1. 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/

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

3. Outline SEIPS model of work and patient safety  Importance of work and processes for patient safety DESIGN What kind of research? Challenges and questions

4. SEIPS Model of Work System and Patient Safety SEIPS = System Engineering Initiative for Patient Safety Carayon et al., 2006

6. SMArT HF Project Team University of Wisconsin-Madison / UW Hospital & Clinics Madison-Wisconsin-USA Funding provided by the Agency for Healthcare Research and Quality Medication Administration Technologies

7. Work System (or a sociotechnical system) (Balance Theory; Smith and Carayon, 1989; Carayon and Smith, 2000)‏ Technology and Tools Organization Environment Tasks Person

8. BCMA Technology Implementation… BCMA = Bar Coding Medication Administration Technology and Tools Organization Environment Tasks Person

10. Sequence according to policy Potentially unsafe sequence Most frequent workaround: documentation before medication administration BCMA = Bar Coding Medication Administration

11. Organizational factors: interruptions, shift Environment: where tasks completed, lighting, noise Tasks: sequence of acts, handoffs, unsafe acts Technology: automation surprises, malfunctions Individual (nurse or patient): patient in isolation

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

13. Design of … … work system … process Purposeful activity Continuous process Knowledge, principles, tools  Design principles (human factors)‏

14. 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?

15. Design Principles of Human Factors and Ergonomics (HFE)‏ User-centered design Dimensions of HFE:  Physical ergonomics physical characteristics of end users  Cognitive ergonomics cognitive characteristics of end users  Organizational ergonomics psychosocial needs of end users

16. 51 chapters, 1,000 pages: Human error Sociotechnical systems and macroergonomics Technology, medical devices Physical ergonomics Methods and tools Various care settings …

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

18. What Kind of Research? Probably not RCT…  Action research framework Collaborative multidisciplinary research Multiple data collection methods

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

20. Challenges and Questions Design 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