Improving patient care and staff well-being

The discipline of human factors and ergonomics is key to improving patient safety and ensuring NHS staff aren’t put at risk when caring for patients. The Chartered Institute of Ergonomics and Human Factors explains why

Ensuring the practice of human factors and ergonomics (HF&E) is factored into a design is the key to success. By focussing on the systems in which people interact with, in physical, organisational and social environments, will give two key outcomes; well-being and performance.

Professor Sue Hignett, fellow of the Chartered Institute of Ergonomics and Human Factors (CIEHF), the professional membership body for ergonomists and human factors practitioners, explains: “HF&E looks at redesigning ‘systems’ and ‘objects’ to allow people to succeed, by ensuring certain tasks and systems are designed to suit human capabilities and limitations. This type of practice is common in industrial sectors and safety critical industries, but is slightly more complicated when it comes to the healthcare sector at it’s both people-centred and people-driven. This means even more focus is required, but benefits could be worth investment.”

Input from chartered ergonomists and Human Factors specialists within the healthcare sector is often requested following a major incident or change in legislation. This was apparent in the 1990s when the main focus was on staff well-being following a high number of musculoskeletal injuries. HF&E professionals were brought in to help improve staff well-being, especially for nurses and midwives to reduce injuries. Some of the initiatives included redesigning tasks, equipment and taking systems approaches to complex challenges. For example replacing hydraulic hospital beds with electric beds enabled hospitals to both reduce risks for nurses and improve patient well-being with better pressure care mattresses.

Creating user-friendly devices
More recently, further opportunities have arisen for HF&E professionals to look more closely at many of the systems, tasks and equipment in the healthcare sector. Following input from HF&E specialists, medical devices are now required to fulfil usability criteria, with specialists being brought in to provide expert advice in task analysis and interface design. The importance of the human factors element within the design of medical devices is paramount. The discipline will help minimise user related incidents, create user-friendly devices, and support better treatment of a patient’s medical condition, all while reducing human error risks.

Professor Hignett added: “The industry is now taking HF&E into account when designing systems. This is clearly demonstrated in increased interest levels from both healthcare regulators and professional bodies. This means we need to be ready to respond to any enquiries and offer support to ensure that the healthcare industry gets expert advice from qualified Chartered Ergonomists and Human Factors specialists.”

In 2013 a National Quality Board Concordat was signed by 16 healthcare agencies in England, which helps demonstrates a commitment to embedding a recognition and understanding of human factors across the NHS. The signed agreement shows how the health sector is taking the right steps in improving patient well-being and understanding the value and support that human factors can offer in this area.

What’s more, Health Education England, the commission on ‘Learning to be Safer’, has recently reported its findings in regard to improving safety through education and training with 12 additional recommendations, three of which include human factors: develop and use a common language to describe all elements of quality improvement science and Human Factors with respect to patient safety; the content of mandatory training for patient safety needs to be coherent across the NHS; and the principles of human factors and professionalism must be embedded across education and training. Multi-professional human factors training should form part of the induction process for every new employee.

Commenting on the updated Health Education England findings, Professor Hignett says: “As professionals, we need to engage with this opportunity sooner rather than later. One of the many strengths of Chartered Ergonomists is our ability to bring together knowledge, concepts and experiences within a systems framework. So in my opinion there are three key ways in which we, the CIEHF, can respond.

“Firstly, supporting healthcare workers by providing professional HF&E expertise and making sure that they understand the importance of qualified advice from a Chartered Professional Ergonomist (C.Erg.HF). There is no guarantee of professional competency, knowledge or indemnity insurance from non-qualified individuals who may claim expertise in HF&E.

“Secondly, engaging with healthcare regulators and professional bodies such as Royal Colleges and Chartered Societies to include HF&E knowledge in competency frameworks for undergraduate education and ‘Continuing Professional Development’.

“And finally, providing accredited education and training for healthcare workers with an interest in HF&E, for example, Postgraduate Certificates for Human Factors in Patient Safety, and Ergonomics in Health & Community Care as well as within Quality Improvement programmes and initiatives.”

Unrealised potential
Although the use of HF&E in healthcare is an established element in improving patient well-being, it has been a long and laborious process, often met with restrictions by healthcare professionals who proclaim the systems rhetoric without really understanding what a system is, or how to analyse it. This means that the benefits of using HF&E to improve patient safety have yet to be fully realised.

When a chartered ergonomist talks about a systems approach, they could be talking about a small system such as the interactions between a patient, nurse, bed, mattress, bed table or monitoring equipment, or a larger system such as a patient journey from A&E, to x-ray, to a ward, to the operating theatre, or to recovery. This large system will include interactions with technology and equipment such as beds, operating tables, anaesthetic machines, information transfer and communication, and building design for turning space, monitoring sight lines and navigation.

Taking a systems approach to safety will support integration of well-being and safety for both staff and patients. A lack of integration can increase the complexity of organisational systems with, for example, separate risk assessments for falls, pressure ulcers, mobility/safe patient handling, continence and confusion, including dementia.

Professor Hignett concludes: “The way forward is to embed Human Factors and ergonomics across healthcare with a champion at executive board level for each trust or healthcare provider. This will transform healthcare safety culture from trying to fit the human to the environment to a safety culture which understands human capabilities and limitations. HF&E within the healthcare sector will support the design of efficient systems that are fit for patients and staff. A greater use of HF&E and design will create many opportunities for healthcare to take ‘giant leaps’ in improving safety.”