A systems ergonomics analysis of the Maidstone and Tunbridge Wells infection outbreaks

This paper describes a systems ergonomics analysis of the recent outbreaks of Clostridium difficile, which occurred over the period 2005–07 within the UK Maidstone and Tunbridge Wells NHS Trust. The analysis used documents related to the outbreak, alongside the construction of a system model in order to probe deeper into the nature of contributory factors within the Trust. The findings from the analysis demonstrate the value of looking further at cross-level and whole-system aspects of infection outbreaks. In particular, there is a need for further study of the causal relationships that exist between hospital management and clinical management levels within the system. Finally, the paper discusses ways forward and strategies that could be adopted in order to limit the outbreak of hospital-related infections and shape future research. The approach used for the system analysis described in the paper could be used by healthcare practitioners and ergonomists to probe deeper into the causes of infection outbreaks and to extend the scope of interventions aimed at preventing their occurrence.     

Design for patient safety: a systems-based risk identification framework

Current risk identification practices applied to patient safety in healthcare are insufficient. The situation can be improved, however, by studying systems approaches broadly and successfully utilised in other safety-critical industries, such as aviation and chemical industries. To illustrate this, this paper first investigates current risk identification practices in the healthcare field, and then examines the potential of systems approaches. A systems-based approach, called the Risk Identification Framework (RID Framework), is then developed to enhance improvement in risk identification. Demonstrating the strengths of using multiple inputs and methods, the RID Framework helps to facilitate the proactive identification of new risks. In this study, the potential value of the RID Framework is discussed by examining its application and evaluation, as conducted in a real-world healthcare setting. Both the application and evaluation of the RID Framework indicate positive results, as well as the need for further research.

Practitioner Summary: The findings in this study provide insights into how to make a better amalgamation of risk identification inputs to the safer design and more proactive risk management of healthcare delivery systems, which have been an increasing research interest amongst human factor professionals and ergonomists.     

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.     

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.     

A Review of: “The Elite Athlete”. By NANCY BUTTS,T. T. GUSHIKEN and B. ZARINS (Champaign,IL.: Life Enhancement Publications, 1985.) [Pp. 283.] $28·00. ISBN 0873229053

The past decade has seen an increase in the application of human factors and ergonomics (HFE) techniques to healthcare delivery in a broad range of contexts (domains, locations and environments). This paper provides a state of science commentary using four examples of HFE in healthcare to review and discuss analytical and implementation challenges and to identify future issues for HFE. The examples include two domain areas (occupational ergonomics and surgical safety) to illustrate a traditional application of HFE and the area that has probably received the most research attention. The other two examples show how systems and design have been addressed in healthcare with theoretical approaches for organisational and socio-technical systems and design for patient safety. Future opportunities are identified to develop and embed HFE systems thinking in healthcare including new theoretical models and long-term collaborative partnerships. HFE can contribute to systems and design initiatives for both patients and clinicians to improve everyday performance and safety, and help to reduce and control spiralling healthcare costs.     

Effect of physical activity and air velocity on the thermal insulation of clothing

Abstract

Intrinsic thermal clothing insulation and surface air insulation were measured on human subjects by the use of indirect calorimetry. Four male clothing ensembles (0-1-1 -8 clo) and three female clothing ensembles (0-2-1-2 clo) were investigated. Using the standing position as a reference, the influence of sitting, bicycling (40r.p.m., 20 W), walking (3-75 km hour^?1) and of light packing work on the thermal insulation was studied. The influence of an air velocity of 11ms^?1 on thermal insulation during the standing and walking conditions was investigated. The results showed that: (i) intrinsic clothing insulation was maximal in the standing position. It was reduced by 8-18% in the seated position and by 30-50% during bicycling and walking. An air velocity of 11ms^?1 did not influence the intrinsic clothing insulation during walking, but decreased it by 18% in the standing position; (ii) surface air insulation varied with activity and air velocity, but not with clothing. It was increased by up to 25% in the seated position, reduced by 7-26% during bicycling and by 30-50% during walking. An air velocity of 11 ms-1 reduced the surface air insulation by 50% in the standing position and 30% during walking.     

Designing sustainable work systems: The need for a systems approach

There is a growing discussion concerning sustainability. While this discussion was at first mainly focused on a society level – and sometimes regarding especially environmental problems, one can now see that this topic is of increasing relevance for companies worldwide and even the social dimension of this three pillar approach is gaining more and more importance. This leads to some questions: Is sustainability already a part of human factors thinking or do we have to further develop our discipline? How can we define sustainable work systems? What are the topics we have to consider? Do we need a new systems ergonomics perspective regarding whole value creation chains and a life-cycle perspective concerning products (and work systems)? How can we deal with potential contradictions about social, ecological, and economic goals?     

A cognitive approach to safe violations

Classically, humans have been perceived as a source of faults in systems. Modern ergonomic views are promoting a somewhat different idea according to which humans are a factor of safety in unexpected situations. The safety of a system cannot be achieved without taking into account these two sides of cognition which compose what is called cognitive flexibility. In this paper, we will consider the cases of a nuclear accident and a plane crash-landing where human cognitive flexibility has impacted the final safety of the system. We aim to discuss the violations that humans have performed in these cases with the assumption that these violations do not always deteriorate system safety. The discussion gravitates around a core argument according to which violations per se do not inform on the safety impairments in a system. Some other dimensions have to be taken into account. We are of the opinion that, among these other dimensions, the accuracy of the operators mental model plays a key role, allowing some violations to improve system safety in emergency situations.This revised version was published online in November 2003 with corrections in the article history.     

Decolonising critical information systems research: A subaltern approach

Theories used in the Information Systems (IS) field come in large majority from authors based in Western countries, a bias that holds for critical theories as well. Such a bias is made more problematic by the mandate of critical theory, which is meant exactly to illuminate the oppressive conditions of the status quo. Against this backdrop, this paper explores the subalternity theory approach – developed by the Subaltern Studies collective from the early 1980s – as an indigenous theory that, proposing a socially and geographically connotated narration of ‘history from below’, can play a major role in the effort to decolonise critical IS research. By positioning subaltern theory in the IS field, the paper offers an alternative to the Western hegemony of critical theories, exploring the potential of such an alternative to voice systematically silenced and marginalised perspectives.     

Assessment of patient safety research from an organizational ergonomics and structural perspective

The aim of this study is to review patient safety improvement initiatives within a conceptual framework that builds upon principles of organizational ergonomics and emphasizes structural factors that influence patient safety. The literature review included 131 English language published studies of patient safety improvement strategies extracted using Medline, Ovid Healthstar, PubMed and CINAHL searches. Keywords for the search included: ‘patient safety’; ‘medical errors’; ‘adverse event’; ‘iatrogenic’; and truncated options for ‘improve’. The multilevel, hierarchical framework offered in this paper integrates quality management principles and organizational ergonomics theory and organizes patient safety initiatives according to sociotechnical system elements within three structural levels: health policies and associated health care organizations; health care delivery organizations; and health care microsystems. Utilizing the conceptual framework, this review of patient safety improvement initiatives highlights the need for consideration of the impact of all improvement proposals on each structural component within health care systems. The review also supports the need for patient safety research to evolve from exploratory, 1-D reporting to multi-level, integrated research.     

A multi-level socio-technical systems telecommuting framework

Telecommuting can help to create organisational efficiencies and improve competitive advantage. It has been studied from a variety of perspectives, including that of transportation, management, psychology, and information systems. However, telecommuting literature, while abundant and diversified, often reports contradictory results, creating dilemmas for practice and research. Past researchers noting such conflicting findings often identify the lack of guiding theoretical bases as a key problem. In an attempt to explain the contradictory results found in prior research and in practice, we review telecommuting literature and expose conceptualisation issues that need to be addressed in the development of a telecommuting research model: telecommuting as both a context and an aspect of work, as a multi-level concept and as a time-dependent concept. The proposed multi-level model, guided by socio-technical systems theory, illustrates the inter-relationships of telecommuting antecedents and outcomes across levels of analysis and over time. The research offers a number of important implications for future research, as well as for managers involved in or affected by telecommuting in their organisations.     

GUIDED PRACTICE IN DIRECT AND REVERSED SERIAL TRACKING

Abstract

A discrete tracking task was arranged in which movements of a lever extinguished a series of stimulus lights, using either compatible or incompatible display-control relationships. Movement of the lever could be controlled by the subject, or made automatic in order to provide guidance. Six groups of subjects were given nine, one or no guided runs before beginning normal practice on either the direct or reversed form of the task.

As expected, the reversed task was more difficult than the direct version. On both forms of the task guidance formed effective pretraining, although nine trials of guidance wore not nine times as effective as one such trial. Guidance tended to have a greater effect upon the reversed form of task, as would be expected were its main function to prevent the commission of errors.     

面向安全关键系统的CAN总线应用研究综述*

控制器局域网适合小型安全关键系统的现场总线控制要求,能够以最大1Mbps速率发送和接收实时短消息。分析了CAN总线的结构、特点、协议仲裁机制、接口设计方法、实时特性和错误处理机制。为了支持任务关键网络,比较了事件触发协议与时间触发协议的特性,讨论了时间触发CAN协议的研究进展。     

面向安全关键系统的实时数据处理软件设计

介绍了一种针对单片机、PSD,12C接口存储芯片为主要组件设计的一类针对安全关键系统的测量与控制装置的实时软件设计、数据传输、存储及处理方法。通过各项实验考核表明,这种设计方法可靠灵活、高效,而且有较好的开放性及通用性。     

Lean production in complex socio-technical systems: A systematic literature review

Although lean production (LP) is usually associated with complexity reduction, it has been increasingly applied in highly complex socio-technical systems (CSS) (e.g. healthcare), in which the complexity level cannot be reduced below a certain (high) threshold. This creates a paradoxical situation, which is not well understood in theory and can be underlying the frustrating results of many lean implementations. This article presents a systematic literature review of how LP has dealt with complexity, both in theory and in practice, from a complexity science perspective. The review was based on 94 papers, which were analyzed according to seven criteria: how the concept of complexity is being used in lean research; the complexity level of the studied systems; the compatibility between the methodological approach and the nature of complexity; how complexity is managed by LP; barriers to LP in CSS; side-effects of LP in CSS; and whether complexity is always detrimental to LP. A research agenda is also proposed.     

A safe regression testing approach for safety critical systems

Regression testing is important activity during the software maintenance to deal with adverse effects of changes. Our approach is important for safety critical system as usually formal methods are preferred and highly recommended for the safety critical systems but they are also applied for the systems development of other than critical system. Our approach is based on Regression testing using VDM++ which takes two VDM++ specifications, one baseline and other delta (Changed) along with test suite for the baseline version. It compares both versions by using comparator module, identifies the change. By analyzing the change we classify the test cases from original test suite into obsolete, re-testable, and reusable test cases. Our scope is at unit level i.e. at class level. Our approach gets two versions of VDM++ specification and returns regression test suite for the delta version. Our approach distinguishes test cases which are still effective for the delta version of VDM++ specification and it differs from re-test all strategy as it can distinguish the test cases and identifies test cases which are useful for delta version. Test cases reusability and test case reduction is the main objective of our approach. Our approach presents how to perform regression testing using VDM++ specification during the maintenance of systems.     

Human reliability and safety evaluation of man-machine systems

The security of a plant is strongly affected by human factors. Though human reliability in a man-machine system has been studied using a probabilistic approach the same as machine components, human behavior is quite different from that of a machine. We make clear some characteristics of human reliability by experiment, and suggest a mathematical model which represents the reliability of man-machine systems by using fuzzy set theory.     

Mapping ergonomics application to improve SMEs working condition in industrially developing countries: a critical review

In industrially developing countries (IDC), small and medium enterprises (SMEs) account for the highest proprotion of employment. Unfortunately, the working conditions in SMEs are often very poor and expose employees to a potentially wide range of health and safety risks. This paper presents a comprehensive review of 161 articles related to ergonomics application in SMEs, using Indonesia as a case study. The aim of this paper is to investigate the extent of ergonomics application and identify areas that can be improved to promote effective ergonomics for SMEs in IDC. The most urgent issue found is the need for adopting participatory approach in contrast to the commonly implemented top-down approach. Some good practices in ergonomics application were also revealed from the review, e.g. a multidisciplinary approach, unsophisticated and low-cost solutions, and recognising the importance of productivity. The review also found that more work is still required to achieve appropriate cross-cultural adaptation of ergonomics application.     

Ergonomic evaluation of slide boards used by home care aides to assist client transfers

Home care aides risk musculoskeletal injury because they lift and move clients; the body weight of most adults exceeds the NIOSH recommended limit for lifting. Methods to reduce manual patient lifting in institutional settings are often technically or economically infeasible in home care. Our goal was to identify suitable, safe, low-technology transfer devices for home care use. Sixteen experienced home care aides performed client transfers from wheelchair to bed (upward) and bed to wheelchair (downward) in a simulated home care environment (laboratory), using four different slide boards and by hand without a device. Aides’ hand forces were measured during client transfers; aides also evaluated usability of each board. Hand forces exerted while using slide boards were mostly lower than in manual transfer, and forces were lower in downward versus upward transfers. Aides judged a board with a sliding mechanism easier to use than boards without a sliding mechanism.

Practitioner Summary: This paper provides quantitative biomechanical measurements showing that slide boards reduced the hand forces needed by home care aides to transfer clients from bed to wheel chair and vice versa, compared to manual lifting. Using a semi-quantitative usability survey, aides identified boards with a sliding mechanism easiest to use.     

The perceived importance and the presence of creative potential in the health professional's work environment

The value of creative employees to an organisation's growth and innovative development, productivity, quality and sustainability is well established. This study examined the perceived relationship between creativity and work environment factors of 361 practicing health professionals, and whether these factors were present (realised) in their work environment. Job design (challenges, team work, task rotation, autonomy) and leadership (coaching supervisor, time for thinking, creative goals, recognition and incentives for creative ideas and results) were perceived as the most important factors for stimulating creativity. There was room for improvement of these in the work environment. Many aspects of the physical work environment were less important. Public health sector employers and organisations should adopt sustainable strategies which target the important work environment factors to support employee creativity and so enhance service quality, productivity, performance and growth. Implications of the results for ergonomists and workplace managers are discussed with a participatory ergonomics approach recommended.

Practitioner summary: Creative employees are important to an organisation's innovation, productivity and sustainability. The survey identified health professionals perceive a need to improve job design and leadership factors at work to enhance and support employee creativity. There are implications for organisations and ergonomists to investigate the creative potential of work environments.