A strategy for human factors/ergonomics: developing the discipline and profession

Patient ergonomics: 10-year mapping review of patient-centered human factors

Patient ergonomics is the application of human factors or related disciplines to study and improve patients' and other non-professionals' performance of effortful work activities in pursuit of health goals. We performed a mapping review of 212 full-text patient ergonomics publications in two conference proceedings, 2007-2017. The review 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. Findings highlighted gaps deserving future research, including research with 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. The growth of patient-centeredness in general and of patient ergonomics in particular compel other more focused reviews, new primary research, and developing a roadmap for future patient ergonomics research.

Is One-Pen, One-Patient Achievable in the Hospital? A Quality Improvement Project to Reduce Risks of Inadvertent Insulin Pen Sharing at a Large Academic Medical Center

BACKGROUND

The Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Institute for Safe Medicine Practices (ISMP) have issued warnings regarding the risk of potential transmission of blood-borne diseases if an insulin pen is used for more than one person. Many hospitals continue to use insulin pens due to their benefits of decreased risk of dosing error and improved work efficiency. Best practices for insulin pen use have been published; however, little is known about how these perform in hospitals.

METHODS

This article describes a multifaceted quality improvement project to address the safety issues of single-patient insulin pens. Major interventions included adding patient-specific bar coding on insulin pens, redesign of labels, systematic removal of discharged patients' medications, and ongoing staff education.

RESULTS

Self-reported events of insulin pen sharing events over 40 months showed a significant increase in the number of patient-days between events. The significant change occurred after implementation of patient-specific bar code scanning. There was a gradual decrease in latent errors found during medication drawer audits, and nursing compliance with patient-specific bar code scanning improved over time, reaching 90% on the last recorded month. Of 35 expert recommendations for insulin pen safety, 28 directly affected pen sharing-8 had been implemented prior to this project, and 20 had been implemented by the conclusion.

CONCLUSION

Insulin pen use is highly complex in hospital settings where multiple steps provide opportunities for error. To protect patients, all gaps need to be reviewed, and interventions that address major contributing factors are required to ensure safe insulin pen use.

A preliminary ergonomic analysis of the MRI work system environment: Implications and recommendations for safety and design

INTRODUCTION

The MRI work system environment in acute hospitals poses a significant risk of harm to patients, healthcare practitioners and others, but knowledge of hazards and potential design improvements are limited as safety research is lacking. The aim of this exploratory study was to understand how the discipline of Human Factors and Ergonomics (HFE) can support the understanding and improvement of safety and performance of MRI working environments.

METHODS

A multi-method study of two MRI units in Scottish acute hospital settings based on Human Factors and Ergonomics (HFE) principles was undertaken in May 2016. Data collection sources included published literature, local and national safety incident data, site observations and staff interviews which were triangulated and subject to a content analysis.

RESULTS

A diverse range of system-wide hazards were highlighted which impact on the complexity of MRI work, patient and staff safety and system performance (e.g. adequacy of training and procedures, interactions with equipment, organisation of work). Preliminary recommendations were made to improve system design related to national approaches to safety (e.g. equipment procurement; staff training and procedural standards); interaction design and standardisation (e.g. physical design and barriers, staff uniforms, checking processes); and introduction of MRI passports for patients.

CONCLUSIONS

This exploratory study suggests the need for national co-ordination and standardisation of MRI safety management strategies, based on safety science and HFE evidence and approaches to improve system design and reduce risk to patients, staff and others. A series of provisional recommendations are offered for consideration.

Assessing human factors and ergonomics capability in organisations - the Human Factors Integration Toolset

This paper presents the development of a tool that allows an organisation to assess its level of human factors (HF) and ergonomics integration and maturity within the organisation. The Human Factors Integration Toolset (available at: https://www.researchgate.net/project/Human-Factors-Integration-Toolset ) has been developed and validated through a series of workshops with 45 participants from industry and academia and through industry partnered field-testing. HF maturity is assessed across five levels in 16 organisational functions based on any of 31 discrete elements contributing to HF. Summing element scores in a function determines a percent of ideal HF for the function. Industry stakeholders engaged in field-testing found the tool helped to establish the status of HF in the organisation, plan projects to further develop HF capabilities, and initiate discussions on HF for performance and well-being. Improvement suggestions included adding an IT function, refining the language for non-HF specialists, including knowledge work and creating a digital version to improve usability. Practitioner summary: A tool scoring HF capability in 16 organisation functions has been developed collaboratively. Industry stakeholders expressed a need for the tool and provided validation of tool design decisions. Field-testing improved tool usability and showed that beyond scoring HF capability, the tool created opportunities for discussions of HF-related improvement possibilities. Abbreviations: HF: human factors; HFIT: Human Factors Integration Toolset.

Human Factors and Sociotechnical Issues

OBJECTIVE

To summarize significant research contributions on human factors (HF) and organizational issues in medical informatics published in 2018.

METHODS

An extensive search using PubMed/Medline and Web of Science^® was conducted to identify the scientific contributions published in 2018 that address human factors and organizational issues in medical informatics. The selection process comprised three steps: (i) 15 candidate best papers were first selected by the two section editors, (ii) external reviewers from internationally renowned research teams reviewed each candidate best paper, and (iii) the final selection of four best papers was conducted by the editorial board of the Yearbook.

RESULTS

The four selected best papers are excellent contributions to the HF literature: they show the added value of HF studies by providing nice illustrated and rigorous interventions.

CONCLUSION

HF interventions are known to have great potential to contribute to efficient HIT design, but the interventions still face challenges in successfully demonstrating their value to the main stakeholders of the healthcare domain. There is a need to strengthen the demand for high-quality HF studies by increasing awareness among powerful stakeholders of the value of high-quality HF studies.

Validity and reliability of the Persian version of the Dutch musculoskeletal questionnaire

Background: Dutch Musculoskeletal Questionnaire (DMQ) is used to examine physical and environmental risk factors and to identify high-risk groups for exposure to the risk factors of musculoskeletal disorders at workplace. The aim of this study was to develop the Persian version of the DMQ and to assess its psychometric properties.

Methods: This study was conducted on 212 employees of Gas Transmission Company. Using a standard forward-backward translation procedure, the English version of the questionnaire was translated into Persian and culturally adapted. Content validity was established by 10 expert opinions. The intraclass correlation coefficient (ICC) was used for the statistical analysis of reproducibility. Kuder-Richardson-20 was used for internal consistency and confirmatory factor analysis for structural validity.

Results: This study revealed high internal consistency and good test-retest reliability for the Persian version of the questionnaire. The means of the content validity ratio (CVR) and content validity index (CVI) for the total 35 items of the questionnaire were 0.96 and 0.91, respectively. The internal consistency of the factors was satisfactory, ranging from 0.83 to 0.88. Confirmatory factor analysis confirmed the existence of 7 factors in the questionnaire and an acceptable fit for the Persian version of the DMQ.

Conclusion: The Persian version of the DMQ has acceptable psychometric properties. Thus, it can be used as a valid instrument to assess workload and to identify high-risk groups of musculoskeletal disorders at workplace.

Applications of an interaction, process, integration and intelligence (IPII) design approach for ergonomics solutions

This paper first reviews current ergonomics design approaches in delivering digital solutions to achieve a unified experience from interaction and business process design perspectives. Then, it analyses the opportunities that new technologies may bring in for enhancing current ergonomics design approaches from integration and intelligence design perspectives. To address the challenges in today's ergonomics practices in delivering digital solutions, an interaction, process, integration and intelligence (IPII) design approach is proposed. A case study is presented that implemented the IPII approach. The quantitative data gathered from the case study demonstrates that the IPII approach has achieved significant advantages in reaching the goal of a unified experience and operational benefits for delivering digital solutions. The IPII approach also demonstrates improvements compared to today's ergonomics design approaches, such as user-centred design, for digital solutions. Finally, the paper highlights the contributions of the IPII approach for future ergonomics practices in delivering digital solutions. Practitioner Summary: In addition to the interaction design for the UI of digital solutions, as is the case in current typical ergonomics practice, the IPII adds three additional design components: process, integration and intelligence design. The case study demonstrates the advantages of the IPII, providing an enhanced approach for designing digital solutions. Abbreviations: IPII: interaction, process, integration and intelligence; IEA: International Ergonomics; Association; HFE: human factors/ ergonomics; HCD: human-centred design; UX: user experience; UI: user interface; ISO: International Organization for Standardization; UCD: user-centred design; ERP: enterprise resource planning; E2E experience: end-to-end experience; UXD: user experience design; AI: artificial intelligence; ML: machine learning; HCI: human-computer interaction; IaaS: infrastructure as a service; PaaS: platform as a service; SaaS: software as a service; CRM: customer relation management; SCM: supply chain management; HCM: human capability management; BI: business intelligence; BOMA: Bill of Materials Application; POC: proof of concept; TCM: transition change management; SMEs: subject matter experts; PMO: program management office; UAT: user acceptance test; iBPMS: intelligent business process management suite.

Improving Sustainability in Architectural Research: Biopsychosocial Requirements in the Design of Urban Spaces

There is an ever increasing interest in identifying the links between architecture and public health and in how urban design can positively influence the latter. The psychology of sustainability and sustainable development represents an innovative research area as a recent contribution to sustainability science and its trans-disciplinary configuration. The research topic deals with the importance and the centrality of the user-centered approach in the observation of the relationships among mankind, technological systems, and built environments, for projects that guarantee the conditions of physical, mental, and social well-being. Starting from the plurality of different disciplinary sectors, from anthropometry and sociology to psychology, “human experience” and user’s expectations are explored, understood, and systematized. The analysis of the relationship between health and urban design has allowed researchers to identify design strategies to improve the level of urban livability. The city of Pisa is the case study; mobility within the city is redefined through various levels of the use of space so that paths and areas of inclusion and socialization are re-valued, while new scenarios for some urban spaces open up. In this perspective, the design strategies synthetically follow two main directions: the re-appropriation of these places by the citizens and, at the same time, the promotion of their well-being from both a physical and psychological point of view.

Neonatal nasogastric tube feeding in a low-resource African setting - using ergonomics methods to explore quality and safety issues in task sharing

BACKGROUND

Sharing tasks with lower cadre workers may help ease the burden of work on the constrained nursing workforce in low- and middle-income countries but the quality and safety issues associated with shifting tasks are rarely critically evaluated. This research explored this gap using a Human Factors and Ergonomics (HFE) method as a novel approach to address this gap and inform task sharing policies in neonatal care settings in Kenya.

METHODS

We used Hierarchical Task Analysis (HTA) and the Systematic Human Error Reduction and Prediction Approach (SHERPA) to analyse and identify the nature and significance of potential errors of nasogastric tube (NGT) feeding in a neonatal setting and to gain a preliminary understanding of informal task sharing.

RESULTS

A total of 47 end tasks were identified from the HTA. Sharing, supervision and risk levels of these tasks reported by subject matter experts (SMEs) varied broadly. More than half of the tasks (58.3%) were shared with mothers, of these, 31.7% (13/41) and 68.3% were assigned a medium and low level of risk by the majority (≥4) of SMEs respectively. Few tasks were reported as 'often missed' by the majority of SMEs. SHERPA analysis suggested omission was the commonest type of error, however, due to the low risk nature, omission would potentially result in minor consequences. Training and provision of checklists for NGT feeding were the key approaches for remedying most errors. By extension these strategies could support safer task shifting.

CONCLUSION

Inclusion of mothers and casual workers in care provided to sick infants is reported by SMEs in the Kenyan neonatal settings. Ergonomics methods proved useful in working with Kenyan SMEs to identify possible errors and the training and supervision needs for safer task-sharing.

Barriers for implementation of successful change to prevent musculoskeletal disorders and how to systematically address them

This scoping review identified common barriers and facilitators encountered during the implementation of changes to prevent musculoskeletal disorders (MSD) and examined their relationship with those encountered in general Occupational Health and Safety (OHS) efforts. Thematic analysis of the literature identified 11 barriers: (i) Lack of time; (ii) Lack of resources; (iii) Lack of communication; (iv) Lack of management support, commitment, and participation; (v) Lack of knowledge and training; (vi) Resistance to change; (vii) Changing work environment; (viii) Scope of activities; (ix) Lack of trust, fear of job loss, or loss of authority; (x) Process deficiencies; and (xi) Difficulty of implementing controls. Three facilitators identified were: (i) Training, knowledge and ergonomists' support; (ii) Communication, participation and support; and (iii) An effective implementation process. The barriers and facilitators identified were similar to those in general OHS processes. The integration of MSD prevention into a general management system approach may overcome these barriers.

Production quality and human factors engineering: A systematic review and theoretical framework

The purpose of this paper is to systematically examine available empirical evidence on the impact of human factors (HF) in the design and management of manufacturing operations on system quality performance. A systematic review was conducted to map the linkages between the human-system fit in the design of operations systems (OS) with production quality. A total of 73 empirical studies were identified linking HF to OS performance in manufacturing. Quality risk factors included HF aspects in product design, process design and workstation design of the manufacturing OS. Quality deficits were associated with undesirable human effects of workload like fatigue and injury-related risk factors. Forty-six percent of the studies reported on efforts to improve HF in the OS with effect sizes for quality improvements reaching up to 86%. The paper documents available quality risk factors in the design of OS. It also provides a conceptual framework explaining HF-Quality linkage.

From the seat to the system: Re-designing a tram drivers' workstation combining technical and contextual aspects

Through the detailed account of a design case-study, the paper aims to demonstrate how the activity-oriented approach promotes a systems perspective in ergonomics interventions. Specifically, by presenting an activity-oriented re-design of a tram drivers' workstation, it is shown: (i) how technical and contextual aspects were jointly considered, (ii) how their combination affects workers' activity in a non-trivial manner, and (iii) how this system level view helped generate feasible and sustainable design solutions. First, the activity-oriented theoretical lens is briefly presented, followed by the analysis of the tram driving activity, emphasizing on drivers' efforts to compensate for the original work-system design flaws. Next, key elements of the re-design process are presented, through a concept map, combining technical and contextual aspects, coupled with an account of stakeholder debates and resolution processes. The paper ends with a discussion on the lessons learned, concerning the adopted approach for design interventions in real work situations.

Positive Secular Trend in Slovak Population Urges on Updates of Functional Dimensions of Furniture

The presented study is focused on the evaluation of the changes in weight and height of the adult population in Slovakia to provide updated information on the secular growth trend. The main objective was to identify and quantify the pace of gradual changes in the dimensions of the Slovak adult population, which is key ergonomic information for multiple disciplines. The measurements of weights, heights and body mass indices of the current adult population of Slovakia ranging from 26 to 94 years of age that were obtained in period 1993–2017 were compared with a sample of students studying at four Slovak universities during the same years (aged 18 to 25). The increase of mean heights was app. 0.104–0.203 cm per one year (or app. 1–2 cm per decade) for males and app. 0.031–0.178 cm per one year (or app. 0.3–1.8 cm per decade) for females was statistically confirmed at different age classes covering the age structure of the whole adult population. The positive secular height trends were manifested in weight and BMI increases too. The changes in means and variation of distributions of selected variables also cause changes in quantile values. For example, the 95% quantiles of heights derived for the period 1993–2003 only cover 92–93% of the heights in the current population. This fact could have a major impact on proposals for optimal and safe arrangement of work, residential and non-residential space, including the furniture production.

Home is where the head is: a distributed cognition account of personal health information management in the home among those with chronic illness

Managing chronic illness requires personal health information management (PHIM) to be performed by lay individuals. Paramount to understanding the PHIM process is understanding the sociotechnical system in which it frequently occurs: the home environment. We combined distributed cognition theory and the patient work system model to investigate how characteristics of the home interact with the cognitive work of PHIM. We used a 3D virtual reality CAVE that enabled participants who had been diagnosed with diabetes (N = 20) to describe how they would perform PHIM in the home context. We found that PHIM is distinctly cognitive work, and rarely performed 'in the head'. Rather, features of the physical environment, tasks, people, and tools and technologies present, continuously shape and are shaped by the PHIM process. We suggest that approaches in which the individual (sans context) is considered the relevant unit of analysis overlook the pivotal role of the environment in shaping PHIM. Practitioner Summary: We examined how Personal Health Information Management (PHIM) is performed in the homes of diabetic patients. We found that approaches to studying cognition that focus on the individual, to the exclusion of their context, overlook the pivotal role of environmental, social, and technological features in shaping PHIM.

Exploring organisational competences in Human Factors and UX project work: managing careers, project tactics and organisational strategy

Organisational competence in Human Factors and UX (user experience) has not been looked at before despite its relevance to project success. We define organisational competence as the collective competence of the individuals, bringing together their complementary abilities to deliver an outcome that is typically more than the sum of its parts. Twenty-two UX and Human Factors practitioners were interviewed about their project work in two contrasting domains: web design and safety-critical systems to explore organisational competences. Through doing a FRAM analysis, 29 functions and 6 main areas of competences were identified: the central project process; the process of learning about the problem; maintaining and developing client relations; staff development; evolving practices; and the management of documentation for audit and quality control. These dynamic and situated competences form a web of interactions. Managing competences is essential for project success. Implications for managing careers, project tactics and organisational strategy are discussed. Practitioner Summary: Organisational competences impact how routine and non-routine project work is performed, but these have received little attention in the literature. Six key areas of competences in Human Factors and UX project work were identified from practitioner interviews. Managing combinations of adaptive competences is important for developing careers, project tactics and organisational strategies.

Twelve tips for embedding human factors and ergonomics principles in healthcare education

Safety and improvement efforts in healthcare education and practice are often limited by inadequate attention to human factors/ergonomics (HFE) principles and methods. Integration of HFE theory and approaches within undergraduate curricula, postgraduate training and healthcare improvement programs will enhance both the performance of care systems (productivity, safety, efficiency, quality) and the well-being (experiences, joy, satisfaction, health and safety) of all the people (patients, staff, visitors) interacting with these systems. Patient safety and quality improvement education/training are embedded to some extent in most curricula, providing a potential conduit to integrate HFE concepts. To support evolving curricula and professional development at all levels - and also challenge prevailing "human factors myths and misunderstandings" - we offer professional guidance as "tips" for educators on fundamental HFE systems and design approaches. The goal is to further enhance the effectiveness of safety and improvement work in frontline healthcare practice.

State of Science: ergonomics and global issues

In his 1993 IEA keynote address, Neville Moray urged the ergonomics discipline to face up to the global problems facing humanity and consider how ergonomics might help find some of the solutions. In this State of Science article we critically evaluate what the ergonomics discipline has achieved in the last two and a half decades to help create a secure future for humanity. Moray's challenges for ergonomics included deriving a value structure that moves us beyond a Westernised view of worker-organisation-technology fit, taking a multidisciplinary approach which engages with other social and biological sciences, considering the gross cross-cultural factors that determine how different societies function, paying more attention to mindful consumption, and embracing the complexity of our interconnected world. This article takes a socio-historical approach by considering the factors that influence what has been achieved since Moray's keynote address. We conclude with our own set of predictions for the future and priorities for addressing the challenges that we are likely to face. Practitioner Summary: We critically reflect on what has been achieved by the ergonomics profession in addressing the global challenges raised by Moray's 1993 keynote address to the International Ergonomics Association. Apart from healthcare, the response has largely been weak and disorganised. We make suggestions for priority research and practice that is required to facilitate a sustainable future for humanity.

A participatory systems approach to design for safer integrated medicine management

It is recognised that whole systems approaches are required in the design and development of complex health care services. Application of a systems approach benefits from the involvement of key stakeholders. However, participation in the context of community based health care is particularly challenging due to busy and geographically distributed stakeholders. This study used action research to investigate what processes and methods were needed to successfully employ a participatory systems approach. Three participatory workshops planned and facilitated by method experts were held with 30 representative stakeholders. Various methods were used with them and evaluated through an audit of workshop outputs and a qualitative questionnaire. Findings on the method application and participation are presented and methodological challenges are discussed with reference to further research. Practitioner Summary: This study provides practical insights on how to apply a participatory systems approach to complex health care service design. Various template-based methods for systems thinking and risk-based thinking were efficiently and effectively applied with stakeholders.

Theory versus practice in the human factors and ergonomics discipline: Trends in journal publications from 1960 to 2010

The research-practice gap has been highlighted as a barrier to effective practice in human factors and ergonomics (HFE). There is also evidence of a theory-research gap that may be limiting the scientific evidence base of HFE. The purpose of this study was to examine trends in journal publications, especially relating to the research-practice gap and the involvement of theory over time. A content analysis was conducted on 425 journal articles published in Human Factors, Ergonomics, and Applied Ergonomics from 1960 to 2010. Results showed evidence of growth in applied research with increasing collaborative research between research and industry, larger research teams, and more empirical research-especially on applied problems. While there has been a corresponding increase in the involvement of theory in HFE publications, around half of the publications failed to acknowledge theory. This calls into question whether the HFE discipline may be missing the benefits of theory to guide research and subsequent practice, and to enhance the development of new ideas.

The dichotomy of the application of a systems approach in UK healthcare the challenges and priorities for implementation

There is increasing demand for a systems approach within national healthcare guidelines to provide a systematic and sustainable framework for improvements in patient safety. Supported by this is the growing body of evidence within Human Factors/Ergonomics (HFE) healthcare literature for the inclusion of this approach in health service design, provision and evaluation. This paper considers the current interpretation of this within UK healthcare systems and the dichotomy which exists in the challenge to implement a systems approach. Three case studies, from primary and secondary care, present a systems approach, offering a novel perspective of primary care and blood sampling. These provide practical illustrations of how HFE methods have been used in collaboration with healthcare staff to understand the system for the purpose of professional education, design and safety of clinical activities. The paper concludes with the challenge for implementation and proposes five roles for systems HFE to support patient safety. Practitioner Summary: healthcare is classified as a complex and dynamic system within this paper and as such HFE system methods are presented as desirable to understand the system, to develop HFE tools, to deliver education and integrate HFE within healthcare systems.

A sociotechnical systems approach to enhance safety climate in the trucking industry: Results of an in-depth investigation

The purpose of this study was to develop a methodology that extends safety climate beyond an overall score by using the framework of macroergonomics to examine the entire system in a more comprehensive manner. The study is discussed in two papers: one paper describes the study methodology in detail (Murphy, Robertson, Huang, Jeffries, & Dainoff, in press), and the current paper describes the results of the study. Multiple methods were combined to create a systems approach, and those methods include the critical incident technique, contextual inquiries with functional role diagrams, and affinity mapping. Key informants in the trucking industry identified 19 themes that affect safety. The themes ranged from balancing work and family/personal time, the company's policy vs. practice, respecting the job of the driver, and active listening and meaningful feedback. The most prominent themes were related to the workers and their activities; the internal environment, including psychosocial job design elements; and organizational design. Such information can be used to design interventions to change the safety climate of an organization in order to reduce negative safety outcomes.

Human factors in mental healthcare: A work system analysis of a community-based program for older adults with depression and dementia

Mental healthcare is a critical but largely unexplored application domain for human factors/ergonomics. This paper reports on a work system evaluation of a home-based dementia and depression care program for older adults, the Aging Brain Care program. The Workflow Elements Model was used to guide data collection and analysis of 59 h of observation, supplemented by key informant input. We identified four actors, 37 artifacts across seven types, ten action categories, and ten outcomes including improved health and safety. Five themes emerged regarding barriers and facilitators to care delivery in the program: the centrality of relationship building; the use of adaptive workarounds; performance of duplicate work; travel and scheduling challenges; and communication-related factors. Findings offer new insight into how mental healthcare services are delivered in a community-based program and key work-related factors shaping program outcomes.

Applying human factors and ergonomics to the misuse of nonsterile clinical gloves in acute care

BACKGROUND

Health care workers (HCWs) are recommended to wear nonsterile clinical gloves (NSCG) for direct contact with blood and body fluids. However, there is evidence of extensive inappropriate NSCG use.

METHODS

A mixed-methods study comprising observation of NSCG use in 2 acute hospitals and semistructured HCW interviews. Qualitative data were categorized using thematic analysis. Findings were mapped to the Systems Engineering Initiative for Patient Safety model and used to develop a strategy for improving NSCG use.

RESULTS

Two hundred seventy-eight procedures performed in 178 episodes of care involved the use of NSCG. NSCG were inappropriate for 59% of procedures (165 out of 278). Risk of cross-contamination occurred in 49% (87 out of 178) episodes. Twenty-six HCWs were interviewed; emotion and socialization were key factors influencing decisions to use NSCG. Data from observation and thematic analysis were mapped to 6 interacting components of the Systems Engineering Initiative for Patient Safety work system. Interventions targeting each component informed quality improvement strategies CONCLUSIONS: Despite intense promotion of hand hygiene as the key measure to protect patients from health care-associated infection, NSCG dominate routine clinical practice and potential cross-contamination occurs in 50% of care episodes. Such practice is associated with significant environmental and financial costs and adversely affects patient safety. The application of human factors and ergonomics to the complex drivers of inappropriate NSCG behavior may be more effective than conventional approaches of education and policy in achieving the goal of preventing health care-associated infection and improving patient safety.

Qualitative ergonomics/human factors research in health care: Current state and future directions

The objective of this systematic review was to understand the current state of Ergonomics/Human Factors (E/HF) qualitative research in health care and to draw implications for future efforts. This systematic review identified 98 qualitative research papers published between January 2005 and August 2015 in the seven journals endorsed by the International Ergonomics Association with an impact factor over 1.0. The majority of the studies were conducted in hospitals and outpatient clinics, were focused on the work of formal health care professionals, and were classified as cognitive or organizational ergonomics. Interviews, focus groups, and observations were the most prevalent forms of data collection. Triangulation and data archiving were the dominant approaches to ensuring rigor. Few studies employed a formal approach to qualitative inquiry. Significant opportunities remain to enhance the use of qualitative research to advance systems thinking within health care.

Impact of task design on task performance and injury risk: case study of a simulated drilling task

Existing evidence is limited regarding the influence of task design on performance and ergonomic risk, or the association between these two outcomes. In a controlled experiment, we constructed a mock fuselage to simulate a drilling task common in aircraft manufacturing, and examined the effect of three levels of workstation adjustability on performance as measured by productivity (e.g. fuselage completion time) and quality (e.g. fuselage defective holes), and ergonomic risk as quantified using two common methods (rapid upper limb assessment and the strain index). The primary finding was that both productivity and quality significantly improved with increased adjustability, yet this occurred only when that adjustability succeeded in reducing ergonomic risk. Supporting the inverse association between ergonomic risk and performance, the condition with highest adjustability created the lowest ergonomic risk and the best performance while there was not a substantial difference in ergonomic risk between the other two conditions, in which performance was also comparable. Practitioner Summary: Findings of this study supported a causal relationship between task design and both ergonomic risk and performance, and that ergonomic risk and performance are inversely associated. While future work is needed under more realistic conditions and a broader population, these results may be useful for task (re)design and to help cost-justify some ergonomic interventions.

Young consumers' considerations of healthy working conditions in purchasing decisions: a qualitative examination

Research has suggested that products manufactured under healthy work conditions (HWC) may provide a marketing advantage to companies. This paper explores young consumers' considerations of HWC in purchasing decisions using data from qualitative interviews with a sample of 21 university students. The results suggest that interviewees frequently considered the working conditions of those who produced the products they purchased. Participants reported a willingness to pay 17.5% more on a $100 product if it were produced under HWC compared to not. Their ability and willingness to act on this issue was, however, hampered by  a lack of credible information about working conditions in production, the limited availability of HWC goods and a presumed higher price of HWC goods. While caution should be applied when generalising from this targetable market segment to a general population, these results provide actionable direction for companies interested in using a HWC brand image to gain a strategic sales advantage. Practitioner Summary: This interview study shows that young consumers are interested in, and willing to pay a premium for, goods made under healthy working conditions (HWC). Reported barriers to acting on this impulse include a lack of credible information on working conditions. Ergonomics can help provide a strategic marketing advantage for companies.

'Power base' tactics for workplace change - an interview study with industrial engineers and ergonomists

The work activities of industrial engineers (IEs) and ergonomists drive workplace changes. The purpose of this study is to compare the work practices of the two professions and examine (1) how IEs and ergonomists gain influence over workplace changes and (2) whether there are prevailing types of intentional interaction behaviours called Power bases (PB) present in the interaction tactics they employ. The study identified key behavioural strategies used by the interviewees to successfully influence workplace changes; these were then mapped to their corresponding PB. Results showed that IEs and ergonomists were successfully influencing workplace changes using several tactics across the spectrum of PB, with the exception of Reward and Coercion. The study concludes with a list of recommended workplace change agent tactics, and proposes that a PB 'analytical lens' can serve to increase the budding ergonomists' critical and analytical skills when considering possible workplace change tactics. Practitioner Summary: This interview study examines how workplace ergonomics change agents, represented by the two professions: industrial engineers and ergonomists, perceive and exercise their capacity to influence workplace change. Key behavioural tactics that interviewees have found successful are reported, alongside effects on short- and long-term relations with other workplace-influencing stakeholders.

State-of-science: situation awareness in individuals, teams and systems

Our review addresses one of the most used, but debated, topics in Ergonomics: Situation Awareness (SA). We examine and elaborate upon key SA models. These models are divided into individual SA, team SA and systems SA categories. Despite, or perhaps because of, the debates surrounding SA it remains an enduring theme for research and practice in the domain of Ergonomics, now for over two decades. A contingent approach, which seeks to match different models of SA to different types of ergonomics problem, enables the differences between positions to be revealed and reconciled, and the practitioner guided towards optimum methodological solutions. Practitioner Summary: Measuring SA in individuals, teams and systems has become a key objective in Ergonomics. One single approach to SA does not fit all problems encountered. This review shows the importance of considering all three types of models and achieving a match between them and the problem at hand.

A sociotechnical approach to occupational safety

We present an integrated conceptual framework for improving occupational safety. This framework is based on sociotechnical principles and is based on the premise that occupational safety should not be an isolated function but rather seen as directly related to an organizational mission which combines performance and well-being. As such, a fundamental goal is to achieve joint optimization between social and technical components of the system. This framework consists of four basic questions: (1) How can we determine the overall level of safety in the system? (2) How can we determine what kinds of interventions would improve safety? (3) How can we determine if the organization is ready to implement safety interventions? (4) How can we determine the best pathway for implementing safety interventions? A sociotechnical approach implies that safety must be considered from a complexity perspective as an emergent property. Hence, a variety of methodological approaches is required.

HTO - A complementary ergonomics approach

The field of human factors and ergonomics constitutes a strong potential in systems analysis, design and improvement. However, it is difficult to communicate its potential value. This paper addresses how the human-technology-organization (HTO) concept can be defined and supports the understanding, communication and development of the systems' character and potential of human factors and ergonomics. Empirical examples from the authors' experiences of working with the HTO concept in R&D and teaching are illustrated, including its usefulness as: 1) a conceptual model; 2) an analysis framework; 3) a meta methodology; 4) a pedagogical tool; and 5) a design tool. The use of HTO provides guidance on how the system can be designed to better support health, individual and systems performance. It is further suggested that there is a strong potential for developing the theory, applications and methodological aspects of HTO.

Quantum ergonomics: shifting the paradigm of the systems agenda

A paradigm is an accepted world view. If we do not continually question our paradigm then wider trends and movements will overtake the discipline leaving it ill adapted to future challenges. This Special Issue is an opportunity to keep systems thinking at the forefront of ergonomics theory and practice. Systems thinking prompts us to ask whether ergonomics, as a discipline, has been too timid? Too preoccupied with the resolution of immediate problems with industrial-age methods when, approaching fast, are developments which could render these operating assumptions an irrelevance. Practical case studies are presented to show how abstract systems problems can be tackled head-on to deliver highly innovative and cost-effective insights. The strategic direction of the discipline foregrounds high-quality systems problems. These are something the discipline is well able to respond to provided that the appropriate operating paradigms are selected. Practitioner Summary: High-quality systems problems are the future of the discipline. How do we convert obtuse sounding systems concepts into practical interventions? In this paper, the essence of systems thinking is distilled and practical case studies used to demonstrate the benefits of this new paradigm.

Beyond human error taxonomies in assessment of risk in sociotechnical systems: a new paradigm with the EAST 'broken-links' approach

Risk assessments in Sociotechnical Systems (STS) tend to be based on error taxonomies, yet the term 'human error' does not sit easily with STS theories and concepts. A new break-link approach was proposed as an alternative risk assessment paradigm to reveal the effect of information communication failures between agents and tasks on the entire STS. A case study of the training of a Royal Navy crew detecting a low flying Hawk (simulating a sea-skimming missile) is presented using EAST to model the Hawk-Frigate STS in terms of social, information and task networks. By breaking 19 social links and 12 task links, 137 potential risks were identified. Discoveries included revealing the effect of risk moving around the system; reducing the risks to the Hawk increased the risks to the Frigate. Future research should examine the effects of compounded information communication failures on STS performance. Practitioner Summary: The paper presents a step-by-step walk-through of EAST to show how it can be used for risk assessment in sociotechnical systems. The 'broken-links' method takes a systemic, rather than taxonomic, approach to identify information communication failures in social and task networks.

What is a 'good' job? Modelling job quality for blue collar workers. ERGONOMICS 2017;60:138-149. [PMID: 27005957 DOI: 10.1080/00140139.2016.1165870]

This paper proposes a model of job quality, developed from interviews with blue collar workers: bus drivers, manufacturing operatives and cleaners (n  =  80). The model distinguishes between core features, important for almost all workers, and 'job fit' features, important to some but not others, or where individuals might have different preferences. Core job features found important for almost all interviewees included job security, personal safety and having enough pay to meet their needs. 'Job fit' features included autonomy and the opportunity to form close relationships. These showed more variation between participants; priorities were influenced by family commitments, stage of life and personal preference. The resulting theoretical perspective indicates the features necessary for a job to be considered 'good' by the person doing it, whilst not adversely affecting their health. The model should have utility as a basis for measuring and improving job quality and the laudable goal of creating 'good jobs'. Practitioner Summary: Good work can contribute positively to health and well-being, but there is a lack of agreement regarding the concept of a 'good' job. A model of job quality has been constructed based on semi-structured worker interviews (n  =  80). The model emphasises the need to take into account variation between individuals in their preferred work characteristics.

The Role of Haptic Feedback in Robotic-Assisted Retinal Microsurgery Systems: A Systematic Review

Retinal microsurgery is one of the most technically difficult surgeries since it is performed at the threshold of human capability. If certain retinal conditions are left untreated, they can lead to severe damage, including irreversible blindness. Thus, techniques for reliable retinal microsurgery operations are critical. Recent research shows promise for improving surgical safety by implementing various types of sensory input and output. Sensory information is used to inform the surgeon about the environment inside the eye in real time. This review examines literature that discusses human factors and ergonomics (HFE) of sensory inputs and outputs of retinal microsurgery instrumentation with a focus on force and haptic feedback. Thirty-four studies were reviewed on the following topics: (1) variation between different input sensory devices and their performance, (2) variation between alternative output sensory devices and their performance, and (3) variation between alternative output sensory devices and their user satisfaction. This review finds that the implementation of HFE is important for the consideration of retinal microsurgery devices, but it is largely missing from current research. The addition of direct comparisons between devices, measures of user acceptance, usability evaluations, and greater realism in testing would help advance the use of haptic sensory feedback for retinal microsurgery instruments.

Macroergonomic factors in the patient work system: examining the context of patients with chronic illness

Human factors/ergonomics recognises work as embedded in and shaped by levels of social, physical and organisational context. This study investigates the contextual or macroergonomic factors present in the health-related work performed by patients. We performed a secondary content analysis of findings from three studies of the work of chronically ill patients and their informal caregivers. Our resulting consolidated macroergonomic patient work system model identified 17 factors across physical, social and organisational domains and household and community levels. These factors are illustrated with examples from the three studies and discussed as having positive, negative or varying effects on health and health behaviour. We present three brief case studies to illustrate how macroergonomic factors combine across domains and levels to shape performance in expected and unexpected ways. Findings demonstrate not only the importance of context for patients' health-related activities but also specific factors to consider in future research, design and policy efforts. Practitioner Summary: Health-related activities of patients are embedded in and shaped by levels of social, physical and organisational context. This paper combined findings from three studies to specify 17 contextual or macroergonomic factors in home- and community-based work systems of chronically ill patients. These factors have research, design and policy implications.

A review of the design and development processes of simulation for training in healthcare - A technology-centered versus a human-centered perspective

This article reviews literature about simulation systems for training in healthcare regarding the prevalence of human-centered approaches in the design and development of these systems, motivated by a tradition in this field of working technology-centered. The results show that the focus on human needs and context of use is limited. It is argued that a reduction of the focus on technical advancements in favor of the needs of the users and the healthcare community, underpinned by human factors and ergonomics theory, is favorable. Due to the low number of identified articles describing or discussing human-centered approaches it is furthermore concluded that the publication culture promotes technical descriptions and summative evaluations rather than descriptions and reflections regarding the design and development processes. Shifting the focus from a technology-centered approach to a human-centered one can aid in the process of creating simulation systems for training in healthcare that are: 1) relevant to the learning objectives, 2) adapted to the needs of users, context and task, and 3) not selected based on technical or fidelity criteria.

Ergonomics in the arctic - a study and checklist for heavy machinery in open pit mining

BACKGROUND

Heavy mining vehicle operators at arctic mines have a high risk of discomfort, musculoskeletal disorders and occupational accidents. There is a need for tailored approaches and safety management tools that take into account the specific characteristics of arctic work environments.

OBJECTIVE

The aim of this study was to develop a holistic evaluation tool for heavy mining vehicles and operator well-being in arctic mine environments.

METHODS

Data collection was based on design science principles and included literature review, expert observations and participatory ergonomic sessions.

RESULTS

As a result of this study, a systemic checklist was developed and tested by eight individuals in a 350-employee mining environment.

CONCLUSIONS

The checklist includes sections for evaluating vehicle specific ergonomic and safety aspects from a technological point of view and for checking if the work has been arranged so that it can be performed safely and fluently from an employee's point of view.