Abstract
Human factors in the delivery of service are considered in many occupations of high impact on others such as airline industry and nuclear power industry, but not sufficiently in healthcare delivery. A common administrative framework of healthcare involves focus upon costs, quality and patient satisfaction (The Triple Aim). Many industries which support healthcare and healthcare administrators do not have firsthand knowledge of the complexities in delivering care. As a result, the experience and human factors of providing care are often overlooked at high level decision-making unless incorporated into the healthcare delivery framework, proposed as the fourth aim of The Quadruple Aim framework. Research is pointing to consequent negative effects on quality, safety, joy, meaning and sustainability of healthcare practice. High acute occupational stress and chronic occupational stress can cause direct and indirect effects on safety and quality of care. The biological, psychological and social consequences of burnout from excessive acute and chronic occupational stress are more of a threat to healthcare than commonly acknowledged. Patient safety, quality of care and clinician well-being are inextricably linked. This report will describe the process of transition from The Triple Aim to The Quadruple Aim administrative framework of healthcare delivery at the University of Rochester Medical Center. Developing the fourth aim of improving the experience of providing care, had high acceptability and aligned with other health system goals of optimization of safety, quality, and performance by applying a human factors/ergonomic (HFE) framework that considers human capabilities and human limitations. The goal of HFE is to fit the healthcare system to the human instead of the human to the healthcare system. Concepts include removal of extraneous cognitive load, using clinician neural resource (brain power) optimally for highest order decision making in patient care. An integrative model of patient safety and clinician wellbeing is a product of this effort.
Highlights
Many professions, especially in the delivery of healthcare, experience burnout
The following relevant theories were incorporated into building a final wellness program: Business case for healthy workplace, conservation of energy, economy of scale, psychosocial safety climate, organizational health, emotional intelligence, cognitive load theory, preservation of clinician executive functions to improve clinical decision-making, positive behavioral support, neuro-cognitive ergonomic concepts for reducing cognitive strain in workflow and process designs, organizational ergonomics, bottom-up impact on work environment, clinician and staff engagement, and enhancing esprit de corps—(feeling of pride, fellowship, common loyalty shared by members of the medical center)
High burnout/emotional exhaustion was assessed if respondents chose either once a week, a few times a week, or every day as an answer to “I feel burned out from my work” In addition, 32% of MD/DOs and 45% of Advanced Practice Providers (APPs) reported high callousness/depersonalization
Summary
Especially in the delivery of healthcare, experience burnout. The human condition of burnout is the same among occupations, but the stressors differ by field. When the brain is in this survival mode, it “knows” it is working in a low neural resource condition, and automates response to a preceding stimuli without link to outcome that follows [20] [21] This reduction in executive control compromises cognitive flexibility, medical decision-making quality, and degree of conscious choice as the clinician’s behavior is more strongly guided by environmental signals than the individual’s own goals and intentions. An unintended consequence from many well-meaning efforts to improve quality, reduce costs and improve patient satisfaction, when in the absence of consideration of human factors in the delivery of care, is increasing latent error risk In other industries such as the airline industry, latent conditions are actively reduced and managed through industrial engineering and HFE principles to allow the best performance of the pilot. Extraneous cognitive load is modifiable factor that can be the target of efforts to improve the experience of providing care and performance
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