EFFECTIVENESS OF APPLYING HUMAN FACTORS AND ERGONOMICS MODEL DURING CRISIS SITUATION IN AN ICU SETTING

Abstract

TOPIC: Disaster Medicine TYPE: Original Investigations PURPOSE: Healthcare crisis presents an opportunity to harvest extensive learning around optimizing the real-time support for physical, cognitive, and organizational work of healthcare staff in a rapidly transforming work setting. We aim to inform the 'service reset' program of healthcare services at Northern Health and Social Care Trust (NHSCT) in Northern Ireland during the Covid-19 crisis. METHODS: We retrospectively applied the systems engineering initiative for patient safety (SEIPS) model in-situ at the Intensive Care Unit (ICU) of the Antrim Area Hospital-NHSCT. A quality improvement and human factors professional during June 2020 shadowed and interviewed the ICU staff one-to-one, gathering qualitative data using the SEIPS model. The findings were analyzed using the human factors and ergonomics (HFE) approach to identify successful interventions during the Covid-19 healthcare crisis. RESULTS: HFE adaptations enabled the ICU to consistently run at 200% of its funded capacity during the healthcare crisis due to the Covid-19 surge. We found that HFE analysis learnings for efficient and safe day-to-day healthcare operations during the crisis were focused on five major domain elements of the SEIPS model work system, 1) person via upskilling through a buddy system by matching redeployed staff with experienced staff, medical simulations, and just-in-time training;staff motivation when seeing Covid-19 patients recover and discharged;providing access to psychological services for staff well-being;2) organization via teamwork with a compassionate leadership approach and virtual communication platforms;management supervisory style of shared leadership in and across clinical teams promoting the non-silo working;organizational quality improvement culture facilitating staff empowerment in collective decision making;3) tools and technologies by providing access to technology through increased electronic health record workstations and virtual ICU visits to ease patient care;standardizing medical devices to enhance staff familiarity;4) tasks by reducing cognitive workload via staff role-specific action cards, and stickers for staff identification;creating new teams;enhanced job autonomy through Covid-19 specific medication preparation areas;5) environment by focusing on healthcare work environment layout and human-centered workstation design to support 'work as done' instead of 'work as imagined.' CONCLUSIONS: Application of the HFE based design to support the frontline staff performance during a large-scale healthcare crisis yields an effective and efficient crisis response. CLINICAL IMPLICATIONS: It is of great utility to consider human cognition and behavior as healthcare organizations redesign the services and operations during a crisis. Leaderships at high-stakes organizations should consider approaches to encourage and empower frontline staff for rapidly adaptive change during a healthcare crisis. DISCLOSURES: No relevant relationships by Muhammad Hasan Abid, source=Web Response No relevant relationships by Muhammad Mohsin Abid, source=Web Response No relevant relationships by Iqbal Ratnani, source=Web Response No relevant relationships by Gill Smith, source=Web Response