Assessment of patient safety management from human factors

perspective

指導教授 ： 李元墩 博士 王正華 博士

博 士 生 ： 周蕙苓

1

研究進程

2

領導者價值觀

•重視顧客•參與與團隊•持續改善•資訊分享

領導者特質

經驗開放性責任

領導者行為

•溝通行為•團隊設計與教練行為

「運用階層程序法 (AHP)於醫院護理長甄選模式之建構與應用」 (2011/05/06發表於博士生論壇 ) ；醫

護科技學刊投稿中

Introduction

• The pursuit of increased and enhanced safety for patients in health care has resulted in the patient safety movement in most industrialized nations(Richardson & Storr,2010).

• In some developed countries, the occurrence of adverse events is estimated to stand at 10% of admissions(Richardson & Storr,2010).

• According to Institute of Medicine (IOM) report that medical errors kill between 44,000 and 98,000 people in U.S. hospitals each year(Sammer, Lykens, Singh, Mains, & Lackan, 2010).

Introduction

• Medical error or patient safety research has seen an explosion of activity since the publication of the US Institute of Medicine (2000) report ‘‘To Err is Human’’.

4

Introduction

• In a systemic perspective, the assessment of the overall safety of an organization involves the assessment of integrated human and machine (technical) systems.

• Therefore, it is appropriate to speak about the entire set of situations and interactions that may involve humans and machines (Cacciabuea & Vella, 2010).

Introduction

• Recently, much emphasis has been put on human factors approaches to patient safety (Bogner, 1994; Cook, Woods, & Miller, 1998; Leape, 1994; Wears & Perry, 2002).

• Just as the Institute of Medicine has recommended the use of human factors methods and principles to improve health care (Kohn et al. 2000).

Introduction

• human factors have been studied more frequently in areas outside health care, eg, aviation, military, and nuclear power plants (Ross, 2009).

• The application of HFE in healthcare and patient safety is not new. In the late 1950s, such as the study conducted by Safren and Chapanis (1960), they found that most (90%) causes of the medication errors fell in human factors.

Introduction

• However, an understanding of human factors is lacking for the nursing field (Rivera & Karsh, 2007).

• Therefore, the purpose of this study is to outline the main human factors that have relevance for patient safety.

Human factors

• During the last years, different management systems (e.g. quality management, environmental management and health or occupational and health systems management) have been introduced and brought together within an integrated management system to use all possible synergies (Strasser &  Zink, 2007).

9

Human factors

• Human factors, in terms of the pragmatic design of the workplace and in close co-operation with technology must strive for the harmonization of human characteristics with technical and economic goals and attempt to reconcile the individuality of people with the technical and organizational demands of the world of work.

10

Figure 2. Hawkins SHEL model of Human Factors.(Molloy & O’Boyle, 2005)

SHEL Model

• The SHEL model illustrates the interrelationship of three types of resources and their environment (E). These three resources include: software (S), hardware (H), and liveware (L). All of these resources are continuously interacting within the context of their environment.

Figure 4. The Swiss Cheese Model (Reason 1990, 1997)

Figure 5 Stages in the development and investigation of an organizational accident (Reason 1997)

Literature Review

• Work Environment Factors • This factor deals mainly with the workplace

environment, includes such as staffing structures and levels, availability and environment condition(Karsh, Holden, &Alper, Or, 2011).

• Besides, the team's environment is partly controlled by senior clinicians and managers. Equipment is also an important area of concern for patient safety (Buckle et al, 2006, Thomas & Galvin, 2008).

Literature Review

• Organizational and Management Factors • There are many organizational and managerial factors that can

influence all workers’ behavior (Landy & Conte, 2008) • These factors include: safety culture, manager’s leadership,

and workplace communication procedures (Flin, Winter, Sarac, & Raduma, 2009).

• The healthcare organization, in turn, is also affected by financial constraints (Valente, & Stanhope, 1988).

Literature Review

• Work Group/ Team Factors• Good teamwork can help to reduce patient safety problems

(Bower, Campbell, Bojke, & Sibbald, 2003). • The factors that influence team performance include the group

structure, group processes or dynamics and by the team leader or supervisors’ actions (Valente, & Stanhope, 1988; Flin, Winter, Sarac, & Raduma, 2009).

• The way individuals practice are also constrained and influenced by the way the team members communicate with, support, and supervise each other (Valente, & Stanhope, 1988).

Literature Review

• Task factors• For each task, it is important that the nurse be sure

that she/he is dealing with the right patient (Beuscart-Zéphira, Pelayoa, Bernonville, 2010).

• These are characteristics of the tasks or jobs, including what the tasks themselves are, as well as characteristics such as time pressure, job control, and workload (Karsh, et. al., 2011).

• For example, if not having sufficient time may cause some of the workload-related problems (Carayon, Gurses, 2005).

Literature Review

• Individual Factors (staff and Patient)• At the individual level, there are many different

psychological and physiological factors which can influence workers’ behaviors that contribute to safety outcomes (Flin, Winter, Sarac, & Raduma, 2009).

• The human factors addressed at this level, such as the patient's personality, may influence communication with staff.

• A number of staff factors, such as personality, experience, training and managing personal resources (stress and fatigue), may be influential (Valente, & Stanhope, 1988; Flin, Winter, Sarac, & Raduma, 2009).

Literature Review

• According to literature review, the focus of this research is on five main categories of factors, including: Environment Factors, Organizational and management factors, Team factors, Task factors and Individual (staff and Patient) factors.

A B C D E F G

Patient & HCP (Human Capital Planner)factors

ˇ ˇ ˇ ˇ ˇ ˇ

Task / Job factors ˇ ˇ ˇTechnology & tool factors ˇEnvironmental factors ˇ ˇ ˇ ˇ ˇ ˇ ˇOrganizational factors ˇ ˇ ˇ ˇ ˇExternal environment factors ˇLiveware factors ˇSoftware factors ˇHardware factors ˇTeam /Crew factors ˇ ˇ ˇ ˇCommunication ˇCognition & mental workload ˇService / product design ˇProcess design ˇNote: A: Input-transformation-output modrl (Karsh,Holden,Alper,Or,2011)B: SHEL model (Molloy,& O’Boyle, , 2005)C: TheUniversity of Texas Threat&Error Model(Helmreich &Musson, 2000)D: WHO patient Safety Report(Flin,Winter,Sarac,&Raduma,2009)E: Team Training Program(Marshall&Manus,2007)F: Carthey,&Clarke,(2009)G: Valente, Taylor-Adams & Stanhope (1988)

Methodology

• Factor Analysis

This study will choose Exploratory Factor Analysis (EFA) to test those underlying factors that are present in the scale

• Fuzzy AHP

This paper proposes the use of fuzzy AHP method to determine the factors of patient safety assessment systems. The AHP addresses how to determine the relative importance of a set of activities in a multi-criteria decision problem(Saaty, 1980).

Expected results

• This study does offer initial information about the factor structure of a validated assessment scale for patient safety.

• Identifying and ranking the important of factors of patient safety by expert consultation.

• Provide an insight for the senior clinicians and managers to confirm the factors that enhance safety for patients in health care.

23