design of work for patient safety pascale carayon, ph.d. procter & gamble bascom professor in...

Design of Work for Patient Safety

Pascale Carayon, Ph.D.Procter & Gamble Bascom Professor in Total Quality

Department of Industrial and Systems Engineering

Center for Quality and Productivity Improvement

University of Wisconsin-Madison

http://www2.fpm.wisc.edu/seips/

Outline

SEIPS model of work and patient safety DESIGNDESIGN What kind of research? Challenges and questions

Outline

SEIPS model of work and patient safety Importance of work and processes for patient safety

DESIGN What kind of research? Challenges and questions

SEIPS Model of Work System and Patient SafetySEIPS = System Engineering Initiative for Patient Safety

Carayon et al., 2006

SMArTHF Project TeamUniversity of Wisconsin-Madison / UW Hospital & Clinics

Madison-Wisconsin-USA

Funding provided by the Agency for Healthcare Research and Quality

Medication Administration Technologies

Work System (or a sociotechnical system)(Balance Theory; Smith and Carayon, 1989; Carayon and Smith, 2000)

Technology and Tools

Organization

Environment Tasks

Person

BCMA Technology Implementation…BCMA = Bar Coding Medication Administration

Technology and Tools

Organization

Environment Tasks

Person

scan self

obtain meds

check med vs device

enter pt room

scan med

scan med

doc admin

double check

enter pt room

M (1)

give med to pt

scan pt ID band

doc admin

N (1)

give med to pt

scan pt ID band

enter pt room

scan med

scan pt ID band

doc admin

give med to pt

O (1)

scan med

check med vs device

enter pt room

scan ptID band

Q(1)

give med to pt

doc admin

P (1)

scan ptID band

D(22)

E (1)

docadmin

doc admin

give med to pt

give med to pt

F (17)

give medto pt

G(1)scan pt ID band

docadmin

I(1)doc

admin

H(2)

double check

scan pt ID band

give med to pt

docadmin

J(1)

enter pt room

docadmin

give med to pt

K(2)

START

obtain meds

scan pt ID band

A(1)

give med to pt

docadmin

scan self enter pt room

check med vs device

scan med enter pt room

enter ptroom

scan ptID band

give medto pt

docadmin

B(1)

scan self

check medvs device

scan med

scan pt ID band

give med to

pt

doc admin

C(2)

scan pt ID band

docadmin

enter pt room

L (1)

give med to pt

enter ptroom

scan pt ID band

doc admin

R (1)

give med to pt

1

9

3

2

5

4

7

6

8

Sequence according to policy

Potentially unsafe sequence

Most frequent workaround: documentation before medication administration

BCMA = Bar Coding Medication Administration

Organizational factors:

interruptions, shift

Environment: where tasks completed,

lighting, noise

Tasks: sequence of acts, handoffs,

unsafe acts

Technology: automation surprises, malfunctions

Technologyand Tools

Organization

EnvironmentTasks

Person

Technologyand Tools

Organization

EnvironmentTasks

Person

Individual (nurse or patient): patient

in isolation

Outline

SEIPS model of work and patient safety DESIGNDESIGN What kind of research? Challenges and questions

Design of …

… work system… processPurposeful activityContinuous processKnowledge, principles, tools

Design principles (human factors)

Opportunities for Design of Work

Technology implementation (e.g., EHR, CPOE, bar coding medication administration)

Renovation or new building/facility…Any change that affects work and

processes… Can you think of a change currently going on in

your organization that can affect the work of healthcare providers and processes?

Design Principles of Human Factors and Ergonomics (HFE)

User-centered designDimensions of HFE:

Physical ergonomics physical characteristics of end users

Cognitive ergonomics cognitive characteristics of end users

Organizational ergonomics psychosocial needs of end users

51 chapters, 1,000 pages:•Human error•Sociotechnical systems and macroergonomics•Technology, medical devices•Physical ergonomics•Methods and tools•Various care settings•…

Outline

SEIPS model of work and patient safety DESIGN What kind of research? Challenges and questions

What Kind of Research?

Probably not RCT… Action research framework

Collaborative multidisciplinary researchMultiple data collection methods

Outline

SEIPS model of work and patient safety DESIGN What kind of research? Challenges and questions

Challenges and QuestionsDesign of Work for Patient Safety

Complex system with interactions Who are the end users?

Example = medication management in ambulatory care Design for multiple groups of end users

Who is the designer of work and processes? Home care:

Role of patient and family Transitions of care:

Design of interaction

HIT Impact on work system Design of HIT-supported work and processes