Human Factors Science Research Articles

The value of active followership

Followership is an emerging concept based on human factors science. It describes a set of skills and behaviours that help improve team performance. An effective leader creates vision, sets direction and enables a culture in which others can thrive and work together to deliver the goals. Like leadership, good followership is increasingly being recognised as an important component for high performance. Good followership is based on good communication and 'upward influencing' (Willson 2012). This article discusses the concept arid provides scenarios to illustrate examples of good and poor followership, and how they affect care.

The science of human factors: separating fact from fiction

BackgroundInterest in human factors has increased across healthcare communities and institutions as the value of human centred design in healthcare becomes increasingly clear. However, as human factors is becoming more...

Recognizing nurse stakeholder dissonance as a critical determinant of patient safety in new healthcare information technologies

Proper identification of all stakeholders and the comprehensive assessment of their evolving and often conflicting Needs, Wants, and Desires (NWDs) is a fundamental principle of human factors science and human-centered systems engineering; it is not yet a consistent element in development and deployment of new health information technologies (HIT). As the single largest group of healthcare professionals, nurses are critical stakeholders for these new technologies. Careful analysis can reveal nurse stakeholder dissonance (NSD) when integrating new technologies into the healthcare environment. Stakeholder dissonance is a term that describes the conflict between the NWDs of different stakeholders which, if left unresolved, can result in dissatisfaction, workarounds, errors, and threats to patient safety. Three case studies drawn from the authors' experience in a variety of acute-care settings where new HITs have been recently deployed are examined to illustrate the concept of NSD. Conflicting NWDs, other stakeholders, and possible root causes of the NSD are analyzed and mapped to threats to patient safety. Lessons learned, practical guidance for anticipating, identifying, and mitigating NSD, future research and implications for HFE and nursing practice are discussed.

Patient Safety as the Number One Priority in Healthcare Design

Over the past few decades, healthcare has become increasingly more complex, difficult to coordinate among multiple providers, heavily impacted by technology, and subject to situations and conditions that have the potential to diminish quality or breach patient safety. Patients come to hospitals in their most vulnerable state-often in pain, usually fearful, and always feeling a bit out of place. How can this be? Hospitals are supposed to be a safe haven and a place of healing and rest; yet many patients are victims of errors in treatment, procedure, or medication, or they are injured by elements of the hospital environment. A hospital can be a dangerous place for patients because its unfamiliar environment contrasts with home (Tzeng & Yin, 2008a). As designers and healthcare professionals, what can we do to design a healthcare facility that minimizes the potential for risk and enhances patient safety?Although there are many claims that specific design features reduce medication errors, decrease patient falls, lessen cross-contamination, and improve patient safety outcomes, disseminated evidence to support the direct relationship between specific design features and patient outcomes has been sparse. This issue of HERD focuses on patient safety in healthcare design with the intent of adding to a body of knowledge about the relationships between the built environment and patient safety outcomes. I am excited about this issue and fully believe that we will see more research demonstrating the effects of design features on patient safety outcomes that will guide future design decisions. Patient safety should be the number one priority when evaluating the efficacy of design alternatives, and we have unprecedented opportunities to affect quality and patient safety by creating safer work environments for professional staff and safer care environments for patients.A Multidisciplinary ApproachReducing patient risk by means of facility design requires a multidisciplinary approach, because each discipline brings a body of knowledge, viewpoints, preferences, and interpretations to the table to expose hidden assumptions about what could make a difference in ensuring patient safety (Reiling, 2006; Wears, Perry, & Sutcliffe, 2005). We do not often think of safety as a science, yet it is a science with its own body of knowledge, research, and vested academic degrees. According to Wears, When the patient safety movement first began, an important early insight was the realization that a great deal was already known about the problem of safety in complex socio-technical systems based on years of research and practice in a wide variety of (p. 4). Many lessons have been learned from the space program, aviation, the military, and the nuclear power industry that can and have directly influenced assumptions about safety in healthcare design. The same-handed room design concept is one example of borrowing safety knowledge from the aviation field, where all cockpits in certain types of aircraft are designed identically to reduce the potential for pilot confusion and error. Some have accepted this idea as evidence that can be applied to healthcare design (Reiling, 2006).Human factors science applies what is known about human capabilities and limitations to the design of systems, processes, and environments to maximize human potential in the environment and reduce the potential for stress, strains, and errors. Applying human factors science to the healthcare setting, the user (patient) interface with a design would be studied in detail and tested to determine requirements for the built environment that would ensure patient safety (Blanchard & Fabrycky, 1998; Wickens, Lee, Liu, & Gordon Becker, 2004). Some of the research methodologies that could be used as human factors evaluation methods might include: (1) focus groups with patients and providers to identify potential risk areas for patients; (2) ethnography to understand the real-world or lived experience of patients in the healthcare environment; (3) iterative design processes, with each design evaluated in relation to patient safety priorities; and (4) systematic task analysis to evaluate human interaction with the environment under specified conditions (patients with different conditions in specific situations). …

Nontechnical Skills

Nontechnical Skills

Healthcare Recovery: How the Science of Human Factors is Challenging Healthcare to Move Patient Safety Forward

The current panel brings together a variety of expertise to bear on two critical questions: (1) How is the science of Human Factors challenging healthcare to move patient safety forward and (2) How will this role evolve given recent calls and mandates for healthcare reform? Specifically panelists will discuss issues related to healthcare informatics, team-centric approaches to care, and human-system integration factors related to medical error and care quality.

Human Centric Environmentalism: Opportunities for the Human Factors Community to Contribute to Global Environmental Solutions

Previous psychological research into human induced causes of environmental change has stemmed largely from a behavior modification approach and has shown only modest results. We suggest that the lack of long term success in this area may be due to the lack of attention toward the underlying design dimensions to these problems. In this paper, we attempt to illustrate that by using our understanding of design principles related to human behavior and performance, the human factors community has the unique potential to make significant strides in improving these underlying design dimensions. Along these lines, applicable research areas include cognitive decision making, product design, surface transportation, and environmental design. We argue that, by shaping technologies in a way that is both user friendly and environmentally benign, the science of human factors has the potential to grow in new areas of research – areas that are not only theoretically relevant but also of societal importance.

Just What the Doctor Ordered?: The Role of Cognitive Decision Support Systems in Clinical Decision-Making & Patient Safety

Human expertise is limited by both cognitive workload and the boundaries of attention. With the spread and integration of healthcare informatics, cognitive decision support (CDS) technologies have been suggested as a means for improving the effectiveness and efficiency of healthcare. The current panel brings together leading human factors and medical experts in the fields of decision-making, design, and human-system interaction to provide their insight and perspective on the following question: What contributions can human factors science bring to bear on (1) the design, (2) integration, and (3) training necessary for effective CDS implementation?

Measuring Usability of Assistive Technology From a Multicontextual Perspective: The Case of Power Wheelchairs

Assistive technology (AT) devices enable people with disabilities to function in multiple contexts and activities. The usability of such devices is fundamentally indicative of the user's level of participation in multiple roles and occupations. Seventy people who used power wheelchairs were interviewed using a novel tool, the Usability Scale for Assistive Technology (USAT). The USAT uses a human factors science framework to investigate the wheelchair user's perceived independence in mobility-related activities within home, workplace, community, and outdoors in accordance with the characteristics of the wheelchair, environmental factors, and abilities and skills of the user to operate the wheelchair. Descriptive analysis of the data revealed usability issues with the use of power wheelchairs in all contexts. Users confronted far more significant issues within the community and outdoor environment compared with those at home and in the workplace. These issues have been elucidated and applied to an intervention framework with relevance to a multitude of AT stakeholders.

Forensic Human Factors: People, Places, Products

Forensic human factors (HF) consultants apply the science of human factors to litigation. After someone has been injured and a lawsuit has been filed, attorneys will often seek the expertise of forensic HF consultants to analyze the incident and determine if features of the person, place, or product involved were causal factors in the incident. In this chapter we describe the conventions, guidelines, and procedures involved in a typical forensic HF case. In addition, we describe the human factors content areas that are most frequently addressed over the course of an HF evaluation.

Human Factors and Ergonomic Science in the Courts: Expert Testimony in the Dispute Resolution Process

The science of human factors and ergonomics (HF/E) contributes to the dispute resolution process in many ways. HF/E analysis can provide insights into product liability issues, vehicular accidents, industrial accidents, and more. The field is increasingly being recognized by lawyers as a means to help jurors and judges understand why events may have occurred; for example, why someone would use a product or drive a vehicle in a seemingly unsafe manner. Often, probable causes relate to design-induced or system-induced error. To understand the litigation influence of HF/E, we analyzed cases involving HF/E experts. Our findings revealed that: (1) HF/E science is well recognized in the judicial system; (2) competent HF/E experts are viewed as contributing to litigated matters; (3) individuals without HF/E training and experience will not be recognized as HF/E experts; and (4) admissibility demands that the intellectual rigor used for court must be consistent with other discipline-related work.

The SHEL Model: A Useful Tool for Analyzing and Teaching the Contribution of Human Factors to Medical Error

Recent reports on the problem of medical error pointed to a discipline that has been until recently, largely disregarded by the medical profession. The interdisciplinary science of Human Factors, the reports argue, provides a pragmatic framework for analyzing and assessing risk and reducing error in health care. The argument for applying Human Factors analysis to health care is increasingly accepted, and the application of Human Factors systems models for understanding medical error in particular have proved to be especially illuminating. The authors present a conceptual model of Human Factors--the SHEL model (named after the initial letters of its components' names, Software, Hardware, Environment, and Liveware)--that has been used in investigations of error in aviation. The authors use this simple model to examine and elucidate the Human Factors issues in a specific real-life example of medical error. The SHEL model is particularly useful in examining Human Factors issues in microsystems in health care such as the emergency room or the operating theatre; it argues that mismatches at the interface between the components in these health care microsystems are often conducive to medical errors. The authors propose that the SHEL model may have some unexploited potential in analyzing error and in training medical professionals about the science of Human Factors and its application to medical error. Empirical studies are needed, however, to ascertain the optimal amount of training needed to make clinically significant reductions in the occurrence of medical error.

Bibliometric Analysis of the Science of Human Factors

Domain visualization attempts to present the interrelationships between research areas by spatially representing the fields or sub fields of science. The science of human factors has grown over the past decade. In addition, sub specialties within the field have developed making it even more complex to understand. As a future human factors practitioner, understanding a multidisciplinary field such as this necessitates a domain analysis because of its evolutionary and complex nature. This paper reports the preliminary results of this analysis using author co-citation analysis (ACA) and three domain visualization tools, cluster analysis, multidimensional scaling, and Pathfinder Networks. Sixty authors were mapped selected from core ergonomics, human factors (HF) and human computer interaction (HCI) journals. Preliminary results suggest that ergonomics is treated as a separate entity, while HF and HCI are more intertwined with some key researchers forming the core of the research community. Future research directions are discussed.

System Innovation: Concord Hospital

The Cardiac Surgery Program at Concord Hospital (Concord, NH) restructured clinical teamwork for improved safety and effectiveness on the basis of theory and practice from human factors science, aviation safety, and high-reliability organization theory. A team-based, collaborative rounds process--the Concord Collaborative Care Model--that involved use of a structured communications protocol was conducted daily at each patient's bedside. The entire care team agreed to meet at the same time each day (8:45 AM to 9:30 AM) to share information and develop a plan of care for each patient, with patient and family members as active participants. The cardiac surgery team developed a structured communications protocol adapted from human factors science. To provide a forum for discussion of team goals and progress and to address system-level concerns, a biweekly system rounds process was established. Following implementation of collaborative rounds, mortality of Concord Hospital's cardiac surgery patients declined significantly from expected rates. Satisfaction rates of open heart patients scores were consistently in the 97th-99th percentile nationally. A quality of work life survey indicated that in every category, providers expressed greater satisfaction with the collaborative care process than with the traditional rounds process. Practice patterns in the Cardiac Surgery Program at Concord Hospital have changed to a much more collaborative and participatory process, with improved outcomes, happier patients, and more satisfied practitioners. A culture of continuous program improvement has been implemented that continues to evolve and produce benefits.

Core Principles of Human Factors Science

This report introduces three core principles that define human factors science, and summarizes conceptual and empirical evidence in support of their validity. The principles are: (1) performance and design are interdependent; (2) the unit of analysis is the human-machine system; and (3) tailor design to the control capabilities of behavior.

Human Factors and Design Factors: Two Sides of the Same Coin?

Since its emergence, the field of human factors has been engaged in an ongoing debate regarding the scientific essence of the discipline. Many observers believe that the crux of the debate centers upon the link between human factors and design factors, or performance-design interaction. Presenters in this symposium offer a series of perspectives on this theme, in relation to: (1) emphasis on behavioral considerations in design of complex automated systems (Meister); (2) emphasis on contextual specificity in teaching of design (Moray); (3) an ecological analysis of human-environment interaction as an integrated system (Flach); and (4) core principles of human factors science centered upon performance-design interaction (Smith). The rationale for this symposium rests upon the widespread belief that the relationship between performance and design represents the defining issue of human factors science. That is, through its focus on functional integration of performance and design, human factors departs from the traditional dissected treatment of these phenomena by psychology and engineering. Therefore, the status of human factors science as an integral discipline may be considered to rest upon the answer to the question of how and why human behavior and performance vary in relation to design factors in the performance environment. Papers presented in this symposium provide insight into this question from a number of different perspectives.

The influence of human factors science on safety in the offshore industry

This paper aims to clarify applications of human factors science in the offshore process industry in terms of what can be done, why and how. Illustrative examples are given. An explanation is given of the meaning of ‘human factors’, and the use of human factors science before and after the Piper Alpha disaster is outlined. The influence of approaches developed after the nuclear Three Mile Island accident is discussed briefly. The need for human factors review of offshore installations in design, construction and operation is highlighted by providing quantitative information on underlying causes of loss-of-containment accidents. Human factors review should be part of the safety management system, which is described in terms of a set of control and monitoring loops; the control and monitoring requirements for optimizing human performance are outlined briefly. Using the concept design stage of an installation as an example, the use of human factors review in safety decision-making is exemplified by indicating which areas should be targeted for review and how this would influence safety. Key human factors review methods are identified and an example is given of one approach, a ‘walk-through’ of design and procedures. It is concluded that identification of causes of accidents has prompted the development of human factor applications, but that there is still room for much more comprehensive and long-term human factors programmes in the offshore industry, with considerable potential for risk reduction.

The Scientific Basis of Human Factors - A Behavioral Cybernetic Perspective

This report summarizes a body of empirical evidence supporting the conclusion that the preponderance of variability in human behavior and performance is attributable to design factors in the performance environment. This may be considered the central doctrine of human factors science that establishes the scientific basis of human factors as an integral discipline. The report goes on to offer a conceptual interpretation, based on behavioral cybernetic theory, of how and why design factors influence human behavior and performance. [This is not an official Bureau publication. The views expressed are not necessarily those of the U.S. Bureau of Mines.]

Critical Issues and Developments in Graduate Training and Continuing Education in Human Factors

Considering the variety and sources of graduate training and continuing educational programs which lead to the science and professional practice of human factors, this panel identifies and discusses important issues and developments in the training and education of human factors specialists. Then it recommends appropriate and professional solutions and approaches to these issues from the perspectives of universities and other institutions which are engaged in human factors training and education, research and application, and the professional practice and utilization of human factors. In the training and education of human factors specialists, there are important professional and scientific issues which may be examined as the human factors discipline progresses toward accreditation and certification, and new developments and accelerated growth continue to increase professional competence and social responsibility.

Human factors in decision and control: Nonstandard modeling and information processing

The study of human factors is increasingly important in information science and technology for studying the foundations of man-machine systems and also for medical research and applications. The time is not yet ripe to form a complete foundation of human factors concerning human information processing, particularly the infrastructure and mechanism of brainware, but it is time to provide some—though by no means all—foundations of human factors science as explicit and well established as those for the internal dynamics of humans, and to make suggestions for human-computer interaction in decision-making analysis. In this paper the study of human factors and related topics in information science and technology is advanced through the construction of an advanced control system, namely, the triple {man, machine, environment}, and the establishment of the formalism of this complex system by using the fuzzy set theories, such as general theories of fuzzy topology, sequences of fuzzy sets, fuzzy-continuous functions, compact fuzzy spaces, lattice of continuities of fuzzy topological space, and not least, fuzzy filters. Human-factors modeling can be based on oriental medical theories, namely, the five-elements theory and the Yin-Yang theory; fuzzy set and system theories have been applied to create the analytical expression for the model. Two examples are furnished as possible applications of these ideas: a model for estimation of the human state, and one for the man-computer interaction in decision-making analysis.