Work System Design Research Articles

Work System and Process Designs for Community Pharmacy-Medical Clinic Partnerships to Improve Retention in Care, Antiretroviral Adherence, and Viral Suppression in Persons with HIV.

The objective of this project was to collect and analyze information about work systems and processes that community pharmacy-medical clinic partnerships used for implementing the Patient-Centered HIV Care Model (PCHCM). Paired collaborations of 10 Walgreens community pharmacies and 10 medical clinics were formed in 10 cities located throughout the United States that had relatively high HIV prevalence rates and existing Walgreens HIV Centers of Excellence. Patient service provision data and most significant change stories were collected from key informants at each of the clinic and pharmacy sites over an 8 week period in 2016 and through in-depth phone interviews. Written notes were reviewed by two authors (J.C.S. and O.W.G.) and analyzed using the most significant change technique. The findings showed that half of the partnerships (n = 5) were unable to fully engage in service implementation due to external factors or severe staff turnover during the project period. The other half of the partnerships (n = 5) were able to engage in service implementation, with the most impactful changes being related to strong patient care systems, having a point person at the clinic who served as a connector between sites, and having pharmacists integrated fully into the health care team.

Development and application of HVDC Cable polarization/depolarization current detecting instrument

In order to test the insulation state of 6kV XLPE cable reliably, the system design and related test work are carried out in this paper. High voltage excitation source, weak current test module, data acquisition system, communication, power supply and other hardware design work are described. The control of high voltage signal, switching of measurement mode, data acquisition of current and software design of man-machine interface are introduced. Finally, the designed test instrument is presented, and the field test results show that the home-made polarization and depolarization current (PDC) instrument can be used for testing, and the overall test performance is relatively good.

Surfacing the social factors early: A sociotechnical approach to the design of a future submarine

Socially oriented approaches to work systems design are increasingly important as new and disruptive technologies become more prevalent. Existing approaches used by organisations to integrate such technologies are often techno-centric and do not adequately consider human issues. Sociotechnical systems (STS) tools are intended to ensure that the technical and organisational aspects of a system are considered together, and given equal attention. However, they are predominately applied late in the design process, limiting their impact. In this article, we outline an STS approach to the early-phase development of a complex work system. The case study illuminates how an STS approach can facilitate the inclusion of socially oriented factors into the design process. We close with recommendations to guide the early-phase application of STS principles in other industries and contexts. JEL Classification: C93, D02

ERGONOMIC WORK SYSTEM DESIGN USING KANSEI ENGINEERING APPROACH

Work fatigue is a problem that most often arises in the workplace and can affect work productivity. That problem also occurs at PT ASA Yogyakarta, many workers who complain of aches in the upper muscles and waist at work. Based on this, the research aims to design an ergonomic work system on the sewing production floor of PT. ASA Yogyakarta. The design of the work system is done to fix the problems done by workers so that it is expected to increase productivity. The method used is Kansei Engineering. The results of this study indicate that the proposed work system design meets the desires of workers with Stuart-Maxwell values testing marginal homogeneity of Z> 0.05. Work system designs made include sewing chairs and tables adjusted in size to worker anthropometry, approved backrests on chairs, lighting lamps replaced with LED lights, plug lamps on sewing machines, and plug bulkheads as sound dampers.

Diagnosing rare diseases: A sociotechnical approach to the design of complex work systems

How do complex healthcare systems that are organised into distinct speciality areas achieve effective patient care transitions when patients present with a rare constellation of symptoms that affect multiple body systems? How do these patients challenge existing ways of organising tasks, clinical activities, and interdependent responsibilities? The current study applies a sociotechnical systems perspective to understand how these complex work design and care-related challenges were resolved by the Western Australian Undiagnosed Diseases Program. We conducted a two-year longitudinal, qualitative study of this program, conceived to improve the diagnosis and management of patients with rare, multi-system disorders by piloting a re-design of the local system of diagnostic work. Specifically, we (1) compared the configuration and effectiveness of the old system and the re-designed system; and (2) analysed the process of system re-design (i.e., the design, implementation, and operation of the program) in order to understand the factors that contributed to – or inhibited – its success. We discuss the theoretical and practical implications of our findings for effectively re-designing complex, trans-organisational work systems.

Relating Medical Errors to Medical Specialties: A Mixed Analysis Based on Litigation Documents and Qualitative Data.

BackgroundWe know a great deal about types, causes, and prevention of medical errors, as well as the risks of each medical specialties. Although we know something about medical errors, much remains to be done in this area particularly around effective prevention. However, little is known about whether medical errors are related to medical specialties. Our objective was to categorize and map the distribution of medical errors and analyze their relationships with medical specialties.MethodsFirst, public cases of medical disputes were searched on “China Judgment Online” according to the key words including medical errors. Second, we set up a database with 5237 medical litigations. After removing unrelated judgment documents, we used systematic random sampling to extract half of these. Then, we hired two frontline physicians with M.D. to review the litigation documents and independently determine the medical errors and the departments in which they took place. A third physician further reviewed the divergent results. After the descriptive statistical analysis and mind map analysis, semi-structured interviews were further conducted with 63 doctors to reveal the relationships mentioned above.ResultsMore than 97.8% of medical errors occurred in clinical departments. The insufficient implementation of informed consent obligations is the top medical error in all medical departments [internal medical departments (12.86%, N=36), surgical departments (14.57%, N=106), specialist departments (13.16%, N=86)]. The types of medical errors in diverse medical departments might be associated with therapeutic means used by physicians. Errors related to surgical operations were common in surgical departments, errors related to diagnoses were common in internal medicine departments, and errors related to therapy were common in specialist departments. A lack of clinical experience and undesirable work system design have contributed to the occurrence of medical errors. Inadequate human resources and unreasonable shift systems have increased the workload of staff members and this has in turn increased the incidence rate of medical errors.ConclusionMedical departments are facing medical errors both in humanity and technology. Medical institutions should be alert to the harm caused by medical humanity (mainly including insufficient communication between physicians and patients, insufficient implementation of infringement of informed consent, infringement of patient’s privacy and overtreatment). Improving the clinical skill and vigilance of medical staff is a top priority. Medical institutions should also improve undesirable system designs.

Team Cognition as a Barrier and Facilitator in Care Transitions: Implications for Work System Design

Inpatient care of pediatric trauma patients includes care transitions, including from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU, which are important to patient safety and quality of care. Previous research identified work system barriers and facilitators in these transitions; the most common related to team cognition. We conducted interviews with 18 healthcare professionals to better understand how work system design influences team cognition barriers and facilitators. Using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling, we identified when each barrier/facilitator occurred. The ED to OR transition had more barriers in transition preparation, while OR to PICU had more facilitators in the transition. Future research should explore solutions to support team cognition early in the ED to OR transition, such as designing a technology to be used by distributed teams.

It Takes Partners to Create Solutions Management Wants

The notion of interdisciplinarity is inherent in the principles of human factors and ergonomics. HFE can be described as a multi-disciplinary, user-centric ‘bundling science,’ in that it applies theory, principles, and data from many relevant disciplines to the design of work systems, taking into account the complex interactions between the human and other humans, the external environment, tools and equipment, and technology to enhance human performance and well-being (Wilson, 2000). The 2017 HFES Annual Conference panel addressed how to increase management’s perceived value of HFE by changing the focus of HFE from risk to enhanced employee wellbeing, performance and productivity. This panel furthers this discussion by addressing how HFE can increase its perceived value by partnering with other disciplines to solve a critical organizational problem. We use the example of the Mars spacecraft habitat design to illustrate how HFE and other disciplines can intersect to create a living, working and recreational space that supports astronaut health, wellbeing and performance. First, Mosier describes HFE’s increasing role in interdisciplinarity. Mosier also discusses habitat design from the perspective of team and psycho-social factors. Kennedy describes how architectural and engineering factors affect astronauts’ physiological and psychological well-being. Miller discusses the role automation and technology will play in habitat functioning to keep astronauts safe and healthy. Banks adds concepts of psychological need satisfaction through habitat design to maintain astronaut health and well-being. Imada closes the panel with the role of HFE in the design of suitable human interfaces and consideration of how all elements function together as an effective system. The audience will be invited to contribute their own ideas for how these different disciplines can work together with HFE to create a healthy and productive habitat.

A taxonomy of interactions in socio-technical systems: A functional perspective

Although the modelling of interactions has long been at the core of socio-technical systems theory, and is a key for understanding resilience, there is a lack of a holistic taxonomy of interactions. This study introduces a taxonomy of interactions to be used in association with the Functional Resonance Analysis Method (FRAM). The taxonomy has nine criteria: nature of agents, output nature, levelling, waiting time, distance, degree of coupling, visibility, safety and/or security hazards, and parallel replications. For each criterion, two descriptors are proposed: what the interaction looks like; and - when applicable - the variability level of the interaction. The use of the taxonomy is presented for three systems with clearly distinct complexity characteristics: cash withdrawal from an ATM, teaching a university course, and manufacturing operations. These case studies indicate the usefulness of the taxonomy for the identification of leverage points in work system design. They also show the value of modelling the variability of the interactions in FRAM models, in addition to the traditional modelling of the variability of the outputs of functions. Implications of the taxonomy for resilience engineering are discussed.

A Framework for Designing Work Systems in Industry 4.0

AbstractThe introduction of new digital technologies in industrial work systems and increasing implementation of Cyber Physical Systems are evoking new and unknown challenges and opportunities related to aspects of human work and organisation. To ensure human wellbeing and overall system productivity, there is a need for interdisciplinary methods and approaches for dealing with the challenges and taking advantage of the opportunities. In this paper, we present a conceptual framework for designing Industry 4.0 enabled work systems, which serves to accommodate this need. The framework combines elements and principles of Design- and Lean thinking methodologies and Human Factors and Ergonomics, thus making it a practical, systematic, and iterative, human centred approach. We use examples from a retrospective industrial case study to illustrate elements of the framework and provide several implications for practitioners.

Mapping the territory of renal care: a formative analysis of the cognitive work involved in managing acute kidney injury

The design and evaluation of healthcare work systems requires an understanding of the cognitive work involved in healthcare tasks. Previous studies suggest that a formative approach would be particularly useful to examine healthcare activities for this purpose. In the present study, methods from cognitive work analysis and cognitive task analysis are combined in a formative examination of managing acute kidney injury, an activity that occurs across primary and secondary healthcare settings. The analyses are informed by interviews with healthcare practitioners and a review of practice guidelines. The findings highlight ways in which the task setting influenced practitioners’ activity, and ways in which practitioners approached the activity (for example, how they used data to make decisions). The approach taken provided a rich understanding of the cognitive work involved, as well as generating suggestions for the design of work systems to support the clinical task.Practitioner summary: Healthcare tasks often require decision-making in complex and dynamic circumstances, potentially involving collaboration across different practitioner roles and locations. We demonstrate the use of a formative analysis to understand the cognitive work in managing a clinical syndrome across primary and secondary care settings, and consider the implications for work design.

ANALISIS SISTEM KERJA PRODUK SMOCK MENGGUNAKAN STUDI WAKTU DAN GERAKAN (STUDI KASUS PADA QUALITY CONTROL AND PACKING DEPARTMENT PT ACEPLAS INDONESIA)

For made to order company such as PT Aceplas Indonesia, meet the demand with the right quantity and quality is important. But unfortunately, the company was having trouble working part-time on QC and Packing which is one of the key delivery occurrences. Therefore, conducted an analysis of the work system by using time and motion study to find out the root of the problems that exist. From the results of the study obtained six principles of motion economy that does not match the work system. From a working system that is not suitable, a new work system design is made that is more in line with the economic motion. The results obtained that the new work system that adapts to the motion economy principle have smaller working time amounted to 88% for sealing and 28% for packing.

Internalization of the champion core values in work system design and ergonomics learning

This study aims to obtain the concrete example design of the learning outcomes based on internalization of synergy between the CHAMPION core values of Universitas Katolik Musi Charitas with KKNI of Ergonomics and Works System Design courses in Industrial Engineering Department. The CHAMPION core values are Charity, Humanity, Altruism, Managing-capacity, Persistence, Integrity, Open-minded, and Novelty. Internalization of CHAMPION core values in semester learning plans for ergonomics courses will provide distinctive features that differentiate them from other universities. The application of ergonomics that is synergized with the CHAMPION core values is very possible to produce the work system design of teaching and learning process that are reviewed systemic, holistic, interdisciplinary and participatory so that it has an impact on effective, confortable, safe, healty, efficient. Based on the research results, impact on learning outcomes; attitudes and values is 29,58%, general skills is14,79%, special skills is 33,80%, dan knowledge mastery is 21,83%. Three great interesting learning methods are; student centered learning is 39,47%, interaction / group discussion is 32,89%, and project based is 27,63%. Learning experience; task is 29%, compile papers is 27%, doing practice is 20%, survey or visit is 16%, and comparative study is 8%. Assesment criteria / rubric; assignment test as courses, projects, portfolios is 35,9%, written test is 30,9%, performance test is 16,9%, observation test is 7%, and participation test is 2,8%. Based on the data above designed a Semester Learning Plan for Work System Design and Ergonomics courses based on CHAMPION core values.

ACD3 as a framework for design of ergonomic workplaces.

Workplace Ergonomics and Human Factors (E/HF) remains as relevant and important as ever to respond to contemporary workplace design challenges. Therefore, E/HF expertise must be involved in early and appropriate phases of the workplace design process, in order to leverage user needs and requirements to constrain the proposed design solution. In this process, design decisions are made. The aim of this article is to describe the use of a systems-theoretical framework as a guide in collaborative workplace design, focussing on planning and documenting which decisions and activities should involve E/HF expertise. As this is a conceptual paper, its method is to synthesise a framework from a combination of design process methodology-, general systems theory- and sociotechnical systems literature. The framework organises the design decisions to be made into hierarchical abstraction levels and cross-cuts them into five perspectives from which the design problem can be viewed holistically. The ACD3 framework is intended as an enabler of many types of design, including the design of work systems. It provides a framework that allows all stakeholders to converge around design decisions that ensure that the work system is optimised to human characteristics and the activity to be performed.

A simulation-based approach for time allowances assessment during production system design with consideration of worker’s fatigue, learning and reliability

Health and safety of human operators in production systems is tightly linked to overall work system design. Well-designed production systems must grant adequate allowances to operators, to cope with the variability of predictable situations, whether normal or not. In this article, time allowances concept is presented from two standpoints: industrial engineering and occupational risk prevention field. This is followed by an introduction of a new time allowances indicator. Combined with an agent-based simulation model, this indicator can be used to assess time allowances in a given work organization during its design process. The proposed model integrates worker’s fatigue, learning and reliability as relevant human factors. To uphold the article proposal, three production system configurations are investigated: a classical production line designed based on Ford work paradigm, a cellular configuration with autonomous breaks, inspired from Volvo Uddevalla plant and finally, a hybrid configuration, cellular with planned breaks. The simulations showed that cellular configuration with autonomous breaks grants to operators the time allowances they need to carry out their work activity safely and efficiently.

Inflammation-Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing "the Epidemic" of Chronic Diseases.

Siloed or singular system approach to disease management is common practice, developing out of traditional medical school education. Textbooks of medicine describe a huge number of discrete diseases, usually in a systematic fashion following headings like etiology, pathology, investigations, differential diagnoses, and management. This approach suggests that the body has a multitude of ways to respond to harmful incidences. However, physiology and systems biology provide evidence that there is a simple mechanism behind this phenotypical variability. Regardless if an injury or change was caused by trauma, infection, non-communicable disease, autoimmune disorders, or stress, the typical physiological response is: an increase in blood supply to the area, an increase in white cells into the affected tissue, an increase in phagocytic activity to remove the offending agent, followed by a down-regulation of these mechanisms resulting in healing. The cascade of inflammation is the body‘s unique mechanism to maintain its integrity in response to macroscopic as well as microscopic injuries. We hypothesize that chronic disease development and progression are linked to uncontrolled or dysfunctional inflammation to injuries regardless of their nature, physical, environmental, or psychological. Thus, we aim to reframe the prevailing approach of management of individual diseases into a more integrated systemic approach of treating the “person as a whole,” enhancing the patient experience, ability to a make necessary changes, and maximize overall health and well-being. The first part of the paper reviews the local immune cascades of pro- and anti-inflammatory regulation and the interconnected feedback loops with neural and psychological pathways. The second part emphasizes one of nature's principles at work—system design and efficiency. Continually overwhelming this finely tuned system will result in systemic inflammation allowing chronic diseases to emerge; the pathways of several common conditions are described in detail. The final part of the paper considers the implications of these understandings for clinical care and explore how this lens could shape the physician-patient encounter and health system redesign. We conclude that healthcare professionals must advocate for an anti-inflammatory lifestyle at the patient level as well as at the local and national levels to enhance population health and well-being.

Towards an Understanding of Informal Care Networks of Persons with Dementia: Perceptions of Primary Caregivers

Introduction Although an understanding of the patient work system has been increasing in the field of Ergonomics and Human Factors, the role of informal caregivers (unpaid, nonprofessional caregivers) within the patient work system remains largely unexplored (Holden, Schubert, & Mickelson, 2015; Holden, Valdez, Schubert, Thompson, & Hundt, 2017). Informal caregivers include the family members and friends of persons with dementia (PwD), or anyone else who is unpaid, and a non-professional caregiver for a PWD(Reinhard, Given, Petlick, & Bemis, 2008). Nevertheless, informal caregivers are often unsupported and lack guidance with caregiving activities(Alrashed, 2017; Bossen, Christensen, Grönvall, & Vestergaard, 2013). This study represents a first step to define the work of informal caregivers, identify variations in caregiver involvement across multiple caregivers, and explore the perceptions of the primary caregiver (PC) regarding the care network. Understanding the specific roles and work associated with providing care can help us to support and prepare future and current informal caregivers on how to overcome barriers in the work system and increase quality of care for the PwD. Methods Semi-structured interviews were used to encourage 20 self- identified primary caregivers to discuss their daily experiences in providing care to a PwD. Interview questions related to: 1) the daily activities of informal caregivers; 2) the strategies, tools, and resources used and developed by informal caregivers to manage caregiving responsibilities; 3) unmet needs in providing care; and 4) the context in which informal caregiving occurred. We used a thematic analysis with the goal of understanding informal caregiving roles in the PwD work system. Guided by the research questions, structural coding of passages in the transcripts was performed by two members of the research team. The team also mapped the caregiver networks to understand the differences in each role network level. Results The results revealed that the work of informal caregivers of PwD consists of a wide range of tasks that can be physically challenging as well as mentally and emotionally burdensome. Our analysis also revealed distinct variations in care networks and primary caregiver perceptions of other themes: 1) informal caregivers operate at three role levels of care within the care network; 2) PwD care networks vary greatly in size and relationships, and 3) PCs act as gatekeepers to the care network. Caregivers were mapped across three levels of the PwD's care network based on frequency of interactions with the PC and PwD, communication patterns, and contributions to the care activities. Care networks varied between 2 and 11 caregivers who contributed to the care activities in some capacity. The relationships between caregivers and PwD varied greatly, including spouses, children, siblings, neighbors, and volunteers. Further, we found that there is usually one PC for every PwD. The PC acts as a gatekeeper to the care network by regulating interactions between other caregivers and the PwD. The PC also had different expectations for each caregiver based on their relationship to the PwD. Discussion This research presents preliminary findings on the roles of informal caregivers of persons with dementia. These results warrant further investigation into role delineation, primary, secondary, and tertiary caregiver expectations, and the full conceptualization of caregiver work. A formal network analysis that maps caregiver activities to specific roles may be beneficial to understand all the contributions to the care network. These findings are valuable to inform patient work system design in informal care settings. Currently, there is a lack of guidance on how informal caregivers should coordinate care for patients with chronic illness in their homes, and a lack of support for these informal care activities. Defining caregiver work and understanding caregiver perceptions of work can pave a path towards designing better patient work systems to connect the network more efficiently, while improving care quality in informal settings.

PV water pumping systems for domestic uses in remote areas: Sizing process, simulation and economic evaluation

Abstract PV water pumping technology is recognized as a sustainable and environmentally friendly solution to provide water for domestic use. The appropriate design and smooth operation mostly rely on available solar irradiation, domestic water demand and appropriate configuration of the proposed system. Therefore, the aim of this work is to examine an optimum PV system configuration that is capable of supplying a solar submersible pump system to fulfill domestic water needs of five isolated houses located in a Moroccan remote area. A detailed approach for the design of an optimized PV water pumping system based on real water usage data is proposed. Besides, system design work and performance assessment were carried out based on hourly climatic conditions. Overall, two approaches were investigated for an optimum design of the proposed system. Annual simulations indicated that the direct coupling, as a first option, appears to be unfitting configuration for water pumping in this case. In turn, results proved that second system including a MPPT DC converter with less PV arrays could pump more water and its performance remarkably surpassed the direct coupling configuration. In addition, economic analysis has shown that proposed systems are cost competitive against the conventional water supply methods.

From the seat to the system: Re-designing a tram drivers' workstation combining technical and contextual aspects

Through the detailed account of a design case-study, the paper aims to demonstrate how the activity-oriented approach promotes a systems perspective in ergonomics interventions. Specifically, by presenting an activity-oriented re-design of a tram drivers' workstation, it is shown: (i) how technical and contextual aspects were jointly considered, (ii) how their combination affects workers' activity in a non-trivial manner, and (iii) how this system level view helped generate feasible and sustainable design solutions. First, the activity-oriented theoretical lens is briefly presented, followed by the analysis of the tram driving activity, emphasizing on drivers' efforts to compensate for the original work-system design flaws. Next, key elements of the re-design process are presented, through a concept map, combining technical and contextual aspects, coupled with an account of stakeholder debates and resolution processes. The paper ends with a discussion on the lessons learned, concerning the adopted approach for design interventions in real work situations.

Proactive, Transdisciplinary Safer-System Redesign. A Field Report from the Hospital Frontline

OCCUPATIONAL APPLICATIONS Safety science disciplines, such as Systems Engineering, Human Factors and Ergonomics, or Design Thinking, promise to deliver a breakthrough in proactive, safer systems redesign. But what does the work with clinicians look like when redesigning systems for safer, more effective patient-centered care? The Stanford Health Care Advancing Patient Safety Program is trailblazing by integrating safety science experts and systems designers into clinical practice. This application report provides an overview of the structure, the approach, and methodology, as well as the lessons learned of the program. Two use case examples of analyzing and redesigning complex clinical work systems—the safe administration of blood and blood products and the standardization of set-up and management of cerebrospinal fluid drainage systems—demonstrate the successful application of the human-centered design approach in clinical settings.TECHNICAL ABSTRACT Background (or Rationale): Today, most healthcare systems can be described as “compliant organizations.” However, as the patient safety movement continues to prosper, many scholars have proposed to evolve from a reactive approach toward a more proactive one that better addresses risks for preventable harm. Purpose: Proactive organizations aim to achieve resilience. Stanford Health Care is trailblazing by integrating safety science experts into clinical practice who work in tandem with clinicians to proactively design work systems for safer, more effective, patient-centered care. Methods: Adapting the human-centered design approach, a transdisciplinary team of engineers, physicians, and nurses utilizes an array of methods and tools to identify and analyze systems-related issues proactively and comprehensively, to search for and test a variety of solutions, to select the best options, implement solutions successfully, and to monitor sustainability of improvement. Results: The team-conducted projects, e.g., to improve blood administration and to standardize set-up and management of cerebrospinal fluid drainage systems. Our accomplishments so far, include the systematic examination and comprehensive description of clinical work systems, their components and interactions, successful collaboration with clinical and support services throughout the organization, and the redesign of IT systems, medical devices, and nursing procedures. The efforts also led to price reductions by 50% for a single medical device. Since the completion of the projects, we have had no related adverse patient event, no associated litigation, and the nursing and service-quality indicators are within the satisfactory target range. Conclusions: The SHC Advancing Patient Safety Program is a novel endeavor that analyzes systems issues in an organization-wide manner, executes improvement work in a comprehensive and integrated fashion, is a conduit for innovation, and is a medium for breaking through boundaries and silos thus fostering deeper collaboration among disciplines.