How do health service professionals consider human factors when purchasing interactive medical devices? A qualitative interview study

Prioritizing Patient Safety: Analysis of the Procurement Process of Infusion Pumps in Spain

To understand whether patient safety and human factors are considered in healthcare technology procurement, we analyzed the case of infusion pumps as their use critically affects patient safety. We reviewed infusion pump procurements in the Spanish Public Sector Procurement Database. Sixty-three batches in 29 tenders for supplying 12.224 volumetric and syringe infusion pumps and consumables for an overall budget of EUR 30.4 M were identified and reviewed. Concepts related to "ease of use" were identified in the selection requirements of 35 (55.6%) batches, as part of the criteria for the selection of pumps in 23 (36.5%) batches, related to "intuitiveness" in the selection requirements of 35 (55.6%) batches, and in the criteria in 10 (15.9%) batches. No method to evaluate the ease of use, intuitiveness, or usability was mentioned. A review of the procurement teams responsible for the evaluation of the tenders showed no reported human factors or patient safety expertise. We conclude that infusion pump procurement considers usability as a relevant criterion for selection. However, no human factor experts nor specific methods for evaluation of the technology in this field are usually defined. Potential room for refining the selection of healthcare technology to improve patient safety is detected.

Factors influencing procurement behaviour and decision-making: an exploratory qualitative study in a UK healthcare provider

Background

In 2016 the UK Department of Health and Social Care published the results of a comprehensive review of efficiency in hospitals, identifying “unwarranted variation” in procurement (or purchasing) practices for materials, supplies and devices. Addressing this variation in materials and supplies procurement practice has been identified as particularly important for creating efficiencies in health service delivery. However, little is known about the behaviour and experiences of front-line individuals who make these procurement decisions, which has implications for the development of strategies to improve efficiency. The objective of this study is to improve understanding of the factors influencing procurement behaviour and decisions among requisitioners who use an internal electronic procurement portal for medical supplies and equipment, and identify areas where efficiency could be improved.

Methods

Qualitative semi-structured individual interview study, following approximately 70 h of exploratory observations on site. The study context was a large London National Health Service (NHS) healthcare provider (the Trust), where we focussed primarily on purchases managed by a large hospital. Participants were drawn from requisitioners from multiple directorates across the Trust (n = 15; of these n = 2 clinical staff members, n = 13 non-clinical).

Results

Four factors stood out in our analysis as directly affecting procurement decisions: (1) a high level of variation in electronic purchasing and inventory management procedures throughout the Trust, (ii) an inaccurate and cumbersome search facility on the internal electronic procurement platform, exacerbated by poor IT skills training and support (iii) an inefficient purchase approvals system and (iv) multiple working sites and cluttered environments. We observed that these factors led requisitioners to employ a variety of strategies or so-called ‘workarounds’ to overcome the challenges they encountered, including stockpiling, relying on internal and supplier relationships, by-passing procedures to save time, purchasing outside existing agreements to save cost, and (re) delegating purchasing responsibilities among requisitioner staff - which both addressed and created difficulties.

Conclusions

Working with the assumption that staff ‘workarounds’ indicate where main issues lie, we offer four possible explanations to why they occur: (a) to maintain services and prepare for future care requirements, (b) to save on costs for the organisation, (c) to develop skills and development in purchasing and (d) to break silos and work collaboratively. These four explanations help provide initial starting points for improving efficiencies in health supplies’ procurement processes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07065-0.

Usability testing of radiotherapy systems as a medical device evaluation tool to inform hospital procurement decision-making

PURPOSE

Poor usability designs of radiotherapy systems can contribute to use errors and adverse events. Therefore, we evaluated the usability of two radiotherapy systems through radiation therapists' performance, workload, and experience that can inform hospital procurement decision-making about the selection of appropriate radiotherapy system for radiation therapist use.

METHODS

We performed a comparative usability study for two radiotherapy systems through user testing. Thirty radiation therapists participated in our study, in which four typical operational tasks were performed in two tested radiotherapy systems. User performance was measured by task completion time and completion difficulty level. User workloads were measured by perceived and physiological workload using NASA-TLX questionnaires and eye motion data. User experience was measured by the USE questionnaire.

RESULTS

Significantly less task completion time and an easier task completion difficulty level were shown with the Varian Trilogy than with the XHA600E. The study results suggest that higher perceived and physiological workloads were experienced with the XHA600E than with the Varian Trilogy. Radiation therapists reported better user experience with the Varian Trilogy than with the XHA600E. Five paired t-tests regarding user performance, user workload, and user experience between the Varian Trilogy and the XHA600E were performed, showing that the Varian Trilogy radiotherapy system has a better usability design than the XHA600E radiotherapy system.

CONCLUSIONS

Based on study results, we confirmed that the Varian Trilogy radiotherapy system has a better usability design than the XHA600E radiotherapy system. Furthermore, the study results provide valuable evidence for hospital procurement decision-making regarding the selection of a suitable radiotherapy system for radiation therapists to use.

Usability issues in the operating room - Towards contextual design guidelines for medical device design

Most usability assessments of medical devices describe the problems of individual devices in detail, but few account for the real context of use or provide designers with actionable guidelines for improvement. To fill this gap, this paper reports the results of a case study on the usability of operating room technologies and documents the creation of contextual design guidelines for operating room device design. We spent 64 h in a gynecological operating unit conducting interviews with staff and observing device use during surgery. With qualitative analysis methods and based on existing usability principles, we created 21 design guidelines for the operating room context. The new guidelines highlight interactions between multiple devices, staff members, as well as other contextual factors. While the guidelines require further validation, they can potentially support the creation of more safe, ergonomic, and intuitive medical devices.

Impact of Design on Medical Device Safety

The growing number of emerging medical technologies and sophistication of modern medical devices (MDs) that improve both survival and quality of life indexes are often challenged by alarming cases of vigilance data cover-up and lack of sufficient pre- and post-authorization controls. Combining Quality with Risk Management processes and implementing them as early as possible in the design of MDs has proven to be an effective strategy to minimize residual risk. This article aims to discuss how the design of MDs interacts with their safety profile and how this dipole of intended performance and safety may be supported by Human Factors Engineering (HFE) throughout the Total Product Life-Cycle (TPLC) of an MD in order to capitalize on medical technologies without exposing users and patients to unnecessary risks.

Managing the patient safety risks of bottom-up health information technology innovations: Recommendations for healthcare providers

Health information technology (IT) offers exciting opportunities for providing novel services to patients, and for improving the quality and safety of care. Many healthcare professionals are already improving services through the development of numerous bottom-up local health IT innovations. Such innovations from the ground up are to be welcomed, but healthcare providers are struggling to develop processes for managing the risks that come with the introduction of health IT into clinical processes. I argue that too often the main strategy appears to be one of organisational ignorance. This puts patients at risk, and it threatens the successful adoption of health IT. I recommend that healthcare providers focus on strengthening their processes for organisational learning, promoting proactive risk management strategies, and making risk management decisions transparent and explicit.

Bags, batteries and boxes: A qualitative interview study to understand how syringe drivers are adapted and used by healthcare staff

Syringe drivers are medical devices that are critical for end of life care. They deliver continuous medication over extended periods of time. Their design contributes to the quality of experience for both patients and healthcare professionals. Little research has been published about the factors that influence the usability of this type of equipment for frontline users (i.e. those in direct contact with patients) and how equipment gets introduced. Understanding how syringe drivers are used in practice can help improve the design of equipment. 27 semi-structured interviews were conducted across acute hospitals, community hospitals and hospices (4 organisations in total). All participating organisations used the same type of syringe driver. It was found that frontline staff needed to adapt this equipment to fit the circumstances of use. The analysis provided examples of this happening for aspects relating to the appearance of the device (bags), accessories (batteries) and security (the lockable box).