Human factors in patient safety as an innovation
Introduction
Patient safety is a major concern worldwide. In 2004 the World Health Organization launched the World Alliance for Patient Safety (http://www.who.int/patientsafety/en/index.html) that has initiated numerous programs and activities in areas such as infection control and safe surgery. A series of reports issued by the US Institute of Medicine (IOM) has clearly identified patient safety as a major problem in healthcare delivery (Institute of Medicine Committee, 2001, Kohn et al., 1999). IOM reports have addressed patient safety issues related to medication errors and adverse drug events (Institute of Medicine, 2006), duty hours and fatigue among medical residents (Ulmer et al., 2008), and working conditions of nurses (Institute of Medicine Committee… on the Work Environment for Nurses and Patient Safety, 2004). There has been increasing effort at various levels of healthcare policy, accreditation, reimbursement, operations and associations to improve patient safety; the effects of these interventions and programs on patient safety is unclear however (Vincent et al., 2008). Human factors and ergonomics (HFE) tools, methods, concepts and theories are often recommended as part of patient safety improvement efforts. For instance, the 2005 report by the US Institute of Medicine and the National Academy of Engineering lists HFE as a key systems engineering tool to design and improve healthcare systems, and produce improvements in quality of care and patient safety (Reid et al., 2005). The question then arises as to how we can increase the uptake and use of HFE tools, methods, concepts and theories in order to speed up and improve patient safety efforts.
In this paper, we conceptualize HFE as an innovation that needs to be adopted and implemented in healthcare organizations. Using a conceptual model of innovation (Greenhalgh et al., 2004), we identified various factors that can either inhibit or encourage HFE applications (i.e. innovations) in healthcare and patient safety. We conclude with a series of recommendations for HFE professionals, researchers and educators (see Table 2). The recommendations are organized by target group: (1) HFE professionals, (2) HFE researchers and (3) HFE educators. Each recommendation is provided a code (e.g., P1 for the first recommendation for HFE professionals, R2 for the second recommendation for HFE researchers, or E5 for the fifth recommendation for HFE educators); the recommendations are cited throughout section 2 of the paper using these codes.
Section snippets
HFE as an innovation in patient safety
The application of HFE in healthcare and patient safety is not new. In the late 1950s, Al Chapanis, one of the founders of the human factors discipline, and his colleagues at the Johns Hopkins University conducted a study of medication errors in hospitals (Chapanis and Safrin, 1960, Safren and Chapanis, 1960a, Safren and Chapanis, 1960b). Using the critical incident technique method, they identified a total of 178 medication errors over a 7-month period that were classified in 7 categories
Characteristics of HFE as an innovation
Several authors have described key attributes of innovations that influence their adoption (Greenhalgh et al., 2004, Wejnert, 2002). In this section, we discuss the following five attributes of HFE innovations: relative advantage, compatibility, complexity, task issues and nature of knowledge required.
Recommendations and conclusions
From the discussion about HFE innovations for patient safety, we can draw a series of recommendations for HFE professionals, researchers and educators (see Table 2 for a list of recommendations). Each of the three HFE groups, i.e. professionals, researchers and educators, will need to address these recommendations in order to improve the spread of HFE innovations for patient safety. The three HFE groups will also need to work together to implement those recommendations. For instance, HFE
Acknowledgements
This publication was partially supported by grant 1UL1RR025011 from the Clinical & Translational Science Award (CTSA) program of the National Center for Research Resources, National Institutes of Health and by grant 1R01 HS015274-01 from the Agency for Healthcare Research and Quality. I would like to thank Ann Schoofs Hundt, Carla Alvarado, Peter Hoonakker and Peter Buckle for their review and comments on earlier drafts of this paper.
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