Magic at the Intersection of Psychology and Engineering
The impact of human factors analyses in healthcare deliveryClinical Affairs | CU School of Medicine Aug 1, 2019, 12:00 AM
(August 2019) When it comes to improving healthcare quality and safety, we often think of better training or technology, but not necessarily about how people interact with technology and the environment. According to Laura Barg-Walkow, PhD, that’s often where the magic happens.
A member of the Patient Safety team at Children’s Hospital Colorado, Dr. Barg-Walkow is a human factors engineer, an expert in a field at the intersection of psychology and engineering. She helps the hospital improve care by observing how all types of people in the hospital – clinicians, staff, patients and visitors – interact with the hospital’s environments.
“My goal is to make it easy for people to do the right thing, and harder to do the wrong thing,” Dr. Barg-Walkow explains.
In the healthcare environment, tools and technologies are often developed in isolation, without consideration for how well they work together. A human factors assessment is the key to improving both the tools and how they are used.
Systems and environments that are easy to use are like a living checklist – a site of institutional memory with task cues everywhere. The science of human factors aims to create such systems and environments.
Dr. Barg-Walkow has applied human factors analyses to several areas of the hospital, including isolation precaution signs outside of every patient room. Here, good signage is an essential tool for controlling exposure to infectious disease and communicating safe practices across shifts and roles.
“I sometimes joke that the place to start is where you see a post-it, as someone has had to put it there to remember what to do. This means that something in the system is broken, and users don’t have the right information at the right time.”
One of her big projects in the past year focused on making it easier and safer to ensure correct assembly of a green anesthesia flow-inflating bag, a life-sustaining piece of equipment. The patient safety team saw that the bag components could become disconnected and then incorrectly reconnected, with little to alert them that it was done incorrectly. This can lead to insufficient oxygenation for the patient – a serious safety problem.
Dr. Barg-Walkow and her team tested how well end users could identify this error and found that the vast majority of them could not detect a misconnection, despite having high confidence in their ability to do so. Dr. Barg-Walkow and her team then identified interventions, like adding a rubber end to reduce the likelihood a disconnection and adding color-coded labels to check correct assembly.
Through these simple low-tech solutions, the team was able to drastically improve their ability to recognize a misconnection and reduce the chances of making an error.
This example highlights what human factors engineers do best: they see healthcare delivery through a different lens. “Frustrations begin because we haven’t made it easy for people to do what they intend to do,” says Dr. Barg-Walkow. “We often forget to look at the broader context. For example, is the room dark versus bright? Is the font large enough to see at a distance? Are there enough people on staff? How is everything interacting in the bigger picture?”
“Adding a human factors perspective to our patient safety efforts has allowed us to evaluate problems and identify solutions in new ways that have permitted us to both reduce risks and improve efficiencies in our processes,” says Chief Medical and Patient Safety Officer Daniel Hyman, MD.
Like other human factors engineers, Dr. Barg-Walkow goes through a specific process to understand and address usability problems. Her field is supported by a solid evidence base for how to assess and address usability problems. “I have a firm understanding and an ability to predict how people will interact with the environment because of the science of human factors,” she says. “Sometimes that gets lost. People think, ‘Hey, I’m an end user so if I can use this, everyone can.’” But our intuition as end users doesn’t always align with reality.
A workflow process may need a human factors analysis if, despite training and numerous posted instructions, the same mistakes continue to be made and the same frustrations are expressed by staff. Dr. Barg-Walkow believes that “It’s generally not the person’s fault. For the most part, people try to do the right thing, what’s supposed to be done. We look at what barriers are in place. We think about the person, the tasks they are trying to do, the tools and technology they are trying to use, and the broader context.”
Ultimately, when systems are designed well, patient care is better and the systems become enjoyable and satisfying to use, rather than a frustrating drudgery. A system that works better for all the people involved creates a safer and more streamlined experience. It’s a worthy goal for every part of the hospital.