Ergonomics - time to do my VDU risk assessment again!

In this weeks blog I want to really discuss Ergonomics and start to think about how this is understood, or not, in healthcare. 

My interest in this area started years ago - delivering simulation I started to get invited, or invite myself, to a variety of trust (organisational) meetings focussing on a number of quality improvement areas. Topics that have probably been procrastinated on around the world in healthcare organisations such as 
  • patients slips and falls
  • how to spot the deteriorating patient 
  • rates of infection in central lines and urethral catheters ….etc 
What I realised over a period of time was that I was having very similar conversations with each disparate group i.e. whilst we focussed on very specific clinical elements there was some unseen presence in the shadows that was not recognised - maybe this entity offered a solution across the range of clinical issues and maybe even a solution to issues we were not looking at! 

Initially my focus was around the team - this was something tangible and in my simulations something I could experiment with - adding elements and seeing how the team reacted and focussing on the Big Five elements of Team Work, described by Eduardo Salas, that is embedded in a lot of the team taxonomies. More and more I started to see the predictable nature of human performance and realised how much this was impacted by how our brains interpreted the world around us. 
These human factor focussed sessions strongly focussed on team resources management and non technical skills -  but still there was that unseen force in the shadows. 
As part of understanding how teams worked I started looking at classifications of errors partly out of a growing frustration that our main cultural approach for teaching in healthcare (or learning from errors) seemed to be the presumption the error was caused by a lack of knowledge or just reckless behaviour. 

So enter the world of ergonomics and the system….ok for purists I probably need to state within the UK the terms Ergonomics and Human Factors really are completely interchangeable phrases and is a scientific discipline in its own right. One of the most useful representations for the complex world we work in for me is the SEIPS 2.0 human factors engineering model. 

This model demonstrates how when we do a task we use a myriad of tools and technology, in an internal environment (layout, heat and lighting), in an organisation (teams and culture, senior leadership) and are effected by external environment (national guidelines, process, cultural, regulatory, government etc). Further more when doing a task not only do we have the physical task, but the cognitive, social and behavioural elements. Really fundamentally we are looking to understand what is happening in context of the humans and ensuring that design at all levels is focussed on how we work, think and behave but also recognises the physical and cognitive limitations so that it helps us do the right thing - this is actually almost an alien concept in healthcare where more often than not it feels that systems are there to make our job harder or make us do a job in a way that doesn't feel natural. 
So very much now I see human factors (or ergonomics) as being so much more than team work - indeed I have deliberately chosen to use the term ergonomics in my blogs just to emphasise (to healthcare workers) that I am not talking just about team working and simulation. The system is actually the foundation for all the work we do. Indeed thinking back to the blog on cognition  if we agree we cannot (easily) re-programme the way people think, the natural conclusion is that subconscious errors (cognitive bias) are not really going to be affected by training or the acquisition of knowledge, in fact the only real way to reduce harm events is to have the robust systems that recognise humans may perform variably and support us to do the right thing. 

So where are we in healthcare? 






This picture sums up for me where we are - it is a switch that turns off a drug fridge. When it has been switched off / deliberately or accidentally all the drugs have been wasted and there are clear costs not to mention the issue of drugs not being available. As this has happened a few times someone has fixed it reactively. 

This switch for the drug fridge is a metaphor for how we tend to design processes, systems, new roles, develop quality improvement, new buildings, new pathways, new procedures in healthcare …in fact everything we do and put them into practice and test them - only adapting them when they do not work - or just getting used to them not working! We focus on the technical (clinical) elements and presume our staff will just adhere to our policy and work as we describe (imagine).  For me all to often in healthcare we are do not understand the design or process mapping to maximise human performance. 

I really believe that there is a need for far greater engagement with the individuals (expert) ergonomists who allow this element to become proactive so we don't need to test things in the real world. These individuals can work with the clinical staff to develop transformation, quality improvement process they will help to ensure that our systems and process do the right thing and also consider the well being of our staff. 

...as a final aside ....the plastic pot was removed from the drug fridge switch so we are now back to replacing the fridge contents every now and again !


Comments

Post a Comment

Popular posts from this blog

So simulation, that is all about manikins - right?

Image
So first blog! I'm hoping to do a series of blogs on Healthcare Simulation, Patient Safety and Ergonomics and all things in between - I want this to be a place to share thoughts, ideas and learn (me learn as well!). I also don't want these to become overly academic - I will share and mention others peoples work but will not formally reference these. I wanted to start with What is Simulation as this seems an important starting point to allow further exploration later - without a common mental model or reference point it becomes more difficult. So the aim of this blog is to challenge and expand what people consider healthcare simulation to be (or what it isn't), David Gaba has pointed out that Simulation is a technique not a technology - indeed it is an educational modality. For me healthcare simulation is all encompassing it is any patient focussed learning event where we simulated the process, patient, system, event for the acquisition of skills, knowledge and or
Read more

Patient Safety, Simulation and Human Factors …Part II …the applications of simulation

Image
Out of all my blogs the one that seems to have stimulated most interest was the one I wrote on how simulation should be seen as part of patient safety activity ( click here for that blog )  rather than the typical thought that it is just a form of training and often just resuscitation training at that. Spurred on following some Twitter (@NWSEN) and face to face interactions I wanted to write a blog which built on this work and in particularly looking at the art of the possible and how simulation can, and in fact is, being used to support some of the emerging patient safety concepts.  Remember we are describing simulation as a spectrum of activity ( blog on this is here ) with a variety of underpinning educational theories aligned to the learning outcomes, these learning outcomes can be ones for the individual, team or organisation. Additionally simulation should be a quality assured education event that can be delivered in a variety of ways including with real people ( see
Read more

Patient Safety, Simulation and Human Factors: should we all work together?

Image
So up until now my blogs have focussed on the individual elements of patient safety, simulation and human factors but not really brought them together into a unified piece of work - so here we are - what does Patient, Safety and Human Factors have in common and how can they collaborate to improve patient safety? This actually is very timely too, as it links to the recent Opening Doors (link)  publication from the CQC recognising that we are not reducing Never Events and signalling the need for an improved safety culture and the fact that NHSI are currently developing a Patient Safety Strategy link that aims to half avoidable harm in the NHS. What is clear is that there is some really good examples of good practice and activity going on within NHS organisations but there seems to be a lack of a way to scale up and share these. I do also think this is not just an issue for or with NHS organisations as indeed the same culture exists, and to an extent is reinforced,
Read more