Human Factors Engineering Principles Research Articles

Assessing the Capacity for Change Prior to the Adoption of Human Factors Engineering in Power Plant Maintenance

Even in the epoch of the 4th Industrial Revolution, technologies are introducing human–machine/technology interactions that must be appropriately managed to prevent or reduce avoidable human errors. In recent years, power plants have started examining ways to manage human errors attributable to maintenance, thereby improving performance, safety, and well-being. Maintenance management requires the integration of human factors engineering (HFE) principles with maintenance practices to handle the issue of human errors. When adopting human factors engineering interventions to enhance maintenance, power plants must demonstrate the capacity for change to ensure effective management of change and realize the intervention’s benefits. The main focus in power plants is usually on the technical side of change, with less emphasis on human factors. This study aimed to develop and trial a model for determining the capacity for change to aid HFE adoption in electric power systems maintenance. A quantitative and cross-sectional survey was conducted with maintenance personnel working in South African power plants. The results showed that management commitment, knowledge, and employee involvement are associated with the capacity for change in the maintenance of power plants. This study extends previous studies on the capacity for change when adopting unconventional interventions in maintenance such as HFE principles.

The decision aid is the easy part: workflow challenges of shared decision making in cancer care.

Delivering high-quality, patient-centered cancer care remains a challenge. Both the National Academy of Medicine and the American Society of Clinical Oncology recommend shared decision making to improve patient-centered care, but widespread adoption of shared decision making into clinical care has been limited. Shared decision making is a process in which a patient and the patient's health-care professional weigh the risks and benefits of different options and come to a joint decision on the best course of action for that patient on the basis of their values, preferences, and goals for care. Patients who engage in shared decision making report higher quality of care, whereas patients who are less involved in these decisions have statistically significantly higher decisional regret and are less satisfied. Decision aids can improve shared decision making-for example, by eliciting patient values and preferences that can then be shared with clinicians and by providing patients with information that may influence their decisions. However, integrating decision aids into the workflows of routine care is challenging. In this commentary, we explore 3 workflow-related barriers to shared decision making: the who, when, and how of decision aid implementation in clinical practice. We introduce readers to human factors engineering and demonstrate its potential value to decision aid design through a case study of breast cancer surgical treatment decision making. By better employing the methods and principles of human factors engineering, we can improve decision aid integration, shared decision making, and ultimately patient-centered cancer outcomes.

Using a human factors framework to assess clinician perceptions of and barriers to high reliability in hand hygiene

Hand hygiene (HH) is critical to prevent healthcare-associated infections (HAIs). Clinician perspectives on maintaining high reliability are poorly defined. We surveyed physicians, nurse practitioners, and physician assistants to understand perceptions of and barriers to high reliability in HH. The Systems Engineering Initiative for Patient Safety 2.0 model was used to develop an electronic survey exploring six human factors engineering (HFE) domains. . Among 61 respondents, 70% perceived HH as "essential" to patient safety. While 87% reported alcohol-based hand rub (ABHR) availability as very effective in improving HH reliability, 77% reported dispensers to be "sometimes" or "often" empty. Clinicians in surgery/anesthesia were more likely than those in medical specialties to note skin irritation from ABHR (OR 4.94; 95% CI 1.37-17.81) and less likely to believe feedback was effective in improving HH (OR 0.26; 95% CI 0.08-0.88). One quarter of respondents indicated the layout of patient care areas was not conducive to performing HH. Staffing shortages and the pace and demands of work precluded HH for 15% and 11% of respondents, respectively. Aspects of organizational culture, environment, tasks, and tools were identified as barriers to high reliability in HH. HFE principles can be applied to more effectively promote HH.

Human Factors Engineering in Infection Prevention & Control: Opportunities, Examples, and the Future

Effective and practical infection prevention and control (IPC) processes and protocols are vital to safety of patients and health care workers (HCWs) as well as improving public health. This interdisciplinary panel, composed of experts in IPC, public health, medicine, and human factors engineering (HFE), will discuss the urgent need for developing partnerships with HFE experts for improving IPC across the continuum of care (hospital-to-home), provide examples for consequences of not using HFE principles, and approaches in health care system design and delivery during both ‘normal’ and extraordinary (e.g., COVID-19 pandemic) times, describe previous successful partnerships among IPC, public health and HFE, and delineate possible ways forward for HFE-informed IPC and public health.

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.

Implementation of human factors engineering approach to improve environmental cleaning and disinfection in a medical center

BackgroundInadequate hospital cleaning may contribute to cross-transmission of pathogens. It is important to implement effective cleaning for the safe hospital environment. We conducted a three-phase study using human factors engineering (HFE) approach to enhance environmental cleanliness.MethodsThis study was conducted using a prospective interventional trial, and 28 (33.3%) of 84 wards in a medical center were sampled. The three-phases included pre-intervention analysis (Phase 1), implementing interventions by HFE principles (Phase 2), and programmatic analysis (Phase 3). The evaluations of terminal cleaning and disinfection were performed using the fluorescent marker, the adenosine triphosphate bioluminescence assay, and the aerobic colony count method simultaneously in all phases. Effective terminal cleaning and disinfection was qualified with the aggregate outcome of the same 10 high-touch surfaces per room. A score for each high-touch surface was recorded, with 0 denoting a fail and 10 denoting a pass by the benchmark of the evaluation method, and the total terminal cleaning and disinfection score (TCD score) was a score out of 100.ResultsIn each phase, 840 high-touch surfaces were collected from 84 rooms after terminal cleaning and disinfection. After the interventions, the TCD score by the three evaluation methods all showed significant improved. The carriage incidence of multidrug-resistant organism (MDRO) decreased significantly from 4.1 per 1000 patient-days to 3.6 per 1000 patient-days (P = .03).ConclusionThe HFE approach can improve the thoroughness and the effectiveness of terminal cleaning and disinfection, and resulted in a reduction of patient carriage of MDRO at hospitals. Larger studies are necessary to establish whether such efforts of cleanliness can reduce the incidence of healthcare-associated infection.

An improved probabilistic method for screening safety-related human actions in nuclear power plants

Abstract For the reliability and safety of nuclear power plants (NPPs), their design and operation must follow the relevant principles of human factors engineering (HFE). As various human actions are involved in the operation of NPPs, there is a need to screen human actions first and, then, focus the analysis on the critical ones. In the past, different NPPs have adopted different standards in screening human actions and many of these standards lack theoretical support. In this study, the concept of human action risk achievement worth (HRAW) is introduced to support probabilistic screening. A new probabilistic method for screening safety-related human actions in NPPs is proposed. The results of a case study indicate that the proposed method performs well and better than the previous probabilistic screening method typically used, it also implies that this method can provides methodological support to the probabilistic screening method of human actions. On the one hand, utilizing this method to screen human actions can help identifying those actions that are critical for the safety of NPPs. On the other hand, it can reduce the workload and improve work efficiency. The method is traceable and easy to use. It not only can be used in the design of NPPs, but also can provide guidelines for reviewers to evaluate the NPPs safety.

Patient Safety and the Significance of Human Factors Engineering Modality: A Review

The issue of patient safety and medical human error has been arousing growing concern around the world. Attempts to reduce the rate of human error present a great challenge, and there is an increased understanding that the issue of patient safety in healthcare systems is a complex one that requires in-depth analysis and understanding. Despite the many programs and interventions designed to reduce the rate of human medical errors, various publications that expose the extent of this phenomenon point to a high percentage of human errors that causes injury, and to the difficulties in improving patient safety. The understanding that the focus must be on prevention and the growing need for practical solutions have led to the involvement of disciplines such as human-factors engineering in an attempt to understand the root causes of safety problems and find ways to prevent them. Human-factors engineering is a proactive approach that may contribute to the planning of safe medical systems by taking into account the diverse needs, capabilities, and limitations of the human beings involved in these systems. This article reviews the benefits and challenges in applying the principles of human-factors engineering to promote patient safety, as well as the implications for policy in the field

Coordination of I&C Design With the Obligatory Consideration of Human Factors: A Project Management Approach

Human factors engineering (HFE), such as other engineering disciplines involved in plant design, cannot be considered retroactively. The engineering principles and methods derived from deep knowledge of the cognitive and perceptual capabilities and limitations of the plant’s “human element” are applied instead throughout the plant design. Focusing HFE efforts, the plant’s HMI is designed to ensure effective and error-free performance of the monitoring, control, and administrative tasks allocated to the control-room crew. A project’s HFE program prescribes three main steps (1) The task analysis and the analyses of plant monitoring and control functions to identify those to be performed manually (all others are performed automatically, or in a combination of manual and automatic, while still manually monitored) and determine in turn the HMI inventory of information displays, controls, alarms, and operating procedures required to support their performance. (2) The guided design of the plant’s HMI, ensuring its compliance with HFE principles and the completeness and correctness of the task support it provides. (3) The subsequent evaluation of operator performance, trained to follow the operating procedures and use of the HMI. Authors’ experience shows that the three following required steps pose challenges to project execution: (1) the acquisition and analysis of the multidisciplinary functional requirements (related to plant monitoring and control); (2) the likely interdisciplinary analysis and how fulfillment of these requirements shall be allocated to I&C automation systems or operators (or both); and (3) the HFE-guided HMI design and validation. An additional fourth challenge poses a timely and cost-effective application of HFE to I&C engineering, which can be achieved by adequate planning and project management procedures. This paper aims to summarize some of our industrial experiences gained in new builds and modernization projects of nuclear power plants around the world.

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.

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.

ICONE23-1912 Coordination of I&C Design with the Obligatory Consideration of Human Factors : A Project Management Approach

Human Factors Engineering (HFE), like other engineering disciplines involved in plant design, cannot be considered retroactively. The engineering principles and methods derived from deep knowledge of the cognitive and perceptual capabilities and limitations of the plant's "human element" are applied instead throughout plant design. Focusing HFE efforts on the plant's I&C, the plant's HMI is designed to ensure effective and error-free performance of the monitoring, control, and administrative tasks allocated to the control room crew. Generally speaking, a project's HFE program prescribes three main steps: (i) the analyses of plant monitoring and control functions in order to identify those to be performed manually (all others are performed automatically while still manually monitored) and determine in turn the HMI inventory of information displays, controls, alarms, and operating procedures required to support their performance, (ii) the guided design of the plant's HMI, ensuring its compliance with HFE principles and the completeness and correctness of the task support it provides, and (iii) the subsequent evaluation of operators performance, trained to follow the operating procedures and use the HMI referred to. The I&C systems designed to monitor and control the plant processes and implement, among other functions, the plant's HMI, are likely validated, governed by I&C norms and the project's V&V guidelines. Past experience shows that the three following obligatory steps pose challenges to project execution: (i) the acquisition and analysis of the multidisciplinary functional requirements (related to plant monitoring and control); (ii) the likely interdisciplinary analysis whether and how fulfillment of these requirements shall be allocated to I&C automation systems or operators (or both), and (iii) the HFE-guided HMI design and validation. A timely and cost-effective application of HFE to I&C engineering can be achieved by adequate planning and project management. This paper aims to summarize some of our experiences

Change Fatigue in Health Care Professionals--An Issue of Workload or Human Factors Engineering?

In the demanding and fast-paced world of health care, it is not uncommon for nurses and other health care professionals to have days where they are pushed to their limits. Despite these pressures, each year, new initiatives and practice recommendations are shared within organizations that the nurses must learn, embrace, and include in their practice. Each new initiative can be additive to the nurse's workload; most changes are not time neutral but require staff to expend an allotment of time from their day to complete. In our efforts to adopt new recommendations, is it realistic or possible to add on to workload and stretched resources in an ongoing manner? The following article provides an overview of how issues such as change fatigue and increased workload need to be addressed. Through use of workload measurement tools and guidance by the principles of human factors engineering, we can better support the provision of optimal patient care in a demanding environment.

Human Factors Engineering in Patient Safety

Human Factors Engineering in Patient Safety

Applying Human Factors Engineering : Naturally Safe Software–User Interfaces

Stimulated by regulations and standards as well as commercial imperatives, medical device manufacturers are striving to make medical devices safer by decreasing the potential for harmful use errors. Accordingly, manufacturers are observing and interviewing intended users about their interactions with devices en route to developing user interface requirements; applying human factors engineering (HFE) principles when designing user interfaces; and conducting formative and summative usability tests to improve and validate their devices’ interactive quality. This has represented significant work for manufacturers, particularly the majority who started with little HFE knowledge and experience. Today, the “awakening” to HFE in medical device development is essentially over—an established manufacturer who is just now discovering HFE has been out of touch. After all, the U.S. Food and Drug Administration (FDA) and AAMI conducted their first joint conference on HFE in 1995 when they previewed HFE expectations related to recent changes in quality system regulation (QSR). So, it has been 17 years since HFE entered the medical industry’s zeitgeist. HFE specialists working in the medical industry used to focus on making devices more usable (i.e., user friendly). Since the QSR change, use safety has become the primary focus, resulting in user interfaces that are less vulnerable to harmful use errors. It is rather obvious how HFE affects the safety of some medical devices. In the design of a surgical instrument, for example, HFE’s aim would be to reduce the chance of cutting anything other than the intended target. This goal could be accomplished by including a blade guard and a mechanical interlock that requires more than one deliberate action to enable cutting.

Medical Devices and Patient Safety

Errors related to health care devices are not well understood. Nurses in intensive care and progressive care environments can benefit from understanding manufacturer-related error and device-use error, the principles of human factors engineering, and the steps that can be taken to reduce risk of errors related to health care devices.

Improving Medication Management Through the Redesign of the Hospital Code Cart Medication Drawer

This study utilized usability testing and human factors engineering (HFE) principles to create efficient code cart medication drawer modifications to improve code blue medical emergency (code) medication management. Effective access to medications during a code is a key component in delivering optimal care and has been found to be a major problem among health care organizations; however, little research has been conducted to improve the efficiency of medication management during a code. A total of 26 health care professionals (13 pharmacists and 13 nurses) were asked to locate items within a code cart medication drawer during two independent simulated code scenarios alternately using either a baseline medication drawer (control; Drawer 1) or a prototype medication drawer (prototype; Drawer 2), which was developed using HFE principles and usability testing. Overall medication retrieval time, wasteful actions, and survey responses were recorded. Drawer 2 had significantly faster trial completion times (p = .005) and fewer wasteful actions (p < .001) compared to Drawer 1. Participant survey results rated Drawer 2 (prototype) significantly higher (more favorable) for medication drawer visibility (p < .001), usability (p = .011), and organization (p < .001) compared to Drawer I (baseline). The HFE redesign concepts incorporated into Drawer 2 (consisting of visibility, grouping, and organization) produced successful, low-cost, and generalizable modifications that can improve patient care. The findings demonstrate that HFE and usability applied to code cart design are effective, are customizable, and can affect patient safety by saving valuable time and reducing wasted motions (including errors) during code situations.

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.

Using Human Factors Engineering to Improve Patient Safety: Problem Solving on the Front Line, Second Edition, 2010

Author: John Gosbee, MD, MS, and Laura Lin Gosbee, MASc, Publisher: The Joint Commission, ISBN: 978-1-59940-411-0, Publication date: September 2010, Pages: 176, Price: $85Like the first edition, the second edition of this book provides an excellent introduction to human factors engineering (HFE) with a variety of useful teaching resources and informative case studies. The second edition contains a different set and range of case studies from authors representing hospitals and patient safety organizations. It focuses more on the hospital setting than some of the other books in this area, probably due, in part, to John Gosbee's background as an MD.Audience: This book is suitable for a wide variety of readers. Certainly it is useful for healthcare providers and clinical practitioners, who would benefit from the background and introductory materials, especially the advice on choosing human factors (HF) consultants or HF staff. They would also benefit from the case studies, especially those from hospital settings such as Johns Hopkins and Baylor. Management in clinical settings would learn about the benefits of HF in their operations and might be motivated to hire some HF engineers to improve their patient-safety profile, something that's occurring at more hospitals.Clinical engineers and biomeds would be better consumers of medical devices and systems from a usability and use-safety perspective after reading this book. HF engineers already in healthcare or thinking about a career change into the medical field would benefit from seeing how their skills could be applied to solving the challenging problems of medical accidents and adverse patient events. Legislators would also see opportunities for the place of HF in healthcare legislation. Students would see HF in healthcare as a potentially fulfilling and interesting career choice. HF instructors would also find useful teaching tips in this book. In short, this book would appeal to different types of readers at many levels.Features: The Gosbee book has many useful features. It is well organized with the first section covering the basics and methods of HFE, and the second section containing practical case studies. The introductory chapters give a brief overview of HFE, including Theory and General Principles, Methods and Tools, Lessons Learned Teaching HFE, and Finding and Using HFE Expertise. The first section also includes an outline of a three-day workshop, with suggested class exercises, to teach HFE to hospital staff. Other features: checklists for teaching HFE, tips in hiring HF engineers, and a very helpful appendix on HFE. The book cites resources—including other books, journals, professional societies, and healthcare organizations—relevant to HFE.Assessment: The book is straightforward and written well for all levels of readers. I have a minor problem with the chapter on Finding and Using HFE Expertise. The authors are too narrow in their description of what constitutes a good HF engineer. Having worked at Bell Labs, where HFE was first introduced in industry after its origins in World War II, I saw that many companies recruited HF engineers from the ranks of rigorously trained behavioral scientists specializing in such fields as cognitive psychology and experimental psychology. Successful HF engineers from these backgrounds had a solid grounding in research methods along with a desire to work on applied problems of design and evaluation. Many of the most successful HF engineers did not come from pure HFE academic backgrounds, as suggested in the book.I was also confused by one case study of an insulin pen display potentially being read upside down. The photo of the pen appears to be edited incorrectly, but the learning point is still made. But these are very minor problems in a well-written, edited, and organized book—one that would be a worthwhile addition to anyone's general HFE library and, in particular, for someone in the healthcare discipline.