Manage Risk Better

Medico-legal barriers to practising Realistic Medicine have been identified as fear of criticism from complaints, and concerns about other forms of criticism such as external inspection, clinical reviews and litigation. “The Montgomery ruling states that healthcare professionals must make patients aware of risk, benefits and alternatives that a reasonable patient would think were material and that a reasonable doctor would be aware are relevant to that particular patient.” [The Scottish Government. Practising Realistic Medicine: Chief Medical Officer for Scotland’s Annual Report 2016-17. Published 2018. https://www.gov.scot/publications/practising-realistic-medicine/]

Personalised care can help manage the risk better by having more open conversations and more meaningful dialogue with patients that leads to less criticism and fewer complaints. At a system level, human factors and ergonomics (HFE) is about “understanding and improving the ‘fit’ between people and their working environment to ensure a safer, more productive and efficient workplace”. HFE has been embedded in other safety-critical industries such as energy and transport. NHS Scotland has been involved in work related to HFE areas of interest such as the SPSP (Scottish Patient Safety Programme) but more work needs to be done to incorporate HFE thinking and procedure into everyday practice. [The Scottish Government. Personalising Realistic Medicine: Chief Medical Officer for Scotland’s Annual Report 2017-18. Published 2019. https://www.gov.scot/publications/personalising-realistic-medicine-chief-medical-officer-scotland-annual-report-2017-2018/pages/7/]

“Decisions about care are not always clear cut. It is important that the people we care for are equal partners in decisions about their care, and we provide them with balanced information on benefits and risks which enables them to make an informed choice. Over the last year we have had to manage risk, and make difficult decisions about care when there were many unknowns, yet we have still achieved excellence in care.” [ The Scottish Government. The Chief Medical Officer for Scotland’s Annual Report 2020-21: Recover, Restore, Renew. Published 2021. https://www.gov.scot/publications/cmo-annual-report-2020-21/ ]

iSIMPATHY, (implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years) launched in November 2020, aims to tackle the harms associated with polypharmacy. Polypharmacy medicine reviews will ensure that people receive a personalised assessment of their medication and allow shared prescribing decisions with them. Polypharmacy reviews reduce harm and waste by assessing for side effects of treatment, monitoring for drug interactions and reviewing adherence.  Older people tend to experience worse side effects or consequences of treatment and why we should strive to actively manage risk associated with polypharmacy by regularly reviewing and rationalising patient's medications.  [The Scottish Government. The Chief Medical Officer for Scotland’s Annual Report 2020-21: Recover, Restore, Renew. Published 2021. https://www.gov.scot/publications/cmo-annual-report-2020-21/ ]

Healthcare Improvement Scotland. Scottish Patient Safety Programme http://www.healthcareimprovementscotland.org/our_work/patient_safety/spsp.aspx (accessed 08/10/2019)

CARAYON, P. and PERRY, S., 2021. Human factors and ergonomics systems approach to the COVID-19 healthcare crisis. International Journal for Quality in Health Care, 33(Supplement_1), pp. 1-3.

ALAGHA M.A., et al, 2020. Patient Harm During COVID-19 Pandemic: Using a Human Factors Lens to Promote Patient and Workforce Safety. Journal of patient safety, epub ahead of print

ALBOLINO S., et al, 2020. Human factors and ergonomics at time of crises: the Italian experience coping with COVID19. International journal for quality in health care : journal of the International Society for Quality in Health Care, (pagination), pp. ate of Pubaton: 13 May 2020.
Several of the key organizational issues that we have had to face with the emergence of COVID-19 crisis are related to Human Factors/Ergonomics (HFE) and the safety culture. During the crisis the main activities of the healthcare services have been profoundly affected. Patient safety and risk management units have also experienced the need to adapt rapidly. What can we do as HFE experts, now that the scenario has completely changed? We contend that:We can favour and support the heuristics that are applied to manage the load of psycho-cognitive stress;We can observe, collect strategies and develop analytic schemes, thereby creating a memory of the organization for improvement in the future;And we can support in educating and engaging the public. This crisis has forced the community of healthcare experts to broaden their reflections: for the future to come, our communities of experts in the field of risk management HF/E, quality and safety of care and public health should play together an important role from the very beginning, from the time of peace.

ALBOLINO, S., et al, 2020. Ergonomics in a rapidly changing world. Ergonomics, 63(3), pp. 241-242.

CARAYON P., et al, 2020. Application of human factors to improve usability of clinical decision support for diagnostic decision-making: A scenario-based simulation study. BMJ Quality and Safety, 29(4), pp. 329-340.
In this study, human factors (HF) methods and principles were used to design a clinical decision support (CDS) that provides cognitive support to the pulmonary embolism (PE) diagnostic decision-making process in the emergency department. Emergency physicians made more appropriate diagnostic decisions (94% with PE-Dx; 84% with web-based CDS; p<0.01) and performed experimental tasks faster with the PE-Dx CDS (on average 96 s per scenario with PE-Dx; 117 s with web-based CDS; p<0.001). They also reported lower workload (p<0.001) and higher satisfaction (p<0.001) with PE-Dx.

CARAYON P., et al, 2020. SEIPS 3.0: Human-centered design of the patient journey for patient safety. Applied Ergonomics, 84(pagination), pp. Arte Number: 103033.
Different ways that the process component of the SEIPS models have been described and applied are reviewed. A SEIPS 3.0 model is proposed, which expands the process component, using the concept of the patient journey to describe the spatio-temporal distribution of patients' interactions with multiple care settings over time. This new SEIPS 3.0 sociotechnical systems approach to the patient journey and patient safety poses several conceptual and methodological challenges to HFE researchers and professionals, including the need to consider multiple perspectives, issues with genuine participation, and HFE work at the boundaries.

CATCHPOLE K., et al, 2020. Frontiers in Human Factors: Embedding Specialists in Multi-disciplinary efforts to Improve Healthcare. International journal for quality in health care : journal of the International Society for Quality in Health Care, (pagination), pp. ate of Pubaton: 09 Se 2020.
Despite the application of a huge range of human factors (HF) principles in a growing range of care contexts, there is much more that could be done to realize this expertise for patient benefit, staff wellbeing and organizational performance. Healthcare has struggled to embrace systems safety approaches, mis-applied or misinterpreted others, and has stuck to a range of outdated and potentially counter-productive myths even has safety science has developed. One consequence of these persistent misunderstandings is that few opportunities exist in clinical settings for qualified HF professionals. Instead, HF has been applied by clinicians and others, to highly variable degrees - sometimes great success, but frequently in limited and sometimes counter-productive ways. Meanwhile, HF professionals have struggled to make a meaningful impact on frontline care and have had little career structure or support. However, In the last few years, embedded clinical HF practitioners have begun to have considerable success that are now being supported and amplified by professional networks. The recent COVID-19 experiences confirm this. Closer collaboration between healthcare and HF professionals will result in significant and ultimately beneficial changes to both professions and to clinical care.

DENNERLEIN, J.T., et al, 2020. An Integrative Total Worker Health Framework for Keeping Workers Safe and Healthy During the COVID-19 Pandemic. Human factors, 62(5), pp. 689-696.
OBJECTIVE: The aim was to recommend an integrated Total Worker Health (TWH) approach which embraces core human factors and ergonomic principles, supporting worker safety, health, and well-being during the COVID-19 pandemic. RESULTS: The recommended approach includes six key characteristics: focusing on working conditions for infection control and supportive environments for increased psychological demands; utilizing participatory approaches involving workers in identifying daily challenges and unique solutions; employing comprehensive and collaborative efforts to increase system efficiencies; committing as leaders to supporting workers through action and communications; adhering to ethical and legal standards; and using data to guide actions and evaluate progress. CONCLUSION: Applying an integrative TWH approach for worker safety, health, and well-being provides a framework to help managers systematically organize and protect themselves, essential workers, and the public during the COVID-19 pandemic. APPLICATION: By using the systems approach provided by the six implementation characteristics, employers of essential workers can organize their own efforts to improve system performance and worker well-being during these unprecedented times.

FERDOSI M., et al, 2020. Risk management in executive levels of healthcare organizations: Insights from a scoping review Risk Management and Healthcare Policy, 13, pp. 215-243.
This study attempted to present a framework and appropriate techniques for implementing risk management (RM) in executive levels of healthcare organizations (HCOs) and grasping new future research opportunities in this field.

HADDEN, C., et al, 2020. Staffing for safe and effective care in the UK: 2019 report: reviewing the progress of health and care systems against our principles.
This report provides an overview of progress made against the RCN's safe staffing campaign principles during 2019. It includes country-specific updates as well as a look ahead to priorities during 2020.

HEIDARIMOGHADAM R., et al, 2020. What do the different ergonomic interventions accomplish in the workplace? A systematic review. International journal of occupational safety and ergonomics : JOSE, , pp. 1-26.
Introduction: Improving well-being and overall system performance are the ultimate goals of ergonomics which are achieved through ergonomic interventions. This systematic review aimed to answer this question: What do the different ergonomic interventions accomplish in a workplace? Method: This systematic review followed the PRISMA guidelines. Ergonomic interventions in workplaces focusing on any ergonomics health outcomes or productivity were identified in electronic databases up to 1 Jun, 2019.

HOLDEN, R.J., et al, 2020. Patient ergonomics: 10-year mapping review of patient-centered human factors. Applied Ergonomics, 82, pp. 102972.
Mapping review of 212 full-text patient ergonomics publications in two conference proceedings, 2007-2017 revealed a robust and growing body of literature on patient ergonomics, particularly in the areas of aging and chronic disease, tools and technologies, and evaluations of patient-centered interventions on outcomes such as usability, user acceptance, and performance. Results identified gaps deserving future research, including  understudied populations such as children, informal caregivers, networks and collectives (groups), and marginalized populations; on topics such as health promotion and transitions of care; and using longitudinal and experimental study designs.  Copyright © 2019 Elsevier Ltd. All rights reserved.

OEPPEN, R.S., et al, 2020. Human factors recognition at virtual meetings and video conferencing: how to get the best performance from yourself and others. British Journal of Oral & Maxillofacial Surgery, 58(6), pp. 643-646.
During the current coronavirus pandemic, social distancing and restrictions on travel have resulted in a dramatic rise in the use of technology (including video conferencing) for remote meetings. From local multidisciplinary team (MDT) meetings to national and international committees, this form of communication has been vital to ensure patient-related and other business can continue, albeit in a sometimes unfamiliar environment. In this article we consider some of the human factors elements of remote meetings and provide suggestions to enhance the experience of team and committee members during this unsettling time. It is possible that this form of communication will continue to flourish after the pandemic is over. Copyright © 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

SUTHERLAND A. and PHIPPS, D.L., 2020. The Rise of Human Factors in Medication Safety Research. Joint Commission Journal on Quality and Patient Safety, (pagination), pp. ate of Pubaton: 2020.

WAEHLE H.V., et al, 2020. How does the WHO Surgical Safety Checklist fit with existing perioperative risk management strategies? An ethnographic study across surgical specialties. BMC health services research, 20(1), pp. 111.
BACKGROUND: The World Health Organization (WHO) Surgical Safety Checklist (SSC) has demonstrated beneficial impacts on a range of patient- and team outcomes, though variation in SSC implementation and staff's perception of it remain challenging. Precisely how frontline personnel integrate the SSC with pre-existing perioperative clinical risk management remains underexplored - yet likely an impactful factor on how SSC is being used and its potential to improve clinical safety. This study aimed to explore how members of the multidisciplinary perioperative team integrate the SSC within their risk management strategies.

WATERSON, P., 2020. Causation, levels of analysis and explanation in systems ergonomics - A Closer Look at the UK NHS Morecambe Bay investigation. Applied Ergonomics, 84(pagination), pp. Arte Number: 103011.
An earlier examination of the concept of 'mesoergonomics' (Karsh et al., 2014) is extended and its application to Human Factors/Ergonomics (HFE). Karsh et al. (2014) developed a framework for mesoergonomic inquiry based on a set of steps and questions, the purpose of which was to encourage researchers to cross system levels in the studies and to explore alternative causal mechanisms and relationships within their data. The framework is further developed in this paper and draws on previous work across a diverse range of sources which has examined the subject of accident causation, levels of analysis and explanatory factors contributing to system failure. The outcomes from this exercise are a revised framework which seeks to explore what we term 'isomorphisms' and includes questions covering: (a) how internal isomorphisms develop or evolve within the system; and, (b) how these isomorphisms are shaped by cultural, professional and other forms of external influence. The workings of the revised framework are illustrated through using the example of the UK NHS Morecambe Bay Investigation (Kirkup, 2015). A summary of ways forward for the framework, as well as new directions for theory within systems ergonomics/human factors is presented.

WEST, J.C., 2020. The crisis standard of care: Considerations for risk management. Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management, pp.  30 Ju 2020.
Many writers and organizations have postulated that health care facilities and providers may need to implement a "crisis standard of care" to deal with the exigent circumstances associated with the massive influx of patients infected with the novel coronavirus and suffering from COVID-19. There is a relative scarcity of critical resources, such as intensive care unit beds, emergency department beds, ventilators, personal protective equipment, and medications. Facilities can become overwhelmed. A crisis standard of care can act as a guidepost for rationing supplies and care, should that become necessary. However, that is not without danger. Health care facilities and providers should plan carefully and then act with due deliberation in implementing a crisis standard of care to mitigate or prevent future liability.

CARAYON P., et al, 2019. Application of human factors to improve usability of clinical decision support for diagnostic decision-making: A scenario-based simulation study. BMJ Quality and Safety, (pagination), pp. ate of Pubaton: 2019.
Objective: In this study, we used human factors (HF) methods and principles to design a clinical decision support (CDS) that provides cognitive support to the pulmonary embolism (PE) diagnostic decision-making process in the emergency department. We hypothesised that the application of HF methods and principles will produce a more usable CDS that improves PE diagnostic decision-making, in particular decision about appropriate clinical pathway.

SCHUBEL, L., et al, 2019. Informatics and interaction: Applying human factors principles to optimize the design of clinical decision support for sepsis. Health Informatics Journal, 1460458219839623
In caring for patients with sepsis, the current structure of electronic health record systems allows clinical providers access to raw patient data without imputation of its significance. There are a wide range of sepsis alerts in clinical care that act as clinical decision support tools to assist in early recognition of sepsis; however, there are serious shortcomings in existing health information technology for alerting providers in a meaningful way. Little work has been done to evaluate and assess existing alerts using implementation and process outcomes associated with health information technology displays, specifically evaluating clinician preference and performance. We developed graphical model displays of two popular sepsis scoring systems, quick Sepsis Related Organ Failure Assessment and Predisposition, Infection, Response, Organ Failure, using human factors principles grounded in user-centered and interaction design. Models will be evaluated in a larger research effort to optimize alert design to improve the collective awareness of high-risk populations and develop a relevant point-of-care clinical decision support system for sepsis.

XIE, A., et al, 2019. Use of Human Factors and Ergonomics to Disseminate Health Care Quality Improvement Programs. Quality management in health care, 28(2), pp. 117-118.