Human Factors Science Research Articles

WORKING TOGETHER TO DELIVER SAFE CARE

Throughout this four-part Advancing Practice series, we have explored the science and practice of human factors and ergonomics in healthcare, and how a systems approach can support maternity, midwifery care and patient safety. In this final article, we explore the Maternity Support Worker (MSW) role and how registered midwives and MSWs can work together to support the delivery of safe and efficient maternity care. The reflection points in this article are adapted from NHS Education for Scotland’s Safety Culture Discussion Cards.1 In this series, we hope to support an improved understanding of the current maternity safety landscape.

New research paradigms and agenda of human factors science in the intelligence era

New research paradigms and agenda of human factors science in the intelligence era

Informing Healthcare Alarm Design and Use: A Human Factors Cross-Industry Perspective

Background: Alarms are signals intended to capture and direct human attention to a potential issue that may require monitoring, assessment, or intervention and play a critical safety role in high-risk industries. Healthcare relies heavily on auditory and visual alarms. While there are some guidelines to inform alarm design and use, alarm fatigue and other alarm issues are challenges in the healthcare setting. Automotive, aviation, and nuclear industries have used the science of human factors to develop alarm design and use guidelines. These guidelines may provide important insights for advancing patient safety in healthcare. Methods: We identified documents containing alarm design and use guidelines from the automotive, aviation, and nuclear industries that have been endorsed by oversight agencies. These guidelines were reviewed by human factors and clinical experts to identify those most relevant to healthcare, qualitatively analyze the relevant guidelines to identify meaningful topics, synthesize the guidelines under each topic to identify key commonalities and differences, and describe how the guidelines might be considered by healthcare stakeholders to improve alarm design and use. Results: A total of 356 guidelines were extracted from industry documents (2012–present) and 327 (91.9%) were deemed relevant to healthcare. A qualitative analysis of relevant guidelines resulted in nine distinct topics: Alarm Reduction, Appropriateness, Context-Dependence, Design Characteristics, Mental Model, Prioritization, Specificity, Urgency, and User Control. There were several commonalities, as well as some differences, across industry guidelines. The guidelines under each topic were found to inform the auditory or visual modality, or both. Certain guidelines have clear considerations for healthcare stakeholders, especially technology developers and healthcare facilities. Conclusion: Numerous guidelines from other high-risk industries can inform alarm design and use in healthcare. Healthcare facilities can use the information presented as a framework for working with their technology developers to appropriately design and modify alarming technologies and can evaluate their clinical environments to see how alarming technologies might be improved.

Human factors in anaesthesia: a narrative review.

Healthcare relies on high levels of human performance, as described by the 'human as the hero' concept. However, human performance varies and is recognised to fall in high-pressure situations, meaning that it is not a reliable method of ensuring safety. Other safety-critical industries embed human factors principles into all aspects of their organisations to improve safety and reduce reliance on exceptional human performance; there is potential to do the same in anaesthesia. Human factors is a broad-based scientific discipline which aims to make it as easy as possible for workers to do things correctly. The human factors strategies most likely to be effective are those which 'design out' the chance of an error or adverse event occurring. When errors or adverse events do happen, barriers are in place to trap them and reduce the risk of progression to patient and/or worker harm. If errors or adverse events are not trapped by these barriers, mitigations are in place to minimise the consequences. Non-technical skills form an important part of human factors barriers and mitigation strategies and include: situation awareness; decision-making; task management; and team working. Human factors principles are not a substitute for proper investment and appropriate staffing levels. Although applying human factors science has the potential to save money in the long term, its proper implementation may require investment before reward can be reaped. This narrative review describes what is known about human factors in anaesthesia to date.

Implementing human factors in anaesthesia: guidance for clinicians, departments and hospitals: Guidelines from the Difficult Airway Society and the Association of Anaesthetists: Guidelines from the Difficult Airway Society and the Association of Anaesthetists.

Human factors is an evidence-based scientific discipline used in safety critical industries to improve safety and worker well-being. The implementation of human factors strategies in anaesthesia has the potential to reduce the reliance on exceptional personal and team performance to provide safe and high-quality patient care. To encourage the adoption of human factors science in anaesthesia, the Difficult Airway Society and the Association of Anaesthetists established a Working Party, including anaesthetists and operating theatre team members with human factors expertise and/or interest, plus a human factors scientist, an industrial psychologist and an experimental psychologist/implementation scientist. A three-stage Delphi process was used to formulate a set of 12 recommendations: these are described using a 'hierarchy of controls' model and classified into design, barriers, mitigations and education and training strategies. Although most anaesthetic knowledge of human factors concerns non-technical skills, such as teamwork and communication, human factors is a broad-based scientific discipline with many other additional aspects that are just as important. Indeed, the human factors strategies most likely to have the greatest impact are those related to the design of safe working environments, equipment and systems. While our recommendations are primarily provided for anaesthetists and the teams they work with, there are likely to be lessons for others working in healthcare beyond the speciality of anaesthesia.

Shape Matters: A Neglected Feature of Medication Safety : Why Regulating the Shape of Medication Containers Can Improve Medication Safety.

This paper aims to highlight how to reduce medication errors through the implementation of human factors science to the design features of medication containers. Despite efforts to employ automation for increased safety and decreased workload, medication administration in hospital wards is still heavily dependent on human operators (pharmacists, nurses, physicians, etc.). Improving this multi-step process requires its being studied and designed as an interface in a complex socio-technical system. Human factors engineering, also known as ergonomics, involves designing socio-technical systems to improve overall system performance, and reduces the risk of system, and in particular, operator, failures. The incorporation of human factors principles into the design of the work environment and tools that are in use during medication administration could improve this process. During periods of high workload, the cognitive effort necessary to work through a very demanding process may overwhelm even expert operators. In such conditions, the entire system should facilitate the human operator's high level of performance. Regarding medications, clinicians should be provided with as many perceptual cues as possible to facilitate medication identification. Neglecting the shape of the container as one of the features that differentiates between classes of medications is a lost opportunity to use a helpful characteristic, and medication administration failures that happen in the absence of such intentional design arise from "designer error" rather than "user error". Guidelines that define a container's shape for each class of medication would compel pharmaceutical manufacturers to be compatible and would eliminate the confusion that arises when a hospital changes the supplier of a given medication.

Improving Healthcare Practice Through the Implementation of Human Factors and Ergonomics Principles.

Present a collection of papers focusing on improving healthcare practice through the implementation of human factors and ergonomics principles that were presented at the International Ergonomics Association (IEA) 2021 international conference. The mission of the IEA is to elaborate and advance ergonomics science and practice and to expand its scope of application. We reviewed papers that were submitted for presentation at the IEA 2021 international conference and focused on improving healthcare practice through the implementation of human factors and ergonomics principles. The eight papers that are included in this special issue cover varied aspects of human factors application and implementation. This special issue provides clear evidence that the science of human factors is relevant and is continuing to grow and so is its implementation in healthcare. This special issue offers a selection of applied works, providing a wide scope of human factors guidelines, methods, and theories in healthcare work environments.

Promoting Clinician Well-Being and Patient Safety Using Human Factors Science: Reducing Unnecessary Occupational Stress

Our healthcare delivery system has accumulated complexity of payment, regulation systems, expectations and requirements. Often these are not designed to align with clinical thinking process flow of patient care. As a result, clinicians are utilizing enormous mental (cognitive) resource to comply with these complexities, over and above the baseline mental effort required to give good care to the patient. Recent studies suggest a significant number of physicians, advanced practice providers and nurses no longer want to stay in healthcare due to difficult work expectations and conditions that have become unreasonable. Technology has benefitted healthcare delivery, but also is a conduit of many expectations that have been grafted upon clinician workloads, exceeding the resources provided to accomplish them. Cognitive load is a measure of mental effort and is divided into Intrinsic, Germane and Extraneous Cognitive Load. Extraneous Cognitive Load (ECL) is what is not necessary and can be removed by better design. High cognitive load is associated with increased risk of both medical error and clinician burnout. Chronic high level occupational stress occurs from dealing with this job/resource imbalance and is showing serious personal health impact upon clinicians and the quality of the work they can provide for patients. Since organizational systems have become more complex, leadership methods, clinician wellbeing and patient safety efforts need to adjust to adapt and succeed. Safety efforts have tended to predominantly follow methods of a few decades ago with predominant focus upon how things go wrong (Safety I) but are now being encouraged to include more of the study of how things go right (Safety II). Human Factors/Ergonomics (HFE) science has been used in many industries to preserve worker wellbeing and improve system performance. Patient safety is a product of good system performance. HFE science helps inform mechanisms behind Safety I and II approach. HFE concepts augment existing burnout and safety interventions by providing a conceptual roadmap to follow that can inform how to improve the multiple human/technology, human/system, and human/work environment interfaces that comprise healthcare delivery. Healthcare leaders, by their influence over culture, resource allocation, and implementation of requirements and workflows are uniquely poised to be effective mitigators of the conditions leading to clinician burnout and latent medical error. Basic knowledge of HFE science is a strategic advantage to leaders and individuals tasked with achieving quality of care, controlling costs, and improving the experiences of receiving and providing care.

Commissioning Clinical Spaces During a Pandemic: Merging Methodologies of Human Factors and Simulation.

The objective of this case study is to demonstrate the value of applying tabletop and simulation techniques to highlight high-risk, high-impact outcomes and organizational recommendations in the commissioning of a new clinical spaces. Generalizability of lessons learned from this case study aim to support other health organizations in commissioning of clinical spaces during communicable disease outbreaks. COVID-19 challenged our healthcare system, requiring teams to prepare in a short span of time. Bridging expertise of human factor and simulation teams provided a novel, interdisciplinary, and timely approach to evaluate and commission spaces. Human factors and simulation teams were enlisted to conduct an evaluation of a new space prior to readiness for delivery of safe patient care. An adapted tabletop evaluation and subsequent systems integration simulation was conducted. The goal of the tabletop exercise was to identify and define processes and risks to tested in the physical space using simulation. Applying both human factors science and systems simulation proactively identified the highest risk, highest impact outcomes, validated existing processes and allowed for refining of potential solutions and recommendations of the new space. A strong working relationship between teams fostered an opportunity to share information, debrief, evaluate, and adapt methods while applying timely changes based on emergent findings. These combined methodologies are important tools that can be learned and applied to healthcare commissioning of new clinical spaces in the identification of high-risk, high-impact outcomes affecting staff and organizational preparedness and safety.

A systems analysis of the COVID-19 pandemic response in the United Kingdom – Part 1 – The overall context

The most common reaction to suggesting that we could learn valuable lessons from the way the current pandemic has been/ is being handled, is to discourage the attempt; as it is suggested that it can all be done more accurately and authoritatively after the inevitable Public Inquiry (Slater, 2019). On the other hand, a more constructive approach, is to capture and understand the work that was actually done.This would include normal activities, as well as positive adaptations to challenges and failures that may have occurred. Such an approach aimed at improving what worked, rather than blaming people for what went wrong, has the potential to contribute more successfully to controlling the consequences of the current crisis. Such an approach should thus be aimed at detecting and feeding back lessons from emerging and probably unexpected behaviours and helping to design the system to adapt better to counter the effects.The science and discipline of Human Factors (HF) promotes system resilience. This can be defined as an organisation's ability to adjust its functioning before, during or after significant disturbances (such as a pandemic), enabling adaptation and operation under both anticipated and unanticipated circumstances. A “functional” approach methodology enables the identification of where the system and its various interdependent functions (an activity or set of activities that are required to give a certain output), could be improved and strengthened; if not immediately, at least for the future. Along these lines, suggestions for adding key resilience functions are additionally identified and outlined. The application and insights gained from this functional approach to the 2015 MERS-Cov pandemic in South Korea has been seen as contributing substantially to the effective response to the current crisis in that country (Min, submitted for publication).In this paper, we present an overarching framework for a series of projects that are planned to carry out focussed systems-based analysis to generate learning from key aspects of the COVID-19 pandemic response in the United Kingdom.

Human performance and system safety: Alternative perspectives on safety assessment

Discussion Panel Abstract: The recent Boeing 737MAX accidents crystalized for the public the complexity of anticipating system and operator performance and developing a system design that prevents catastrophic outcomes. The operational situations, progression of flightcrew actions, and system behaviors that led to the two accidents had not been anticipated by the manufacturer or the regulator. These accidents were only the most recent examples of our failure to anticipate and manage operational complexities and operator performance. The art and science of human factors has yet to perfect risk assessment (or safety assessment) for complex systems. In the not-so-distant past, system risk assessment made estimates of human error probabilities (HEPs) for specific operational tasks, which were combined with estimated equipment failure rates to produce an overall risk estimate. Indeed, these Human Reliability Analysis (HRA) techniques have evolved over decades and are still being developed (e.g., IDHEAS-ECA, Xing et al., 2020), partly because they satisfy the need for a simple quantitative threshold that can be used by industry and regulators: if risk probability is too high, change the design or some other aspect of operations. Through the years, there have been critiques of the HRA approach (e.g., Hollnagel, 1998) that led to revisions, such as focusing on cognitive functions instead of operator tasks, but not to the basic quantitative risk-estimation approach. Other approaches to assessing risk/safety have wandered down other paths: attempting to capture system complexity from an operator’s perspective (Roth, Mumaw, Lewis, 1994; Nuclear Regulatory Commission, 2000), or better documenting the many ways in which system operators manage complexity daily to find ways to improve their capacity (Hollnagel, Woods, & Leveson, 2006). These approaches have used different measures than HEPs; e.g., measures of operator performance, measures of interface usability/design, measures of task complexity, and the analysis of system constraints. In this panel, we offer different perspectives on risk/safety assessment as it relates to operator performance in complex systems. Foundational to assessment is deciding the nature of safety and the role of operator performance. Another important question is, as you move away from simple quantitative measures, how do you establish safety thresholds? That is, what guidance can we give to industry and regulators regarding how to measure safety and how to decide that action is required on the basis of safety.

Redesign of a Transfusion Issue Form Using Human Factors Science

Blood transfusions are common procedures but are high risk for patient safety. Verification of the correct blood unit for the patient, assessments of the patient for symptoms of transfusion reactions, and quick responses to suspected reactions are the main interventions to ensure this process are safe. Each of these steps is aided by the transfusion issue form. We identified opportunities to use human factors principles to redesign and evaluate the form. We provide a discussion of the specific design changes and methods to facilitate use in other contexts.

Evaluations for New Healthcare Environment Commissioning and Operational Decision Making Using Simulation and Human Factors: A Case Study of an Interventional Trauma Operating Room

The aim of this article is to provide a case study example of the preopening phase of an interventional trauma operating room (ITOR) using systems-focused simulation and human factor evaluations for healthcare environment commissioning. Systems-focused simulation, underpinned by human factors science, is increasingly being used as a quality improvement tool to test and evaluate healthcare spaces with the stakeholders that use them. Purposeful real-to-life simulated events are rehearsed to allow healthcare teams opportunity to identify what is working well and what needs improvement within the work system such as tasks, environments, and processes that support the delivery of healthcare services. This project highlights salient evaluation objectives and methods used within the clinical commissioning phase of one of the first ITORs in Canada. A multistaged evaluation project to support clinical commissioning was facilitated engaging 24 stakeholder groups. Key evaluation objectives highlighted include the evaluation of two transport routes, switching of operating room (OR) tabletops, the use of the C-arm, and timely access to lead in the OR. Multiple evaluation methods were used including observation, debriefing, time-based metrics, distance wheel metrics, equipment adjustment counts, and other transport route considerations. The evaluation resulted in several types of data that allowed for informed decision making for the most effective, efficient, and safest transport route for an exsanguinating trauma patient and healthcare team; improved efficiencies in use of the C-arm, significantly reduced the time to access lead; and uncovered a new process for switching OR tabletop due to safety threats identified.

Optimal Crash Cart Configuration for a Surgical NICU: Utilizing Human Factors Principles.

Neonates admitted to cardiac and surgical neonatal intensive care units (NICUs) are at an increased risk of requiring emergency lifesaving interventions that require the use of both Neonatal Resuscitation Program (NRP) and Pediatric Advanced Life Support (PALS) algorithms. Clinicians working within the surgical NICU must be able to access emergency equipment and medications quickly in order to respond to critical situations. A crash cart that integrates human factors principles and supports both the NRP and PALS algorithms is necessary to promote patient safety for this high-risk population. A multidisciplinary quality improvement project constructed an optimal crash cart configuration that embedded human factors principles and supported clinical workflow by reflecting both the NRP and the PALS algorithms in an NICU that cares for cardiac and surgical patients. A crash cart working group including frontline NICU staff, simulation experts, and a human factors specialist was formed within a surgical NICU. Human factors principles were utilized to align the organization of the cart with the NRP and PALS algorithms to increase the efficiency and intuitiveness of the cart. The new crash cart configuration was usability tested through simulation, revised on the basis of clinical feedback, and then implemented in a clinical setting. Data were collected following implementation of the new crash cart to validate that the new configuration was viewed as a significant improvement. The Plan-Do-Study-Act cycle was used to make improvements and capture outcome indicators. Evaluation data collected both during usability simulation testing and in situ within the NICU clinical environment indicated that the revised crash cart scored higher on Likert scale response questions than the previous crash cart. Human factors science, in combination with frontline user engagement, should be utilized to create intuitive crash cart configurations, which are then tested in a simulation environment and evaluated in situ in the NICU. Further research around crash cart design within NICUs that use multiple lifesaving algorithms would add to the paucity of research around the impact of human factors theory in the utilization of lifesaving equipment and medications within this specific population.

MUSIC AND ENVIRONMENT IN RESEARCH PERSPECTIVE

This paper is an extended version of the text Environmental Psychology as a Perspective in Musical Analysis published in 2018 [1] and presented during the SGEM Conference in March 2018 in Vienna [section 16. Performing and Visual Arts]. After the discussion during the conference about further connections between music and environment and their impact on music itself, it is obvious that the topic suggested here seems to be wider and needs more exploration. The additional material included here is based on the composers’ reflections in talks and analysis I carried out in autumn 2018 and spring 2019.
 My research about music and environment started started in 2018. Then I observed that the process of composing could be treated from the perspective of influences from space surrounding the author. I was inspired by environmental psychology – human factors science - as an interdisciplinary field that focuses on the interplay between individuals and their surroundings encompassing natural environments, social settings, built environments, learning environments, and informational environments. We know today that environmental psychology expands widely in attracting other areas of knowledge in its pursuit, not only psychologists but also geographers, economists, landscape architects and anthropologists. I propose to add a voice of musical theory here in studying the background of a composer’s strategies and decisions in creating a musical work.
 As the topic of a theoretical view I choose some examples from Polish modern music of leading composers such as Witold Lutosławski, Andrzej Panufnik, Aleksander Kościów and Dariusz Przybylski. I concentrate on the impulse of their output (how they find inspirations to their music) and what is their compositional process (what factors have the biggest impact on it). In the present text I would like to extend the reflection of contemporary composers about this matter to show better the fields of interaction between music and surrounding area. I add new analysis about the works of Aleksander Kościów, Dariusz Przybylski, and another young Polish composer Andrzej Karałow.
 I focused both on composers' statements about their creative process as well as on how it is reflected in selected pieces. The compositional technique and inspirational ideas for compositions will be in the area of my interest. The methodological background for this paper is based on studies by E. Clarke, Music and Consciousness. Philosophical, Psychological and Cultural Perspective, Oxford 2011; R. Gifford, Environmental Psychology: Principles and Practice, New York 2014; R. Gifford, Research Methods for Environmental Psychology, New York 2016.
 The composers' reflections in analysis are valuable because they reflect the style of composing and underline significant factors determining the compositional shape and composers' strategic decisions. The following publications were included as the examples, e.g. A. Kościów, Lithaniae: dzieło jako krajobraz. Autorefleksja twórcy, Warszawa 2013; A. Panufnik, Impulse and design in my music, London 1974; Ch. B. Rae, The Music of Lutosławski, London 1999. https://www.dariuszprzybylski.eu/ 2018. The results from the talks to composers in autumn 2018 and spring 2019 are a new thing I introduce here to extend the topic of my research.

HFES Goes to Washington

Learn how HFES members can get involved in advocating for the science of human factors and ergonomics (HF/E). This panel will present an overview of the Human Factors and Ergonomics Society’s activities in working to promote the science of HF/E in Congress and across government agencies. The activities of the Government Relations Committee will be discussed, to include outreach to Congress and responses to pending legislation, as well as the development of policy statements on Human Systems Integration, Airline Seating, and Autonomous Vehicles. Nicholas Saab will provide a discussion of the many activities Lewis-Burke Associates engages in on behalf of HFES. As our government relations experts, Lewis-Burke tracks relevant legislation, and activities and opportunities for HF/E involvement in supporting government operations across its many agencies. They help represent the society on the ground in DC and provide inputs on our behalf across a wide range of topics. New to HFES, the Science Policy Fellows program was established in 2018 to provide a valuable opportunity for members to learn how to navigate the federal policy process and successfully advocate for human factors and ergonomics on the national stage. They receive extensive training in public affairs, advocacy, and outreach, and represent HFES in an annual Capitol Hill day in Washington, DC. In addition to working with the Government Relations Committee, the Science Policy Fellows are each developing a tailored outreach program to include continued participation in Capitol Hill Day and interactions with policy makers in DC, supporting the Society’s policy objectives at the local and/or state level, serving on the GRC or a subcommittee, or other activities developed by each participant. Our 2018 Science Policy Fellows, Caroline Cao, Holly Handley and Carisa Harris-Adamson, will each present on their experiences and activities. This special session provides an opportunity for HFES members to learn more about how the society is representing and supporting our profession in Washington, and about how they can get involved in promoting human factors and ergonomics at the local, state or national level.

Human Factors and Medical Device Instructions for Use: It’s Not Just Good Business and Good Science, It’s the Law

The stated purpose of this panel was to discuss how the application of human factors science to the design, evaluation and development of medical device labeling and instructions for use is both good business and consistent with the law. Specific examples of the law were briefly discussed in the panel and are described in more detail in this paper. Questions posed by the audience quickly made it apparent that a higher-level conversation around risk was desired. One of the main topics addressed was that of unintended misuse; a summary of that discussion is also included in the paper. The overarching theme of the panel was as follows: The best we can do as human factors professionals is perform good science, document the work that we’ve done and the reasons for decisions that were made. We should also always strive to create the best product which requires balancing numerous constraints and competing goals.

Alerts for community pharmacist-provided medication therapy management: recommendations from a heuristic evaluation

BackgroundMedication therapy management (MTM) is a service, most commonly provided by pharmacists, intended to identify and resolve medication therapy problems (MTPs) to enhance patient care. MTM is typically documented by the community pharmacist in an MTM vendor’s web-based platform. These platforms often include integrated alerts to assist the pharmacist with assessing MTPs. In order to maximize the usability and usefulness of alerts to the end users (e.g., community pharmacists), MTM alert design should follow principles from human factors science. Therefore, the objectives of this study were to 1) evaluate the extent to which alerts for community pharmacist-delivered MTM align with established human factors principles, and 2) identify areas of opportunity and recommendations to improve MTM alert design.MethodsFive categories of MTM alerts submitted by community pharmacists were evaluated: 1) indication, 2) effectiveness; 3) safety; 4) adherence; and 5) cost-containment. This heuristic evaluation was guided by the Instrument for Evaluating Human-Factors Principles in Medication-Related Decision Support Alerts (I-MeDeSA) which we adapted and contained 32 heuristics. For each MTM alert, four analysts’ individual ratings were summed and a mean score on the modified I-MeDeSA computed. For each heuristic, we also computed the percent of analyst ratings indicating alignment with the heuristic. We did this for all alerts evaluated to produce an “overall” summary of analysts’ ratings for a given heuristic, and we also computed this separately for each alert category. Our results focus on heuristics where ≤50% of analysts’ ratings indicated the alerts aligned with the heuristic.ResultsI-MeDeSA scores across the five alert categories were similar. Heuristics pertaining to visibility and color were generally met. Opportunities for improvement across all MTM alert categories pertained to the principles of alert prioritization; text-based information; alarm philosophy; and corrective actions.ConclusionsMTM alerts have several opportunities for improvement related to human factors principles, resulting in MTM alert design recommendations. Enhancements to MTM alert design may increase the effectiveness of MTM delivery by community pharmacists and result in improved patient outcomes.

Human Factor Based Leadership: Critical Leadership Tools to Reduce Burnout and Latent Error in a Time of Accelerating Change

The majority of errors in healthcare are from systems factors that create the latent conditions for error to occur. The majority of occupational stressors causing burnout are also the result of systemic factors. Advances in technology create new levels of stress and expectations on healthcare workers (HCW) with an endless infusion of requirements from multiple authoritative sources that are tracked and monitored. The quality of care and safety of patients is affected by the wellbeing of HCWs who now practice in an environment that has become more complex to navigate, often expending limited neural resource (brainpower) on classifying, organizing, constantly making decisions on how and when they can accomplish what is required(extraneous cognitive load) in addition to direct patient care. New information demonstrates profound biological impact on the brains of those who have burnout in areas that affect the quality and safety of the decisions they make-which affects risk to patients in healthcare. Healthcare administration curriculum currently does not include ways to address these stress-induced problems in healthcare delivery. The science of human factors and ergonomics (HFE) promotes system performance and worker wellbeing. Patient safety is one component of system performance. Since many requirements come without resource to accomplish them, it becomes incumbent upon health system leadership to organize the means for completion of these to minimize the needless loss of brain power diverted away from the delivery of patient care. Human Factor-Based Leadership (HFBL) is an interactive, problem solving seminar series designed for healthcare leaders. The purpose is to provide relevant human factor science to integrate into their leadership and management decisions to make HCWs occupational environment more manageable and sustainable-which makes safer conditions for clinician wellbeing and patient care. After learning the content, a cohort of healthcare leaders believed that adequately addressing HFE in healthcare delivery would significantly reduce clinician burnout and risk of latent errors from upstream leadership decisions. An overview of the content of the seminars is described. Leadership feedback on usability of these seminars is reported. Three HFBL seminars described are Human Factor Relevance in Leadership, Biopsychosocial Approach to Wellness and Burnout, Human Factor Based Leadership: Examples and Applications.

Improving hand hygiene compliance with patient zone demarcation: More than just lines on the floor

Background Hand hygiene compliance can be difficult to improve as this prospective activity may not come to mind easily during busy clinical operations. Clinicians are often driven by clinical goals under time pressure, and the sudden recall to clean hands can either be disruptive or too late. Using patient zones as a reference has been known to be helpful. A low-tech solution of taping patient zones on the floor was introduced in a children’s intensive care unit. Coupled with this demarcation is a simplified protocol that uses patient zones for “just-in-time” reminders. Clinicians now clean their hands whenever they cross zone lines, namely “ before patient zone” and “ after patient zone”, along with “ before aseptic procedure” and “ after bodily fluids exposure”. Methods The mandatory national quarterly hand hygiene surveillance data for children’s intensive care unit and the entire hospital was tracked. Seven pre-intervention and seven post-intervention quarters were compared for improvement and sustainability. Results Overall, children’s intensive care unit hand hygiene compliance rose from an average of 77% to 90%, as well as physicians' hand hygiene compliance rates from 72% to 86%, and these differences are statistically significant. Hand Hygiene Moment 1 as defined by World Health Organization benefited the most from this intervention. Discussion Patient zone demarcation, along with more intuitive hand hygiene guidelines, is a cost-effective, operationally sensitive intervention that can improve hand hygiene compliance. The bundled solution taps on human factors science in understanding the cognitive challenges faced by clinicians. The positive effects are most profound in multi-bed cubicles where patient zones and infection control barriers are not clearly visible.