Human Factors/ergonomics Research Articles

What is known about near miss events in the operating room? A systematic review of studies of mixed methods design.

A near miss event (NME) in healthcare is an event that did not happen but would have caused serious harm if it did. The operating room (OR) is prone to risk and incidents, with estimates that 50% of all hospital adverse events occur in the OR, yet reporting of NME is uncommon in the OR. To carry out a systematic review of studies with mixed methods to establish what is known about NME reporting in the OR. Inclusion criteria will be those studies of mixed methods design, which have been conducted in the OR, with teams of surgeons, anaesthetists or nurses alone or in any combination. Using a publication timeframe of 2001-2023, the following databases were searched: Medline (OVID), CINAHL, Pubmed and Google Scholar. Selected papers for the review were assessed using the Quality Assessment Tool for Studies of Diverse Designs. Fourteen papers were included in the review. NMEs are common occurrences that are underreported in the OR. When NMEs occur in multiples for the same patient, the risk of serious harm increases. Feedback and education about NME helps to improve reporting; ORs with high rates of NME reporting have less serious patient harm events. The implications of the findings for improving healthcare safety are discussed and in particular the adoption of the science of Human Factors Ergonomics into healthcare.

Expanding human factors/ergonomics to address social determinants of health: A patient ergonomics approach to birth justice

Addressing the social determinants of health (SDOH) is imperative to achieving health equity.The field of human factors/ergonomics (HF/E) has started to consider SDOH in influencing patient work, but has not yet extensively encompassed SDOH in patient work system models. Using transportation access to maternal health services as a case study, this research sought to enhance the patient work system framework to include sub-factors specific to SDOH. Following a model of community-based participatory research, semi-structured interviews were conducted with 18 individuals who were pregnant within the last five years, identified as low-income, and identified as having one or more racial or ethnic minoritized identities. Thirty-three secondary themes and 28 tertiary themes were derived inductively under the deductive framework of the consolidated patient work system. Unique sub-factors of the patient work system were identified, expanding our current understanding of the dimensionalities of the patient work system. Sub-factors were mostly expanded in the domains of the physical and organizational environments. HF/E researchers and practitioners, in partnership with other disciplines and communities, should expand work system models to purposefully incorporate a range of work system factors that stem from SDOH. Extending these models produces a holistic view of systems, providing a better foundation to align design interventions with the contextual realities of marginalized populations who experience health inequities.

Hierarchical task analysis as a systems mapping tool in complex health care environments: Emergency department response to chemical, biological, radiological, and nuclear events

AbstractThe emergency department (ED) is at the forefront of the chemical, biological, radiological, and nuclear (CBRN) response. This study adopted a multilevel systems approach using the human factors/ergonomics (HFE) method of hierarchical task analysis (HTA) with document analyses of CBRN plans to represent work‐as‐Imagined. Work‐as‐imagined was compared with data from semistructured interviews using prompt cards for CBRN scenarios (n = 57) representing work‐as‐done. The aim was to provide methodological evidence for the use of HTA with an empirical synthesis of the ED in response to CBRN events. HTA was the preferred systems mapping tool because it aligns with a systems thinking approach, allows multiple‐level comparisons, highlights variability, and has an established usability track record. This study demonstrates the usability of HTA in the context of the ED responding to a CBRN event. The findings for core CBRN concepts included (1) liaise and communicate, (2) isolate and contain, and (3) personal protective equipment.

Human Factors, Ergonomics, and Biomechanical Engineering Approaches to Incidents involving Amusement Rides

Amusement ride incidents resulting in major injuries are a rare occurrence. When they occur, in-depth assessment requires specialized expertise and methodologies. Human Factors, Ergonomics (HF/E), and Biomechanical Engineering (BMechE) professionals are uniquely equipped to evaluate incidents involving these complex systems. An HF/E approach would follow frameworks to understand whether, given the situation and the actions and limitations of the individual, the adverse incident would have been avoidable. As a complement, during the in-depth assessments, BMechE approaches consider principles of mechanical engineering, mechanics, and biology in the context of human responses. This study outlines HF/E and BMechE frameworks and approaches that can be leveraged when performing in-depth accident investigations involving amusement rides and explores areas to enhance these contributions.

Comfort: Beyond HFE to Patient Outcomes and Comfort Zones

Comfort has been a staple of outcome measures in Human Factors / Ergonomics (HFE) for generations. We have theories of comfort and validated measures. But HFE is not alone in studying comfort. Here we review two adjacent applications of comfort: In patient outcomes and in management’s idea of comfort zones. We find some but not much overlap between these three fields and the ability for HFE to learn positive and negative lessons from each.

Bringing the Human Factor to DEI: Increasing Inclusion and Accessibility from Academia and Industry to our Everyday Lives

Given the definitions of such fields, Human Factors, Ergonomics (HF/E), and UX professionals and academics should aim to embed inclusion in their everyday lives. The objective of this panel is to offer tangible examples of how to use our Human Factors and Ergonomics background to be effective allies/advocates towards inclusion. The panelists aim to provide their views and experiences on how we, as HF/E and UX professionals, can translate what we learn and profess to increase accessibility for those around us. The specific theme of this discussion panel is to bring together practitioners, university leads, and consultants to focus a discussion on learning about tools and initiatives that we all, as individuals, can use to be more inclusive in our practice, at work, as well as in our everyday lives. This is an interactive session between the attendees and panelists, guided by the moderator, Mr. Anant Bhushan, co-chair of the HFES’s DCI AG.

Designing for Older Adults with Cognitive Impairment: A Panel Discussion

The population is aging and a subset of older adults will have some level of cognitive impairment. Human factors/ergonomics (HF/E) practitioners must consider them in the design process but often are not prepared to do so, lacking relevant experience or training. In this panel, an interdisciplinary team with expertise in aging, in general, and cognitive impairment, in particular, will (a) provide insights into cognitive challenges confronting older adults with cognitive impairments; (b) discuss impacts of these challenges on everyday performance (e.g., transportation, computer use, health); (c) explore the design cycle as it relates to cognitive impairment; and (d) provide examples of accommodations necessary for research and user testing for this population. Interactive audience discussion will focus on future directions and challenges for design and testing of emerging technologies for persons aging with cognitive impairment. This panel will be of interest to a broad range of HF/E domains.

Human Factors/Ergonomics Contributions to an Equitable Personal Protective Equipment Protections Strategy

The National Institute for Occupational Safety and Health (NIOSH) is developing a National Strategy for Equitable Personal Protective Equipment Protections for All U.S. Workers. This paper describes several formative components of the strategy that have been completed and are ongoing. These efforts clearly indicate the need for human factors/ergonomics (HF/E) contributions to overcome current limitations and barriers to equitable PPE protection for some workers. Fundamental ergonomics approaches are needed to contribute to more equitable PPE protections for all members of the workforce for whom PPE is required. This will ensure that all workers that require PPE are adequately protected from hazards while minimizing negative consequences (e.g., discomfort, reduced perceptual capabilities, performance decrements) while also allowing workers to safely and comfortably work as productively as when not wearing PPE.

Human Factors/Ergonomics (HFE) Evaluation in the Virtual Reality Environment: A Systematic Review

A variety of human factors/ergonomics (HFE) problems have been studied by researchers and developers in VR environments. This systematic review aimed to summarize important HFE issues and classify the validated instruments used to quantify them in virtual reality environments. The most representative electronic databases for this review (2013–2022) were searched for original articles. The results showed that aspects, such as cybersickness, visual fatigue, mental workload, performance, spatial presence, and usability were the most relevant HFE issues assessed, whereas some aspects, such as physical workload, posture, stress, and discomfort, were consider less often. Previous studies have neglected some human factors and ergonomic issues, such as physical ergonomics, stress, and aftereffects, such as fatigue and human error. In virtual environments, presence was an emerging human factor compared to real environments. Most techniques were unidimensional and subjective. Future studies should focus on more factors and risks associated with HFE by emphasizing objective techniques and multidimensional subjective methods.

Human factors’ role in distance healthcare simulation

As educators seek to optimize the utility of distance simulation for healthcare education, several challenges are present in the design, delivery, and evaluation of simulation-based training (SBT) that align with best practices in human factors. The planned outcome of this panel is a strengthening of the collaboration between human factors/ergonomics (HF/E) and healthcare simulation communities with practical tools that can be used to optimize distance healthcare training. Content proposed as part of the current effort should inform the development of strategic partnerships between simulationists, medical education, and HF/E professionals. We anticipate that the panel will be of interest to scientists and practitioners alike who perform work within the medical simulation space. Although the panel is formed with a focus on the needs identified for distance simulation training, panelists will be asked how human factors techniques can be beneficial to simulation in healthcare more broadly.

Barriers and Challenges to Human Factors/Ergonomics Knowledge Transfer to Small Business Enterprises in an Industrially Developing Country

OCCUPATIONAL APPLICATION We found that small business enterprises (SBEs) face intra- and extra-organizational barriers in different dimensions related to their work system to practically implement human factors/ergonomics (HFE) knowledge transfer and to achieve its benefits in an industrially developing country. Utilizing a three-zone lens, we evaluated the feasibility of overcoming the barriers identified by stakeholders, especially ergonomists. To overcome the identified barriers in practice, three types of macroergonomics interventions (top-down, middle-out, and bottom-up) were distinguished through macroergonomics theory. The bottom-up approach of macroergonomics, as a participatory HFE intervention, was considered as the entry point to overcome the perceived barriers in the first zone of the lens, which included such themes as lack of competence, lack of involvement and interaction, and inefficient training and learning approaches. This approach focused on improving emotional literacy as a care zone among the small business enterprise personnel.

The barriers and opportunities to support the early career academics and professionals in human factors/ergonomics - revisiting reflections from IEA2015, IEA2018 & IEA2021.

The Early-Career Community (ECC) comprises researchers, practitioners, and professionals in their "early-career" stages in the Human Factors/Ergonomics (HFE) profession. Early-career HFE professionals are essential to both current industry decision making and future growth of our profession. This paper provides detailed insights into the barriers and suggestions to support engagement with ECC within the International Ergonomics Association (IEA) and its Federated Societies. This report integrates key findings from the formal and informal discussions that occurred with diverse groups of stakeholders (n > 100) at IEA2015, IEA2018 and IEA2021 guided by the participatory inquiry paradigm, cooperative action-inquiry and participatory ergonomics approaches. Barriers to support ECC include: a lack of employment opportunities, poor general awareness and integration of HFE in existing university-courses, financial constraints, inclusivity challenges and a lack of Influence in decision-making. While some of the more systemic challenges are context-specific and cannot be overcome, ECCs suggested that: the IEA and its Federated Societies include ECC members as part of their boards; a Standing Committee for the ECCs be established as part of the IEA; make use of social-media more effectively to engage the ECC. More mentorship, networking, knowledge sharing, training and education, combined with financial-support will ensure that the ECC can participate. ECC members experience complex and dynamic challenges that affect their development and involvement in the broader HFE profession. It is therefore critical that appropriate, global, national and local strategies are developed to continue to support and develop the ECC to ensure the continued growth of and demand for HFE.

Detecting Burnout of Health Care Professionals in a COVID-19 Testing Laboratory

Health care professionals (HCPs) are frequently exposed to Human Factors/Ergonomics (HFE) issues that result in stress, adversely affecting their health and negatively impacting the quality of care. Chronic stress can result in burnout, with negative implications for individuals, health care organizations, and patients. Current approaches to monitor burnout are reactive and require additional work (e.g., survey completion). In this study, we pilot a methodology using unobtrusive sensors and advanced statistics to bridge this important gap. We collected two types of physiological data - heart rate variability (HRV) and electrodermal activity (EDA) - and measures of perceived workload and burnout from three HCPs in a COVID-19 Testing Laboratory. We identified meaningful relationships between physiological data, workload, and burnout, demonstrating that burnout can be identified proactively using real-time sensor data. Future work will expand the timeframe of data collection and include a larger sample with different types of HCPs.

Improving the Experience of Providing Care in Community-Based Pharmacies.

This study applied a human factors and ergonomics approach to describe community-based pharmacy personnel perspectives regarding how work environment characteristics affect the ability to perform the duties necessary for optimal patient care and how contributors to stress affect the ability to ensure patient safety. Data were obtained from the 2021 APhA/NASPA National State-Based Pharmacy Workplace Survey, launched in the United States in April 2021. Promotion of the online survey to pharmacists and pharmacy technicians was accomplished through social media, email, and online periodicals. Responses continued to be received through the end of 2021. A data file containing 6973 responses was downloaded on 7 January 2022 for analysis. Qualitative thematic analysis was applied for developing operational definitions and coding guidelines for content analysis of the data. The patterns of responses for the dependent variables were compared among community-based practice setting types (chain, supermarket/mass merchandiser, and independent) and work positions (manager, staff pharmacist, technician/clerk, and owner). Chi-square analysis was used for determining statistically significant differences. The findings showed that personnel working in community-based pharmacies reported undesirable work environments and work stress that affected their ability to perform assigned duties for optimal patient care and ensure patient safety. Four work system elements were identified that were both facilitators and barriers to the ability to perform duties and ensure patient safety: (1) people, (2) tasks, (3) technology/tools, and (4) organizational context. Acknowledging local contexts of workplaces, giving adequate control, applying adaptive thinking, enhancing connectivity, building on existing mechanisms, and dynamic continuous learning are key elements for applying the HFE (human factors ergonomics) approach to improving the experience of providing care in community-based pharmacies.

Radiography as a sociotechnical system – Improving patient identification with a multi-level human factors approach

Irradiation of the wrong patient or wrong site is a reportable adverse event for hospitals. Improvement efforts to date have been narrowly targeted, often without consideration of wider contextual factors. This study applied a systems human factors/ergonomics (HFE) approach in an NHS trust to develop interventions across micro, unit and organisation levels.At the micro level, the workspace was adapted to reduce distractions during safety critical work. At the unit level a standard operating procedure for patient identification was designed with staff alongside the introduction of wristband barcode scanners. At the organisation level safety workshops were run for staff in the radiology directorate. These introduced a systems approach to managing risk, encouraged near miss reporting and employed scenario-based exercises to raise discussion of risk-efficiency trade-offs.Following implementation interruptions in the control rooms decreased by 34% (from a mean of 4.91/10 min). Interrupted time series analysis showed that the interventions were associated with a decrease in patient identification incidents (rate ratio = 0.37), and an increase in near miss reporting (rate ratio = 2.5), representing an additional 4.7 reports/month. The workshops raised a wide range of system components that influenced the imaging task and provided examples of situated and structural resilience attributes. The safe provision of imaging across different modalities and physical locations is a challenge for many radiology departments; this study indicates that a multi-level systems approach can reduce risk.

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.

Being Bold: How HFES Can Encourage Responsible, Timely and Participative Ergonomics to Address Societal Issues

Human Factors/Ergonomics (HF/E) is a systems discipline focused on jointly optimizing human well-being and overall system performance. Societal problems, including but not limited to health inequity, racism, poverty, and (lack of) sustainability, are inherently systems problems that involve humans, and so recent work has argued that HF IE can and should contribute to addressing these issues. This panel will bring together leaders of the Human Factors and Ergonomics Society (HFES) to discuss if and how HFES can encourage and support responsible, timely, and participative ergonomics to address societal issues. The session will be highly interactive as the organizers will moderate discussion to reflect on the progress the science and Society (i.e., HFES) have made in this space, identify areas for improvement, and creatively consider future actions to ensure our science and Society are responding to these issues in an ethical manner.

Learning Human Factors/Ergonomics (HFE) in Architectural Education: A Study of Studio Approach in Bangladesh

All the human activities take place in the built environment and therefore human factors/ergonomics (HFE) is an essential design consideration for the built environment designing process. Surprisingly, there have been limited studies on integrating HFE in the design process as well as in the education of architecture. Teaching HFE in architecture is different from teaching HFE in the disciplines that focuses on precise ergonomic application. Architectural education primarily deals with accommodating human activities in the built environment; and therefore, teaching HFE focuses on anthropometry, space standards, and an in-depth understanding of space requirements for relevant human activities. In architectural education, HFE can be taught as theory courses and/or in the design studio courses. This article focuses on the studio approach with an overview of several studio courses and a meticulous study of a studio course that teaches HFE principles. The study follows desktop research, participant observation, and a questionnaire survey. It is observed that the studio approach provides an opportunity for a deeper understanding of the HFE principles and their application in space design. Specifically, the practice of learning within the studio setup, group work and peer critique, assessment and feedback with critique sessions before the evaluation, etc. have a profound impact on the students to internalizeHFE in their thought process. A survey among the students also indicates the effectiveness of the studio approach for learning HFE.

DEEP SCOPE: A Framework for Safe Healthcare Design.

Thinking in patient safety has evolved over time from more simplistic accident causation models to more robust frameworks of work system design. Throughout this evolution, less consideration has been given to the role of the built environment in supporting safety. The aim of this paper is to theoretically explore how we think about harm as a systems problem by mitigating the risk of adverse events through proactive healthcare facility design. We review the evolution of thinking in safety as a safety science. Using falls as a case study topic, we use a previously published model (SCOPE: Safety as Complexity of the Organization, People, and Environment) to develop an expanded framework. The resulting theoretical model and matrix, DEEP SCOPE (DEsigning with Ergonomic Principles), provide a way to synthesize design interventions into a systems-based model for healthcare facility design using human factors/ergonomics (HF/E) design principles. The DEEP SCOPE matrix is proposed to highlight the design of safe healthcare facilities as an ergonomic problem of design that fits the environment to the user by understanding built environments that support the “human” factor.

Integration of human factors/ergonomics in healthcare systems: A giant leap in safety as a key strategy during Covid-19.

In this article, we present a model for integrating Human Factors/Ergonomics (HFE) into healthcare systems to make them more robust and resilient. We believe that to increase the impact of HFE during and after the Covid‐19 pandemic this integration should be carried out simultaneously at all levels (micro, meso, and macro) of the healthcare system. This new model recognizes the interrelationship between HFE and other system characteristics such as capacity, coverage, robustness, integrity, and resilience. We hope that the model will serve as a reference for a giant leap to design and improve the safety and effectiveness of healthcare services from a holistic (systems) perspective.