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/]

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

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.

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.

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.