Human Factors and Ergonomics in Practice

Improving System Performance and Human Well-Being in the Real World

Steven Shorrock, Claire Williams, Steven Shorrock, Claire Williams

• Éditeur: CRC Press
• Année: 2016
• ISBN:
  9781317120339
• Édition: 1
• Sujet: Technology & Engineering
• Sous-sujet: Engineering General

This edited book concerns the real practice of human factors and ergonomics (HF/E), conveying the perspectives and experiences of practitioners and other stakeholders in a variety of industrial sectors, organisational settings and working contexts. The book blends literature on the nature of practice with diverse and eclectic reflections from experience in a range of contexts, from healthcare to agriculture. It explores what helps and what hinders the achievement of the core goals of HF/E: improved system performance and human wellbeing. The book should be of interest to current HF/E practitioners, future HF/E practitioners, allied practitioners, HF/E advocates and ambassadors, researchers, policy makers and regulators, and clients of HF/E services and products.

Part III

Domain-Specific Issues

Part III has 15 chapters, which summarize some of the key, industry-specific issues and challenges for practitioners. Working as a human factors and ergonomics (HF/E) practitioner in different industries provides an incredibly varied set of challenges and rewards and requires skills, knowledge, and ways of working that differ from domain to domain. Part III is not intended to cover every industry, and within each there is much more that could be said by many others, also very differently, but it gives a flavor of HF/E in practice in a wide range of industrial contexts.

We begin with Chapter 13 (Ken Catchpole and Shelly Jeffcott) on HF/E in healthcare. Ken and Shelly describe the healthcare system as complex, opaque, and prone to accidents, and as such there are challenges for the HF/E practitioner. There is, however, considerable interest in HF/E, and significant potential.

The next chapters consider two modes of transport. Chapter 14 (Ben O’Flanagan and Graham Seeley) explores HF/E practice in the rail industry. Ben and Graham address the unique characteristics of this sector, which make it a fascinating and challenging place to be as a practitioner. Chapter 15 (Jean Pariès and Brent Hayward) concerns aviation, a sector with a long tradition of human factors in many aspects of the sector. Jean and Brent reflect on their diverse experience with regard to issues of HF/E practice in aviation personnel selection, in aviation training, in equipment design and certification, focusing especially on aviation safety management, and aviation safety occurrence investigation. Chapter 16 (Ben Cook and Ryan Cooper) goes on to consider aviation in a military environment. Ben and Ryan discuss the tactical applications of HF in military aviation and the array of challenges and opportunities to enhance operational effectiveness and safety.

The so-called “process industries” also often have significant HF/E involvement. Some of these are also “high hazard” industries. Chapter 17 (Rob Miles and Ian Randle) discusses HF/E practice in one such industry: oil and gas. Rob and Ian consider the role of HF/E in major capital projects followed by a detailed and very practical consideration of human factors safety issues in operations. Chapter 18 (Clare Pollard) turns our attention toward HF/E in the nuclear industry, with its focus on helping to deliver safety. Clare describes the multiple features that characterize this industry and the opportunities to design systems and processes to help ensure the safety of workers and the public. Chapter 19 addresses HF/E in manufacturing (Caroline Sayce and Fiona Bird), in the context of defense (submarines) and rail (rolling stock). Caroline and Fiona consider HF/E as part of a multidisciplinary design process within a requirements-driven engineering environment.

Chapter 20 (John Wilkinson) stays within the field of process industries, but takes on a regulatory perspective on human and organizational factors, with respect to the formation and compliance with legislation to protect health and safety. John gives an experiential account of working in this field as a former regulator, considering the needs, challenges, and opportunities in this field.

We then turn to HF/E in a range of consumer product and digital service contexts. Chapter 21 (Daniel Jenkins) considers human factors and ergonomics practice for consumer product design. Daniel describes how, unlike the high-hazard process industries, few standards or regulations mandate the involvement of HF/E in this sector, so it must be justified by helping to design products that are more usable and desirable, and have the greatest chance of commercial success. Accessibility is one aspect that is the focus of legislation and standards, but these can have unintended consequences. Chapter 22 (Edward Chandler and Phil Day) discusses how the needs of disabled people can be included in mainstream digital and technological solutions, avoiding a “race to the bottom” or building niche solutions for separate user groups. Many suppliers of products designed for human interaction offer “ergonomic products” or refer to the “ergonomic features” of their products. Chapter 23 (Guy Osmond) considers the issues involved in selling “ergonomic products,” an area where there is only superficial understanding of ergonomics and what it can achieve. Guy emphasizes different approaches for different applications.

The subsequent chapters address two very different aspects of digital services, both fast-growing and limited in regulation and standards. The user experience (UX) field has grown considerably over the past decade. Chapter 24 (Lisa Duddington) considers how this increasing demand, along with financial and time constraints, may contribute to weaker connections with the discipline of HF/E. Lisa describes issues of limited UX practitioner competency and research. At the other end of the digital spectrum is the fast-growing field of web engineering and operations, the subject of Chapter 25 (John Allspaw). John considers the possibilities for HF/E in a complex and opaque domain that crosses geographic and geopolitical boundaries yet has no singular overarching framework or body for regulations and standards.

We end this part by moving from the newest domains to two of the oldest. Chapter 26 (Daniel Hummerdal and Stuart Shirreff) considers HF/E in the construction and demolition industry. Daniel and Stuart outline dimensions that may be relatively unique to the construction and demolition industries with each aspect providing a challenge and an opportunity for HF/E. Finally, Chapter 27 (Dave O’Neill and Dave Moore) provides a comprehensive overview of HF/E practice in a diverse and complex sector of worldwide and fundamental relevance: agriculture.

13 Human Factors and Ergonomics Practice in Healthcare Challenges and Opportunities

Ken Catchpole and Shelly Jeffcott

CONTENTS

Practitioner Summary

The Healthcare System

Fieldwork in Healthcare

Improving Response to Incidents

Interventions

Quality Improvement

Teamwork Interventions

Technological Solutions

Checklists

Multiple Dimensions of Change

Conclusion

References

PRACTITIONER SUMMARY

The healthcare system is complex, opaque, and prone to accidents. This provides challenges and opportunities for the human factors and ergonomics (HF/E) practitioner. The current challenges faced by the healthcare HF/E practitioner are primarily of legitimacy. The needs, benefits, and value of the HF approach are frequently unrecognized, and the business case can be challenging to justify without explicit regulation. Furthermore, those familiar with some HF/E practices may have a limited understanding of the breadth and depth of the discipline. Communication and collaboration with clinicians and other stakeholders are, therefore, prerequisites for success. To understand this complex environment and work, direct observation, listening, and knowledge elicitation from clinicians and managers are vital. Since the role of HF/E is not necessarily understood (Russ et al., 2013), it is also important to explain in simple terms what your role is and how you can help the delivery of frontline care. In a hospital environment, this tends to involve assisting with field investigations, incident analysis, and delivering interventions or training. In each of these areas, the HF/E practitioner can help clinicians to think in new ways about the relationship between humans and other aspects of the system.

THE HEALTHCARE SYSTEM

For the HF/E practitioner, healthcare offers a huge range of application opportunities and is among the most challenging environments for HF/E practice. With initial interest focused on safety, there has been considerable growth in the awareness and activity of HF/E in healthcare in recent years. This was helped in the United States primarily through growing Food and Drug Administration (FDA) regulation and in the United Kingdom through a National Health Service concordat. There are many ways in which HF/E can be deployed successfully to improve patient and practitioner experience, reduce costs, and improve outcomes. However, no application of HF/E or change is simple or easy. In this chapter, we will focus on fieldwork practice, incident analysis, and the process of making change, including specific interventions related to teamwork, technology, and task redesign, largely concentrated in hospital care. Though there is considerable relevance for other healthcare settings, such as the home, they offer other challenges that we do not address.

About 5%–15% of hospitalized patients worldwide are accidentally injured, and about 1 in 300 hospitalized patients has an “error” that contributes to their death (Brennan et al., 1991; Leape and Berwick, 2005; Vincent et al., 2001). Cost estimates for this range from $98 billion to $980 billion per year in the United States alone (Andel et al., 2012). Of the care that should be given, based on a specific diagnosis, only around 55% is successfully delivered (McGlynn et al., 2003).

Although there is a tendency to view events as being more predictable than they really are (i.e., the “hindsight bias”), it is clear that there is a degree of preventable error in the healthcare system, which had previously not been the subject of any major effort or investment from a human-centered perspective. Subsequently, interest in HF/E has been growing at a rate that has outpaced the available expertise.

Unlike virtually all other industries in which HF/E has been developed and practiced, healthcare is not substantially technologically mediated. Most goals are delivered directly by humans, to humans, with technology assisting rather than enabling. Like other safety-critical industries, it has multiple, diverse, conflicting goals that can make an already complex system resemble a chaotic system.

Rather than being engineered in the last 200 years, healthcare has grown organically over the last 2000 (or more) years. Uncertainty about the goals, processes, risks, and workload means that it is not always possible to conduct clinical work methodically or as planned. There is variability in the needs of patients, requirements of treatments, and other work demands over time, and evidence is constantly changing. There is also a very large variety of different professionals.

Since most hospitalized patients are sick, the default condition for any patient is to be “at risk.” Furthermore, there are many treatments and approaches, and the ability to predict the effect of a treatment upon an individual patient is unclear. Some are sensitive to certain drugs; some patients respond well to treatment or are otherwise resilient. Others can respond in highly divergent ways, especially where they have other (known and unknown) conditions.

Healthcare is a highly professionalized sector, with an emphasis on individual accountability and self-determination and a general lack of understanding about the systemic contributions to performance and outcome. There is still a mistaken impression that the outcomes are primarily a function of the individual patient and the individual provider (physician, nurse, or other care deliverer).

This is in spite of the fact that surgical care might start with the primary care doctor, through diagnostic specialists, processes and technologies, appointment booking systems, and administrative clerks, to operating teams, recovery nurses, intensive care and ward nurses, pharmacists, and physiotherapists. A key relationship in the delivery of hospital care is the physician–nurse relationship, which is complex and frequently challenging. The role of senior managers in mediating how frontline work happens is also integral, since they can shape culture.

Equipment is often poorly designed, maintained, and integrated, and environments are noisy, with frequent interruptions. Information technology is often designed and introduced with little involvement from frontline staff, or understanding of the so-called “ironies of automation” (Bainbridge, 1983). Contrary to what might be imagined, healthcare practitioners do not spend the majority of their time practicing their skills in diagnosis or treatment. Rather, most time is occupied by communicating and working with other disciplines, and navigating patients safely through complex bureaucratic and care systems to receive the correct diagnosis and treatment.

As an HF/E practitioner, you will likely be engaged in one of three different activities: (i) field investigations, (ii) incident analysis, or (iii) delivering interventions or training. You may also be i...

Table des matières

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of Figures
• List of Tables
• Foreword
• Preface
• Acknowledgments
• Editors
• Contributors
• Reflections on the Profession
• Fundamental Issues for Practitioners
• Domain-Specific Issues
• Communicating about Human Factors and Ergonomics
• Afterword
• Index