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Human Factors is Vital for
Transforming Health Care
Eric F Shaver, PhD
ericshaver.com @ericshaver

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“The most significant factor in
making the nation’s health care
system safer is the human element.
And that is our business.” (Salas, et al., 2006)

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Current State of U.S. Health Care
• Health care is at a crisis point.
• 2012 Health Spending (Martin, et al., 2014):
• Total health expenditure: $2.8 trillion
• Per person expenditure: $8,915
• Percent of GDP: 17.2%
• U.S. spends more than any other industrialized
nation without achieving better outcomes.

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Changes Are Needed
• The current status and future trajectory are
untenable.
• Substantial changes must be undertaken to
transform health care in order to:
• Reduce costs
• Improve quality of care
• Improve accessibility of care
• Human Factors is vital to assisting in achieving this
transformation.

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Human Factors (HF) Overview

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What is Human Factors?
• Human Factors is a unique scientific discipline that
systematically applies the knowledge of human
abilities and limitations to the design of systems
with the goal of optimizing the interaction between
people and other system elements to enhance
safety, performance, and satisfaction.
• In simpler terms, Human Factors focuses on
designing the world to better accommodate people.

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What is Human Factors?, cont.
• Human Factors are relevant anywhere people work with
systems, whether they are social or technical in nature.
• The breadth of these sociotechnical systems include
situations and circumstances where individuals interact
with other system elements including:
• People
• Technology
• Tasks
• Organizations
• Environments
• Rules & Regulations

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What is Human Factors?, cont.
• Health care is arguably the most complex
sociotechnical system.
• Human Factors takes a people-centered, process-
oriented, systems approach to understanding and
solving complex problems.

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Origins of Human Factors
Human
Factors
Psychology
Anthropology
Applied
Physiology
Environmental
Medicine
Engineering
Computer
Science
Statistics
Operations
Research
Industrial
Design

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Origins of Human Factors, cont.
• In the U.S., Human Factor is generally considered to
have originated during WWII.
• But, advances that contributed to its formation can
be traced to the turn of the 20th century.
• Human Factors started in the military, but expanded
into most industries, including health care.

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Industries Benefiting from Human Factors
• Aerospace
• Automotive
• Chemical
• Computer
• Consumer Product
• Construction
• Defense
• Forestry
• Health Care
• Manufacturing
• Mining
• Nuclear
• Petroleum
• Telecommunication
• Textile

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What Does HF Bring to the Table?
• Increased
• Safety & health
• Quality
• Productivity
• Ease of learning & use
• Satisfaction, trust &
loyalty
• User experience &
engagement
• Sales & market share
• Decreased
• Deaths, injuries &
illnesses
• Accidents
• Error rates
• Absenteeism & turnover
• Training time
• Development costs
• Need for redesign & recall
• Support & services costs
• Maintenance costs

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What Does HF Bring to the Table?, cont.
• A deep understanding of people:
• Sensory
• Visual, auditory, olfactory, gustatory, & somatosensory
• Psychological
• Attention, perception, decision making, memory, & motivation
• Physiological
• Anthropometry & biomechanics
• Psychosocial
• Behavior

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What Does HF Bring to the Table?, cont.
• How people interact with other people in:
• Dyads, teams, groups, & organizations
• How people interact with technology:
• Individually
• Groups (e.g., teams, departments, etc.)
• Organizations (e.g., hospitals, across systems, etc.)
• How systems need to be designed (or redesigned) to
fit the capabilities & limitations of people.

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What Does HF Bring to the Table?, cont.
• A solid foundation, grounded in science, that
includes:
• Theories
• Models
• Principles
• Guidelines
• Findings
• Methods
• Tools

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How has Human Factors Positively
Impacted Health Care?

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Brief History of HF & HC
• Early history
• Medication errors (Chapanis & Safrin, 1960)
• Anesthesia (Cooper, et al., 1978)
• Human Factors came to the forefront with the
publishing of the IOM report To Err is Human in
1999. (Leape, 2004)
• Since then, a primary focus of Human Factors has
been patient safety and medical technology design.

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Human Factors has conducted
research on a variety of Health
Care topics, settings, & people.

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Sample of HC Topics
• Anesthesiology
• Built Environment
• Care Coordination
• Checklists
• eHealth
• Health Communication
• Health Information
Technology
• Infection Prevention
• Medical Error
• Medical Products
• Medication
• Needles
• Organizational Culture
• Patient Safety
• Safety Culture
• Simulation
• Teamwork
• Telemedicine
• Training
• Websites
• Work Design
• Work Schedules

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Sample of HC Settings & People
• Settings
• Emergency Departments
• Home Care
• Intensive Care Units
• Nursing Homes
• Operating Rooms
• Pharmacy Departments
• Physician Offices
• People
• Nurses
• Patients
• Pharmacists
• Physicians
• Technicians

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What value does Human Factors
provide to Health Care?

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Human Factors Interventions Can:
• Increase patient and staff safety;
• Decrease numbers of adverse events;
• Minimize the potential for introduction of new hazards;
• Improve staff acceptance;
• Increase work efficiency;
• Better integrate new technology with existing
technology;
• Decrease training time needed to reach competency;
and
• Minimize the need for modifications, “workarounds,”
and/or shortcuts.

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How can Human Factors assist the
Health Care community?

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Technology Integration
• Medical technology has great potential, but
implementation is often viewed as a mixed blessing.
• HF takes a holistic approach to understanding how
people will interact with technology in a system.
Doing so makes it possible to identify technological
requirements that will best fulfill users’ needs,
which in turn will improve quality and safety.

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Technology Integration, cont.
• Example methods to facilitate integration:
• Heuristic evaluation
• Task & job analysis
• Structured interviews
• Job shadowing
• Focus:
• Prevent poorly designed technology from entering the
system.
• Determine that to be acquired technology will integrate
appropriately within the system.

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Patients
• Focus:
• Must understand the needs, wants, & desires of patients
to optimize their experiences and maximize their
satisfaction.
• Example efforts:
• Identify how technology can be utilized to facilitate
patient understanding & decision making.
• Streamline and/or redesign patient-facing processes.

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Health Care Teams
• Focus:
• Developing teams that increase patient safety by
decreasing medical error.
• Transitioning from a team of experts to expert teams.
• Example efforts:
• Team design
• Team assessment
• Team training

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Health Care Systems
• Health care delivery needs changes.
• HF can help by leading and/or collaborating in
multidisciplinary teams seeking to solve system
problems.
• In-house human factors expertise can be dispatched
to different teams, departments, hospitals, etc.

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Health Care Systems, cont.
• HF can provide comprehensive, macroergonomics
strategies, methods, and tools to assist with
successful change management efforts across health
care systems.
• HF can assist with appropriate integration of
recently acquired hospitals into health care systems.

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Research
• HC has gotten better about collecting important
financial & performance metrics electronically.
• But, it hasn’t fully leveraged the opportunity to
rapidly, reliably, & repeatedly capture data from
patients, family members, physicians, nurses, staff,
etc. on important topics.
• HF can help overcome this challenge.

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Research, cont.
• HF uses a variety of methods to capture data from
individuals, groups, & organizations:
• Surveys (online & in-person)
• Structured interviews
• Usability evaluations
• Observational studies
• Video analysis
• Field studies
• Lab experiments
• Simulation

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Human Factors has made important
contributions to Health Care.
But, more must be accomplished.

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What is Required from HF?
• “…take every opportunity to explain and ‘sell’ HF.”
(Carayon, 2012, p. 12)
• Communicate beyond the boundaries of our
discipline.
• Continue with current health care-related efforts.
• Collaborate with HC domain experts at every
opportunity.

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What is Required from HF?, cont.
• Understand and speak the language of business.
• Be involved at the strategic level.
• Continually demonstrate value.
• Calculate ROI (e.g., internal, external, & social) for
HF interventions. (Wilson & Rosenbaum, 2005)

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What is Required from HF?, cont.
• Realize that HF is an innovation. (Carayon, 2010)
• Move beyond interventions that just “sand the
edges” of the problem.
• Understand there may be barriers to entry; but the
effort is worth the challenge.
• HF should strive for positive societal change. (Vicente, 2008)

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But, Human Factors can’t tackle this
challenge alone. It needs buy-in
from the Health Care community.

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What is Needed from HC?
• Realizations that health care challenges are a
“wicked” problem needing assistance from outside
the health care community.
• Willingness to embrace and learn from HF.
• Understanding that HF contributions are greater
than just patient safety.

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What is Needed from HC?, cont.
• Increased utilization of HF professionals:
• Consultants
• In-house HF experts
• “Biculturals” (HC professionals trained in HF)

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References
Carayon, P. (2010). Human factors in patient safety as an innovation.
Applied Ergonomics, 41, 657-665.
Carayon, P. (2012). Human factors and ergonomics in health care and
patient safety. In P. Carayon (Ed), Handbook of Human Factors and
Ergonomics in Patient Safety, 2nd Ed (pp. 3-15). Boca Raton, FL: CRC
Press.
Chapanis, A., & Safrin, M.A. (1960). Of misses and medicines. Journal
of Chronic Diseases 12, 403–408.
Cooper, J.B., Newbower, R.S., Long, C.D., & McPeek, B. (1979).
Preventable anesthesia mishaps: A study of human factors.
Anesthesiology, 49, 399–406.

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References, cont.
Kohn, K. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (1999). To err is
human: Building a safer health system. Washington, DC: National
Academy Press.
Leape, L.L. (2004, Summer). Human factors meets health care: The
ultimate challenge. Ergonomics in Design, 6-12.
Martin, A.B., Lassman, D., Washington, B., Catlin, A., & the National
Health Expenditure Accounts Team (2012). Growth in US health
spending remained slow in 2010; health share of gross domestic
product was unchanged from 2009. Health Affairs, 31, 1, 208-219.

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References, cont.
Salas, E., Baker, D., King, H., & Battles, J. (2006). Special section
commentary: Opportunities and challenges for human factors and
ergonomics in enhancing patient safety. Human Factors, 48, 1-4.
Vicente, K.J. (2008). Human factors engineering that makes a
difference: Leveraging a science of societal change. Theoretical Issues
in Ergonomics Science, 9, 1-24.
Wilson, C.E., & Rosenbaum, S. (2005). Categories of return on
investment and their practical implications. In R.G. Bias and D.J.
Mayhew (Eds.), Cost-Justifying Usability: An Update for the Internet
Age (pp. 215-263). San Francisco, CA: Morgan Kaufman Publishers.

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Additional Resources to Consult

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Additional Resources to Consult, cont.

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Dr. Shaver is the Human Factors Lead at
FUJIFILM SonoSite, the world leader in
bedside and point-of-care ultrasound.
Dr. Shaver's work has emphasized achieving
an optimal fit between people, technology,
and work systems to facilitate safety,
performance, and satisfaction.
A specific focus has centered on bridging the
research-practice gap by synthesizing and
disseminating the latest scientific findings
about human capabilities and limitations to
the design, development, implementation,
use, and evaluation of technology.