Human factors systems approach to healthcare quality and patient safety

Human factors systems approaches are critical for improving healthcare quality and patient safety. The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is a human factors systems approach that has been successfully applied in healthcare research and practice. Several research and practical applications of the SEIPS model are described. Important implications of the SEIPS model for healthcare system and process redesign are highlighted. Principles for redesigning healthcare systems using the SEIPS model are described. Balancing the work system and encouraging the active and adaptive role of workers are key principles for improving healthcare quality and patient safety.     

Bridging the gap between analysis and design: improving existing driver interfaces with tools from the framework of cognitive work analysis

Two studies of train driving are presented, both within the framework of cognitive work analysis. In the first study, the modelling tool abstraction–decomposition space is adapted to routine conditions, making the analysis more representative for normal procedures. A major contribution to these analyses was the use of the method for ‘collegial verbalisation’. One particular advantage with this method over other verbalisation methods is that it supplies the analysts with data that contain much more information, but not at the expense of being more subjective. On the contrary, this method produces think-aloud protocols from video-recordings that do not have to be interpreted by the researcher. From these analyses, it was possible to distinguish information that is an intrinsic part of the train driver task from information that is dependent on the configuration and design of the current support system. The analyses show that the driver works in three rather separate time intervals with a long-range, a short-term and an immediate sense of perspective. The driver switches between these while travelling between two stations. Based on these behaviour-shaping constraints, a prototype of a planning area of a driver interface was developed, making feed-forward planning possible for the driver. Four design iterations were completed, using a user-centred system design (UCSD) approach. Early tests show that the planning area of the interface supports the feed-forward decision strategy used by drivers who prefer an active driving style. However, the driver group also made substantial changes in the design, indicating that UCSD is an efficient tool in order to capture user competencies, and to bridge the gap between analysis and design.     

Human factors of complex sociotechnical systems

Increasingly products and services result from interactions among people who work across organizational, geographical, cultural and temporal boundaries. This has major implications for human factors and ergonomics (HFE), in particular, challenging the limits of the systems to be designed, and widening the range of system elements and dimensions that we need to consider. The design of sociotechnical systems that involve work across multiple boundaries requires better integration of the various sub-disciplines or components of HFE, as well as increased collaboration with other disciplines that provide either expertise regarding the domain of application or expertise in concepts that can enrich the system design. In addition, 'customers' contribute significantly to the 'co-production' of products/services, as well as to their quality/safety. The design of sociotechnical systems in collaboration with both the workers in the systems and the customers requires increasing attention not only to the design and implementation of systems, but also to the continuous adaptation and improvement of systems in collaboration with customers. This paper draws from research on human factors in the domains of health care and patient safety and of computer security.     

Ergonomics action research II: a framework for integrating HF into work system design

This paper presents a conceptual framework that can support efforts to integrate human factors (HF) into the work system design process, where improved and cost-effective application of HF is possible. The framework advocates strategies of broad stakeholder participation, linking of performance and health goals, and process focussed change tools that can help practitioners engage in improvements to embed HF into a firm's work system design process. Recommended tools include business process mapping of the design process, implementing design criteria, using cognitive mapping to connect to managers’ strategic goals, tactical use of training and adopting virtual HF (VHF) tools to support the integration effort. Consistent with organisational change research, the framework provides guidance but does not suggest a strict set of steps. This allows more adaptability for the practitioner who must navigate within a particular organisational context to secure support for embedding HF into the design process for improved operator wellbeing and system performance.

Practitioner Summary: There has been little scientific literature about how a practitioner might integrate HF into a company's work system design process. This paper proposes a framework for this effort by presenting a coherent conceptual framework, process tools, design tools and procedural advice that can be adapted for a target organisation.     

Development of a stakeholder identification and analysis method for human factors integration in work system design interventions – Change Agent Infrastructure

In any work system design intervention—for example, a physical workplace re-design, a work process change, or an equipment upgrade—it is often emphasized how important it is to involve stakeholders in the process of analysis and design, to gain their perspectives as input to the development, and ensure their future acceptance of the solution. While the users of an artifact or workplace are most often regarded as being the most important stakeholders in a design intervention, in a work-system context there may be additional influential stakeholders who influence and negotiate the design intervention's outcomes, resource allocation, requirements, and implementation. Literature shows that it is uncommon for empirical ergonomics and human factors (EHF) research to apply and report the use of any structured stakeholder identification method at all, leading to ad-hoc selections of whom to consider important. Conversely, other research fields offer a plethora of stakeholder identification and analysis methods, few of which seem to have been adopted in the EHF context. This article presents the development of a structured method for identification, classification, and qualitative analysis of stakeholders in EHF-related work system design intervention. It describes the method's EHF-related theoretical underpinnings, lessons learned from four use cases, and the incremental development of the method that has resulted in the current method procedure and visualization aids. The method, called Change Agent Infrastructure (abbreviated CHAI), has a mainly macroergonomic purpose, set on increasing the understanding of sociotechnical interactions that create the conditions for work system design intervention, and facilitating participative efforts.     

Participatory ergonomics intervention for improving human and production outcomes of a Brazilian furniture company

This article presents a participatory intervention in a furniture manufacturing company in Southern Brazil aiming to improve both ergonomic and production outcomes. The existing Tayloristic model was replaced by a cellular teamwork model. Work enlargement and enrichment, and the improvements in workstation design and process flow increased worker satisfaction and reduced postural risk, fatigue, body pain and production waste. Workload was reduced by 42% and productivity increased by 46% (25% being attributable to unnecessary load handling, waiting and transportation, and 21% attributable directly to manufacturing times). Workers' participation in the stages of problems identification, design and evaluation of solutions played a major role in these outcomes.Relevance to industryThis study indicates that it is possible to balance ergonomics and production demands, and that it is necessary to make it clear to management. The integration of macroergonomics and production management principles increases both worker well-being and productivity levels, thus leading to a more sustainable system.     

A strategy for human factors/ergonomics: developing the discipline and profession

Human factors/ergonomics (HFE) has great potential to contribute to the design of all kinds of systems with people (work systems, product/service systems), but faces challenges in the readiness of its market and in the supply of high-quality applications. HFE has a unique combination of three fundamental characteristics: (1) it takes a systems approach (2) it is design driven and (3) it focuses on two closely related outcomes: performance and well-being. In order to contribute to future system design, HFE must demonstrate its value more successfully to the main stakeholders of system design. HFE already has a strong value proposition (mainly well-being) and interactivity with the stakeholder group of 'system actors' (employees and product/service users). However, the value proposition (mainly performance) and relationships with the stakeholder groups of 'system experts' (experts fromtechnical and social sciences involved in system design), and 'system decision makers' (managers and other decision makers involved in system design, purchase, implementation and use), who have a strong power to influence system design, need to be developed. Therefore, the first main strategic direction is to strengthen the demand for high-quality HFE by increasing awareness among powerful stakeholders of the value of high-quality HFE by communicating with stakeholders, by building partnerships and by educating stakeholders. The second main strategic direction is to strengthen the application of high-quality HFE by promoting the education of HFE specialists, by ensuring high-quality standards of HFE applications and HFE specialists, and by promoting HFE research excellence at universities and other organisations. This strategy requires cooperation between the HFE community at large, consisting of the International Ergonomics Association (IEA), local (national and regional) HFE societies, and HFE specialists. We propose a joint world-wide HFE development plan, in which the IEA takes a leadership role. PRACTITIONER SUMMARY: Human factors/ergonomics (HFE) has much to offer by addressing major business and societal challenges regarding work and product/service systems. HFE potential, however, is underexploited. This paper presents a strategy for the HFE community to strengthen demand and application of high-quality HFE, emphasising its key elements: systems approach, design driven, and performance and well-being goals.     

Systems scenarios: a tool for facilitating the socio-technical design of work systems

Abstract

The socio-technical systems approach to design is well documented. Recognising the benefits of this approach, organisations are increasingly trying to work with systems, rather than their component parts. However, few tools attempt to analyse the complexity inherent in such systems, in ways that generate useful, practical outputs. In this paper, we outline the ‘System Scenarios Tool’ (SST), which is a novel, applied methodology that can be used by designers, end-users, consultants or researchers to help design or re-design work systems. The paper introduces the SST using examples of its application, and describes the potential benefits of its use, before reflecting on its limitations. Finally, we discuss potential opportunities for the tool, and describe sets of circumstances in which it might be used.

Practitioner Summary: The paper presents a novel, applied methodological tool, named the ‘Systems Scenarios Tool’. We believe this tool can be used as a point of reference by designers, end-users, consultants or researchers, to help design or re-design work systems. Included in the paper are two worked examples, demonstrating the tool’s application.     

Packet-level traffic control for the Internet: a framework and its experimental validation

This paper presents a theoretical framework, which can be the basis for traffic control and resource management mechanisms, that provide QoS with quantitative guarantees in the Internet. The starting point is a fairly general traffic shaping algorithm for effective rate enforcement which is based on a packet spacing law. Multiplexing several independent shaped streams results in a tight upper bound to the queue-length distribution at the multiplexer. The algorithm effectively works with any kind of input traffic (non-stationary, non-Markovian, heterogeneous, long-range dependent (LRD), etc.). Based on the definition of shaped streams, we devise mechanisms for aggregating, splitting and policing such streams without affecting the queuing performance at subsequent network nodes. Also, a calculus for end-to-end QoS in this framework is presented. The theoretical statements are supported by simulation and experimental results on a network testbed. Since the enforced effective rate features the convenient additivity property , it can be handily used for many traffic control and accounting functions, like policing, admission control, bandwidth allocation and charging.     

Simulating the task-level control of human motion: a methodology and framework for implementation

A task-level control framework is proposed for providing feedback control in the simulation of goal-directed human motion. An operational space approach, adapted from the field of robotics, is used for this purpose. This approach is augmented by a significant new extension directed at addressing the control of muscle-driven systems. Task/posture decomposition is intrinsically exploited, allowing human musculoskeletal properties to direct postural behavior during the performance of a task. This paper also describes a simulation architecture for generating musculoskeletal simulations of human characters. The evolving capabilities of the collective environment are directed toward autonomously generating realistic motion control for virtual actors in interactive computer graphics applications, as well as synthesizing the control of human-like motion in robotic systems.     

Towards a theoretical framework of SPI success factors for small and medium web companies

ContextThe context of this research is software process improvement (SPI) success factors for small and medium Web companies.ObjectiveThe primary objective of this paper is to propose a theoretical framework of SPI success factors for small and medium Web companies.MethodThe theoretical framework presented in this study aggregated the results of three previous research phases by applying principles of theoretical integration and comparative analysis. Those three previous phases were all empirical in nature, and comprise: a systematic review of SPI in small and medium Web companies [1], [2]; a replication study [3] and a grounded theory-based initial exploratory framework of factors in small and medium Web companies [4].ResultsThe theoretical framework includes 18 categories of SPI success factors, 148 properties of these categories and 25 corresponding relationships, which bind these categories together. With the help of these relationships, the categories and properties of SPI success factors can be directly translated into a set of guidelines, which can then be used by the practitioners of small and medium Web companies to improve the current state of SPI in their companies and achieve overall company success.ConclusionThe comprehensive theoretical framework of SPI success factors presented herein provides evidence regarding key factors for predicting SPI success for small and medium Web companies. The framework can be used as a baseline for a successful implementation of SPI initiatives in the mentioned domain.     

基于ASP．NET的高职工学结合实习管理系统的设计

针对高职工学结合过程中存在的诸多问题,应用ASP．NET及数据库技术,设计了B／S结构的高职工学结合实习管理系统,实现了工学结合实习信息的计算机网络化管理和信息共享。为学校、企业、学生三方的合作交流提供了平台,使实习信息的采集、管理、共享规范化和现代化。     

Educational and intervention strategies for improving a shift system: an experience in a disabled persons' facility

The improvement of an irregular three-shift system with anti-clockwise rotation of workers of a disabled persons' facility covering 42 h a week was a subject for management-labour debate. Workers were complaining of physical fatigue, high prevalence of low back pain, sleep shortages associated with short inter-shift intervals, and irregular holidays. With the co-operation of trade union members, an educational and intervention programme was designed to analyse, plan, and implement improved shift rotation schemes. The programme consisted of (a) a group study on the existing system and effects on health and working life; (b) joint planning of potential schemes; (c) communication and feedback (d) testing and evaluation; and (e) agreement on an improved system. The group study was undertaken by means of time study, questionnaire and physiological methods, and the results were jointly discussed. This led to the planning of alternative shift schemes incorporating more regular, clockwise rotation. It was agreed to stage a trial period with a view to shorter working hours. This experience indicated the importance of a stepwise intervention strategy with frequent dialogues and a participatory process focusing on the broad range of working life and health issues.     

The work compatibility improvement framework: preliminary findings of a case study for defining and measuring the human-at-work system

Although researchers traditionally examined the 'risk' characteristics of work settings in health studies, few work models, such as the 'demand-control' and 'motivation-hygiene theory', advocated the study of the positive and the negative aspects of work for the ultimate improvement of work performance. The objectives of the current study were: (a) to examine the positive and negative characteristics of work in the machining department in a small manufacturing plant in the Midwest USA, and, (b) to report the prevalence of musculoskeletal and stress outcomes. A focus group consisting of worker experts from the different job categories in the machining department confirmed the management's concerns. Accordingly, 56 male and female workers, employed in three shifts, were surveyed on the demand/energizer profiles of work characteristics and self-reported musculoskeletal/stress symptoms. On average, one-fourth to one-third of the workers reported 'high' demand, and over 50% of the workers documented 'low' energizers for certain work domains/sub-domains, such as 'physical task content'/'organizational' work domains and 'upper body postural loading'/'time organization' work sub-domains. The prevalence of workers who reported 'high' musculoskeletal/stress disorder cases, was in the range of 25-35% and was consistent with the results of 'high' demands and 'low' energizers. The results of this case study confirm the importance of adopting a comprehensive view for work improvement and sustainable growth opportunities. It is paramount to consider the negative and positive aspects of work characteristics to ensure optimum organizational performance. The Work Compatibility Improvement Framework, proposed in the reported research, is an important endeavor toward the ultimate improvement and sustainable growth of human and organizational performance.     

Supporting the consumption and co-authoring of locative media experiences for a rural village community: design and field trial evaluation of the SHARC2.0 framework

Locative Media Experiences (LMEs) have significant potential in enabling visitors to engage with the places that they visit through an appreciation of local history. For example, a visitor to Berlin that is exploring remnants of the Berlin Wall may be encouraged to appreciate (or in part experience) the falling of the Berlin wall by consuming multimedia directly related to her current location such as listening to audio recordings of the assembled crowds on 10th November 1989. However, despite the growing popularity of enabling technologies (such as GPS-equipped smart phones and tablets), the availability of tools that support the authoring of LMEs is limited. In addition, mobile apps that support the consumption of LMEs typically adopt an approach that precludes users from being able to respond with their own multimedia contributions. In this article we describe the design and evaluation of the SHARC2.0 framework that has been developed as part of our long-term and participatory engagement with the rural village of Wray in the north of England. Wray has very limited cellular data coverage which has placed a requirement on the framework and associated tools to operate without reliance on network connectivity. A field study is presented which featured a LME relating to Wray’s local history and which contained multimedia content contributed by members of the community including historic photos (taken from an existing ‘Digital Noticeboard’ system), audio-clips (from a local historian and village residents) and video (contributed during a design workshop). The novelty of our approach relates to the ability of multiple authors to contribute to a LME in-situ, and the utilisation of personal cloud storage for storing the contents associated with a multi-authored LME.

     

Gender and ergonomics: a case study on the 'non-formal' work of women nurses

Women's work activities are often characterised by 'non-formal actions' (such as giving support). Gender differences in ergonomics may be due to this peculiarity. We applied the method of organisational congruencies (MOC) to ascertain the 'non-formal' work portion of nurses employed in three hospital units (haematology, emergency room and general medicine) during the three work shifts in a major University Hospital in Rome, Italy. We recorded a total of 802 technical actions performed by nine nurses in 72 h of work. Twenty-six percent of the actions in direct patient's care were communicative actions (mainly giving psychological support) while providing physical care. These 'double actions' are often not considered to be a formal part of the job by hospital management. In our case study, the 'non-formal' work of nurses (psychological support) is mainly represented by double actions while taking physical care of the patients. The dual task paradigm in gender oriented research is discussed in terms of its implications in prevention in occupational health. PRACTITIONER SUMMARY: The main purpose of the study was to assess all the formal and non-formal activities of women in the nursing work setting. Offering psychological support to patients is often not considered to be a formal part of the job. Our case study found that nurses receive no explicit guidelines on this activity and no time is assigned to perform it. In measuring the burden of providing psychological support to patients, we found that this is often done while nurses are performing tasks of physical care for the patients (double actions). The article discusses the significance of non-formal psychological work load of women nurses through double actions from the ergonomic point view.     

Margin of safety for the human back: a probable consensus based on published studies

Despite numerous efforts to control occurrences of work-related low back pain, it continues to be a significant problem. Since the causation of low back pain is under multifactorial control, it is suggested that the factor most vulnerable at any given time will determine the safety. Epidemiological, biomechanical, physiological, and psychophysical information presented in published literature has been analysed. The data available are related to injuries and the projected margin of safety. This paper therefore, is an integrative, inferential synthesis of the published work to discern the margin of safety. An attempt has been made to conclude, on the basis of objective evidence, an all encompassing criterion to ensure the safety of the back. The psychophysical approach appears to integrate biomechanical and physiological variables on a short term basis in the studies surveyed. However, it remains to be proven that the sensory conditioning due to prolonged and repetitive occupational tasks will remain responsive to cumulative load and fatigue failures.     

The keyboard blues: Modern technology and the rights and risks of people at work

Health and safety at work is a moral imperative, but the debates emphasise only the economic and legal sides. Drawing on case material from working with VDUs and other forms of modern technology it is shown that loss of control over their immediate work processes can be stressful and potentially harmful to responsible operators. Autonomy and freedom in work process control enhances the power that workers have to protect their health. It is suggested that unquestioned divisive and dualistic practices at workplaces are a potent and unnecessary reason for this problem.A human being can only survive in the Age of Machinery if the ethical norms of life are held sacred. This Shamanist protest at the destructive power of evil, as expressed in theCurse Upon Iron, stands forth prominently in a society in moral crisis.     

Analysis method for revealing human and organisational factors of occupational accidents with movement disturbance (OAMDs)

Abstract

Slips, trips and other movement disturbances account for 20 to 30% of recorded occupational accidents (OAs). The causal representations of these accidents hamper their prevention. An analysis method dedicated to occupational accidents with movement disturbance (OAMDs) has been developed to change these representations. In France, the causal tree method (CTM) is very commonly used for analysing OAs. An initial version of an OAMD analysis method, which overcomes the problems encountered when analysing these accidents using the CTM, has been developed. This OAMD analysis method was reviewed by six targeted prevention officers and as a result some proposals have been discarded and this initial version has been transformed into three additional CTM modules. The purpose of these modules is to identify human and organisational factors and provide a formal representation of damage caused, beyond bodily injuries.

Practitioner summary: A method for analysing occupational accidents triggered by a slip, a trip or any other movement disturbance has been developed in consideration of the practices and constraints in companies. In particular, this method allows us to highlight the human and organisational factors involved in the accident situation.

Abbreviations: OA: occupational accident; OAMD: occupational accident with movement disturbance; CTM: causal tree method     

Consensus under a fuzzy context: Taxonomy,analysis framework AFRYCA and experimental case of study

Consensus reaching processes play an increasingly important role in the resolution of group decision making problems: a solution acceptable to all the experts participating in a problem is necessary in many real-life contexts. A large number of consensus approaches have been proposed to support groups in such processes, each one with its own characteristics, such as the methods utilized for the fusion of information regarding the preferences of experts. Given this variety of existing approaches in the literature to support consensus reaching processes, this paper considers two main objectives. Firstly, we propose a taxonomy that provides an overview and categorization of some existing consensus models for group decision making problems defined in a fuzzy context, taking into account the main features of each model. Secondly, the paper presents AFRYCA, a simulation-based analysis framework for the resolution of group decision making problems by means of different consensus models. The framework is aimed at facilitating a study of the performance of each consensus model, as well as determining the most suitable model/s for the resolution of a specific problem. An experimental study is carried out to show the usefulness of the framework.