Human Factors Engineering Methods Research Articles

Usability barriers and facilitators of a human factors engineering-based clinical decision support technology for diagnosing pulmonary embolism

BackgroundHealth IT, such as clinical decision support (CDS), has the potential to improve patient safety. However, poor usability of health IT continues to be a major concern. Human factors engineering (HFE) approaches are recommended to improve the usability of health IT. Limited evidence exists on the actual impact of HFE methods and principles on the usability of health IT. ObjectiveTo identify and describe the usability barriers and facilitators of an HFE-based CDS prior to implementation in the emergency department (ED). MethodsWe conducted debrief interviews with 32 emergency medicine physicians as a part of a scenario-based simulation study evaluating the usability of the HFE-based CDS. We performed a deductive content analysis of the interviews using the usability criteria of Scapin and Bastien as a framework. ResultsWe identified 271 occurrences of usability barriers (94) and facilitators (177) of the HFE-based CDS. For instance, we found a facilitator relating to the usability criteria prompting as the PE Dx helps the physician order diagnostic tests following the risk assessment. We found the most facilitators relating to the criteria, minimal actions, e.g. as the PE Dx automatically populates vitals signs (e.g., heart rate) from the chart into the CDS. The majority of the usability barriers related to the usability criteria, compatibility (i.e., workflow integration), which was not explicitly considered in the HFE design of the CDS. For example, the CDS did not support resident and attending physician teamwork in the PE diagnostic process. ConclusionThe systematic use of HFE principles in the design of CDS improves the usability of these technologies. In order to further reduce usability barriers, workflow integration should be explicitly considered in the design of health IT.

Reshaping Human Factors Education in Times of Big Data: Practitioner Perspectives

Human Factors Engineering (HFE) is an applied discipline that uses a wide range of methodologies to better the design of systems and devices for human use. Underpinning all human factors design is the maxim to fit the human to the task/machine/system rather than vice versa. While some HFE methods such as task analysis and anthropometrics remain relatively fixed over time, areas such as human-technology interaction are strongly influenced by the fast-evolving technological trend. In times of big data, human factors engineers need to have a good understanding of topics like machine learning, advanced data analytics, and data visualization so that they can design data-driven products that involve big data sets. There is a natural lag between industrial trends and HFE curricula, leading to gaps between what people are taught and what they will need to know. In this paper, we present the results of a survey involving HFE practitioners (N=101) and we demonstrate the need for including data science and machine learning components in HFE curricula.

Applying Human Factors Engineering Methods for Risk Assessment of a Neonatal Incubator.

This research aimed to find main users, frequent utilized tasks, major usability problems, and the context of use of a neonatal incubator (NI) present in a neonatal intensive care unit from a Brazilian hospital and to find out the problems faced by a new user. The chosen methods were the heuristics analysis, contextual investigation, and usability test (UT). Nurses and technicians are the main users of NIs. The predominant contexts of use are the admission of newborns and the replacement of the equipment. Eight selected tasks were performed in the UT, and the most significant problems refer to alarms and configuration of the Air and Skin Modes, because the interface is not intuitive to novice users. Therefore, mitigating errors should be an investment in human factor engineering methods from the beginning of the product development process to the training of the main users.

Applying human factors engineering methods for hazard identification and mitigation in the radiotherapy process

The radiotherapy process is complex, and there is potential for inappropriate treatment delivery. Human Factors Engineering (HFE) studies interactions between people and systems to improve those relations. Therefore, by using HFE methods, this study analyzes the relations between radiotherapists and their work and limitations in a Brazilian hospital to contribute to hazard mitigation and safety. Results show safety hazards regarding usability and ergonomic issues such as discomfort, distraction, mental fatigue, protocol non-compliance, and errors. That may induce errors of treating the wrong patient, applying radiation to the wrong part of the patient’s body and causing harm. The combination of HFE methods was fundamental to the identification of safety hazards as they involve precisely the multifactorial characteristics of the process, i.e., the relationship among human, technologies, organization, environment and tasks. Hence, safety hazard mitigation depends on everyone involved in the treatment delivery.

Role of Human Factors Engineering in Infection Prevention: Gaps and Opportunities.

Opinion statementHuman factors engineering (HFE), with its focus on studying how humans interact with systems, including their physical and organizational environment, the tools and technologies they use, and the tasks they perform, provides principles, tools, and techniques for systematically identifying important factors, for analyzing and evaluating how these factors interact to increase or decrease the risk of Healthcare-associated infections (HAI), and for identifying and implementing effective preventive measures. We reviewed the literature on HFE and infection prevention and control and identified major themes to document how researchers and infection prevention staff have used HFE methods to prevent HAIs and to identify gaps in our knowledge about the role of HFE in HAI prevention and control. Our literature review found that most studies in the healthcare domain explicitly applying (HFE) principles and methods addressed patient safety issues not infection prevention and control issues. In addition, most investigators who applied human factors principles and methods to infection prevention issues assessed only one human factors element such as training, technology evaluations, or physical environment design. The most significant gap pertains to the limited use and application of formal HFE tools and methods. Every infection prevention study need not assess all components in a system, but investigators must assess the interaction of critical system components if they want to address latent and deep-rooted human factors problems.

The Authors Reply

Urinary tract infections (UTIs) are the most commonly reported health care–associated infection (HAI) in the United States. Among UTIs acquired in the hospital, approximately 75% are associated with urinary catheters, with an estimated 15%–25% of all hospitalized patients receiving urinary catheters during their hospitalization. Despite ambitious national goals to reduce these infections, catheter-associated urinary tract infection (CAUTI) has not decreased in the United States.Systems engineering (SE) and human factors engineering (HFE) methods were used to reduce urinary catheter utilization and CAUTIs in a three-year (June 1, 2012–May 31, 2015) quality improvement project in a 610-bed academic medical center. These methods were used to define the factors leading to CAUTI and promote standardization of urinary catheter utilization, insertion, and maintenance.The total systemwide CAUTI count decreased from 135 cases at baseline to 74 cases at the end of the project’s Year 1, to 59 cases at the end of Year 2, and 25 cases at the end of Year 3—alone, an 81.5% reduction from baseline. The control chart showed a steady decline in the CAUTI count within a few months after the project’s start. By the end of Year 3, on the basis of an average attributable-per-patient cost of CAUTI ($1,007 per case), the estimated annual avoidable CAUTI costs decreased from approximately $135,945 to $25,175 per year. Urinary catheter utilization decreased by 27.3% during the same three-year period, and the systemwide CAUTI standardized infection ratio (SIR) decreased from 3.2 to 0.51 (84.1% from baseline).SE and HFE methods and principles can effectively decrease urinary catheter utilization and CAUTI incidence in an academic medical center hospital environment.

Adverse Outcome Index

Urinary tract infections (UTIs) are the most commonly reported health care–associated infection (HAI) in the United States. Among UTIs acquired in the hospital, approximately 75% are associated with urinary catheters, with an estimated 15%–25% of all hospitalized patients receiving urinary catheters during their hospitalization. Despite ambitious national goals to reduce these infections, catheter-associated urinary tract infection (CAUTI) has not decreased in the United States.Systems engineering (SE) and human factors engineering (HFE) methods were used to reduce urinary catheter utilization and CAUTIs in a three-year (June 1, 2012–May 31, 2015) quality improvement project in a 610-bed academic medical center. These methods were used to define the factors leading to CAUTI and promote standardization of urinary catheter utilization, insertion, and maintenance.The total systemwide CAUTI count decreased from 135 cases at baseline to 74 cases at the end of the project’s Year 1, to 59 cases at the end of Year 2, and 25 cases at the end of Year 3—alone, an 81.5% reduction from baseline. The control chart showed a steady decline in the CAUTI count within a few months after the project’s start. By the end of Year 3, on the basis of an average attributable-per-patient cost of CAUTI ($1,007 per case), the estimated annual avoidable CAUTI costs decreased from approximately $135,945 to $25,175 per year. Urinary catheter utilization decreased by 27.3% during the same three-year period, and the systemwide CAUTI standardized infection ratio (SIR) decreased from 3.2 to 0.51 (84.1% from baseline).SE and HFE methods and principles can effectively decrease urinary catheter utilization and CAUTI incidence in an academic medical center hospital environment.

Viewing Prevention of Catheter-Associated Urinary Tract Infection as a System: Using Systems Engineering and Human Factors Engineering in a Quality Improvement Project in an Academic Medical Center

Urinary tract infections (UTIs) are the most commonly reported health care-associated infection (HAI) in the United States. Among UTIs acquired in the hospital, approximately 75% are associated with urinary catheters, with an estimated 15%-25% of all hospitalized patients receiving urinary catheters during their hospitalization. Despite ambitious national goals to reduce these infections, catheter-associated urinary tract infection (CAUTI) has not decreased in the United States. Systems engineering (SE) and human factors engi- neering (HFE) methods were used to reduce urinary catheter utilization and CAUTIs in a three-year (June 1, 2012-May 31, 2015) quality improvement project in a 610-bed academic medical center. These methods were used to define the factors leading to CAUTI and promote standardization of urinary catheter utilization, insertion, and maintenance. The total systemwide CAUTI count decreased from 135 cases at baseline to 74 cases at the end of the project's Year 1, to 59 cases at the end of Year 2, and 25 cases at the end of Year 3-alone, an 81.5% reduction from baseline. The control chart showed a steady decline in the CAUTI count within a few months after the project's start. By the end of Year 3, on the basis of an average attributable-per-patient cost of CAUTI ($1,007 per case), the estimated annual avoidable CAUTI costs decreased from approximately $135,945 to $25,175 per year. Urinary catheter utilization decreased by 27.3% during the same three-year period, and the systemwide CAUTI standardized infection ratio (SIR) decreased from 3.2 to 0.51 (84.1% from baseline). SE and HFE methods and principles can effectively decrease urinary catheter utilization and CAUTI incidence in an academic medical center hospital environment.

Application of human factors engineering (HFE) to the design of a naloxone auto-injector for the treatment of opioid emergencies

The increased use of opioids for chronic treatment of pain and the resulting epidemic of opioid overdoses have created a major public health challenge. Parenteral naloxone has been used since the 1970’s to treat opioid overdose. Recently, a novel naloxone auto-injector device (EVZIO, kaleo, Inc., Richmond, VA) was approved by the Food and Drug Administration. In this article, we review the Human Factors Engineering (HFE) process used in the development and testing of this novel naloxone auto-injector currently used in nonmedical settings for the emergency treatment of known or suspected opioid overdose. HFE methods were employed throughout the product development process for the naloxone auto-injector including formative and summative studies in order to optimize the auto-injector’s user interface, mitigate use-related hazards and increase reliability during an opioid emergency use scenario. HFE was also used to optimize the product’s design and user interface in order to reduce or prevent user confusion and misuse. The naloxone auto-injector went through a rigorous HFE process that included perceptual, cognitive, and physical action analysis; formative usability evaluations; use error analysis and summative design validation studies. Applying HFE resulted in the development of a product that is safe, fast, easy and predictably reliable to deliver a potentially life-saving dose of naloxone during an opioid overdose emergency. The naloxone auto-injector may be considered as a universal precaution option for at-risk patients prescribed opioids or those who are at increased risk for an opioid overdose emergency.

Improving Quality and Safety through Human Factors Collaborations with Healthcare

Multiple reports from the Institute of Medicine and the National Academy of Engineering, (IOM 2001; Reid et al., 2005; Kaplan et al., 2013) have called for the use of human factors engineering (HFE) and systems engineering principles and methods/tools to improve health care delivery. Yet, the integration of engineers into health care settings and the education of clinicians and other health care professionals on human factors and systems engineering principles and methods/tools remain in its infancy. A recent editorial by Xiao and Fairbanks (2011), discusses a small, but growing presence of professionals who are “bilingual” in both human factors and medicine. Indeed, Carayon (2011) identified human factors as an innovation that will require diffusion into healthcare through the use of HFE methods and tools, increasing the health care professional knowledge of HFE, and the hiring HFEs in healthcare organizations. To achieve the goal of integration, there will be many “models” of healthcare – human factors collaborations, from experts working together from their different ‘silos’ to true bilingualism. SEIPS, the Systems Engineering Initiative for Patient Safety (Carayon et al., 2006), aims to integrate human factors and systems engineering with healthcare disciplines. Our panel of SEIPS-affiliated engineers and healthcare professionals represents many different types of collaborations across this spectrum and their work spans multiple healthcare settings and disciplines, including: ambulatory primary care, inpatient pediatrics, community pharmacy, and oncology.

Human Factors Engineering in Patient Safety

Human Factors Engineering in Patient Safety

Updating Human Factors Engineering Guidelines For Conducting Safety Reviews of Nuclear Power Plants

The U.S. Nuclear Regulatory Commission (NRC) reviews the human factors engineering (HFE) programs of applicants for nuclear power plant construction permits, operating licenses, standard design certifications, and combined operating licenses. The purpose of these safety reviews is to help ensure that personnel performance and reliability are appropriately supported. Detailed design review procedures and guidance for the evaluations is provided in three key documents: the Standard Review Plan (NUREG-0800), the HFE Program Review Model (NUREG-0711), and the Human-System Interface Design Review Guidelines (NUREG-0700). These documents were last revised in 2007, 2004 and 2002, respectively. The NRC is committed to the periodic update and improvement of the guidance to ensure that it remains a state-of-the-art design evaluation tool. To this end, the NRC is updating its guidance to stay current with recent research on human performance, advances in HFE methods and tools, and new technology being employed in plant and control room design. This paper describes the role of HFE guidelines in the safety review process and the content of the key HFE guidelines used. Then we will present the methodology used to develop HFE guidance and update these documents, and describe the current status of the update program.

Improving Employment Outcomes of Breast Cancer Survivors: Development of a Web-Based Educational and Decision Support Tool

A major consequence of surviving cancer is that treatment-related symptoms can persist and result in work disability. This problem will continue to escalate as treatment becomes more successful and the workforce ages. Employment is a critical component of quality of life, yet no effective intervention exists to improve employment outcomes following a cancer diagnosis. An innovative, interdisciplinary approach to improve work ability was used to develop a web-based, information support system for breast cancer survivors. Strategies from human factors engineering (HFE), decision support, and oncology symptom management were used to develop the WISE (Work ability Improvement through Symptom management and Ergonomic education), a survivor-centered intervention. The conceptual framework for the WISE is based on a macroergonomics work systems model that evaluates aspects of the work system and its interaction with the individual. The content and format of the WISE is based on recommendations from subject matter experts and end users. Application of HFE methods may empower survivors to maximize employment and economic self-sufficiency. The purpose of this poster presentation is to report on the content development and refinement of the WISE.

Color-Coding and Human Factors Engineering to Improve Patient Safety Characteristics of Paper-Based Emergency Department Clinical Documentation

Investigators studied an emergency department (ED) physical chart system and identified inconsistent, small font labeling; a single-color scheme; and an absence of human factors engineering (HFE) cues. A case study and description of the methodology with which surrogate measures of chart-related patient safety were studied and subsequently used to reduce latent hazards are presented. Medical records present a challenge to patient safety in EDs. Application of HFE can improve specific aspects of existing medical chart organization systems as they pertain to patient safety in acute care environments. During 10 random audits over 5 consecutive days (573 data points), 56 (9.8%) chart binders (range 0.0-23%) were found to be either misplaced or improperly positioned relative to other chart binders; 12 (21%) were in the critical care area. HFE principles were applied to develop an experimental chart binder system with alternating color-based chart groupings, simple and prominent identifiers, and embedded visual cues. Post-intervention audits revealed significant reductions in chart binder location problems overall (p < 0.01), for Urgent Care A and B pods (6.4% to 1.2%; p < 0.05), Fast Track C pod (19.3% to 0.0%; p < 0.05) and Behavioral/Substance Abuse D pod (15.7% to 0.0%; p < 0.05) areas of the ED. The critical care room area did not display an improvement (11.4% to 13.2%; p = 0.40). Application of HFE methods may aid the development, assessment, and modification of acute care clinical environments through evidence-based design methodologies and contribute to safe patient care delivery.

IDENTIFICATION AND EVALUATION OF HUMAN FACTORS ISSUES ASSOCIATED WITH EMERGING NUCLEAR PLANT TECHNOLOGY

This study has identified human performance research issues associated with the implementation of new technology in nuclear power plants (NPPs). To identify the research issues, current industry developments and trends were evaluated in the areas of reactor technology, instrumentation and control technology, human-system integration technology, and human factors engineering (HFE) methods and tools. The issues were prioritized into four categories based on evaluations provided by 14 independent subject matter experts representing vendors, utilities, research organizations and regulators. Twenty issues were categorized into the top priority category. The study also identifies the priority of each issue and the rationale for those in the top priority category. The top priority issues were then organized into research program areas of: New Concepts of Operation using Multi-agent Teams, Human-system Interface Design, Complexity Issues in Advanced Systems, Operating Experience of New and Modernized Plants, and HFE Methods and Tools. The results can serve as input to the development of a long-term strategy and plan for addressing human performance in these areas to support the safe operation of new NPPs.

Conclusion: You Need Human Factors Engineering Expertise to See Design Hazards That Are Hiding in “Plain Sight!”

The Human Factors Engineering (HFE) series was launched to share the ideas and methods to aid deeper analyses of adverse events and provide tools to ensure more effective and lasting therapies. Articles in the series showed how human limitations and capabilities were important design issues in a variety of areas, ranging from labels and warnings to work place design and complex decision support systems. After reading all the articles, one might ask a number of questions, such as who made all our "puzzle rooms?" How did it happen that so many device components "masquerade" as each other yet perform very distinct functions? What are the procurement systems that gave us medication containers, tubing, and connectors that are hard to see and easy to misconnect? Behind all those questions remains a key query: what stands in the way of developing or hiring the expertise to see and fix these catastrophic design hazards "hiding in plain sight?" HFE has already found its way into health care organizations and industry. As with most large changes in professions and industries, many small steps will need to be taken toward applying HFE methods and principles to the large problems of patient safety. But there already ample incentives and tools to start transforming your health care delivery or manufacturing organization.

Human Factors Engineering Technology Integration into the Naval Ship Acquisition Process

A Navy surface ship represents one of the most complex man-machine systems in existence today. Performance capabilities of personnel required in the propulsion systems, weapon systems, command-control systems, operations systems, supply systems and auxiliary systems should demand that human factors engineering (HFE) receive primary consideration in the design of ships. And yet there is no formal HFE program for ship acquisition. HFE responsibilities are not integrated with each other or with ship systems engineering efforts. There is little or no standardization of HFE methods and data beyond that provided in the design work study approach. Finally, HFE has no formal status within the ship acquisition process. The Navy Sea Systems Command recently moved to correct these problems in implementation of HFE for ships. A ship HFE technology program has been established which has as its primary objectives the integration of available applicable HFE techniques, methods, principles and data into the ship acquisition process. The effort to integrate HFE technology into the ship acquisition process began with a definition of the process itself, with emphasis on the specific events and milestones within the process. The next step entailed identification of HFE requirements appropriate for each event. HFE requirements were described in terms of activities to be completed and products to be provided to the ship design effort. HFE requirements were developed for five major functional areas: manning and training, design for operability, design for maintainability, design for habitability, and test and evaluation. After identification of HFE requirements in each of these areas, determinations were made of the degree to which available HFE technologies were appropriate to satisfy the requirements. HFE technologies consisted of HFE principles, data, methods and techniques which have been reported in the HFE literature. These technology assessments represented the best estimates of the research team concerning the applicability of available technologies for specific HFE requirements.