blue
Yellow
Green
Red
Row 3
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Oxygen?
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Answer?
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Is this 95 CO2 OR 95 O2?
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• A CO2
• B O2
• C O2

A
B
C
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Oxygen
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Air
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Quotes from Adverse Events

• Quickly, have the transport person to SIC get
  the green tank and hook it up to the patient!

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Lets see, the green tank is

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Quotes from Adverse Events

• Tell the nursing student to attach the oxygen
  mask and tubing to the green spigot

Remember, this is air.
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Quotes from Adverse Events

• Get the green and gray tank and put it in the
  endoscopy cabinet attach it to the insufflator
  valve

Green tank and Gray tank? Green and Gray tank.?
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Can we ignore equipment color?

• Ignore the color in some cases, focus on the
  label
• Summary from an ECRI Alert
• Color is not fool-proof, only read and trust the
  label
• Guideline from the Compressed Gas Association

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HFE and Actions that make things safer
Warning Lost Fingers
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Some HFE Actions

• Warnings and labels
• Training
• Policies and Procedures
• Checklists
• Simplify, standardize
• Interlock, lock-out, forcing functions
• Specialized communication (e.g., read back)
• Physical plant changes

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Whats the best action?

• Chose physical over procedural actions (example)
• Chose permanent over temporary actions (example)
• Put knowledge in the world reduce the burden
  on human memory and vigilance (Donald Norman)

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Small Group Exercise

• Groups of 3-5 people
• One person as Director
• Job is to remind end user to think out loud
  leads team after evaluation
• One person as End User
• Job is to USE the product
• Other members as Observers
• Note words used, facial expressions, etc.
• Purpose of Exercise - Find problems and recommend
  HFE redesign of the product

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Some Common Design Problems

• Inconsistent labels, buttons, knobs, etc.
• Unreadable and confusing/ambiguous labels
• No obvious mental model for how the thing works
• Unclear automation
• What is it doing?
• Why is it doing that?
• Mode errors
• Not considering environment of use

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Remember

• Its all about supporting perfect human
  performance (for you, for me, for the next person
  first time and every time)
• Its not me, its bad design
• Its a marathon, not a sprint