The Healthcare Ergonomics Cluster (HEC) formed in 2017 when a group of society members (many with backgrounds as health professionals) recognised opportunities to be working within the healthcare sector in New Zealand across several human factors/ergonomics (HFE) application areas. An HFESNZ position paper (August 2018) identified that HFE is a distinct discipline with its own theories, models and practices which combines elements of psychology, anatomy, physiology, engineering, design and statistics to better understand the nature of human interactions with the world and its complex systems. It is a discipline that focuses on the optimisation of a system through consideration of outcomes related to performance, quality, individual wellbeing and organisational design. It does so by adopting a collaborative approach with the active involvement of all relevant stakeholders. HFE is relevant to all stages of the life-cycle of a product or service, from early planning and design, right through to implementation and evaluation, and re-design.
The Chartered Institute of Ergonomics and Human Factors (our UK equivalent) in October 2018 published a white paper on 'Human factors for health and social care'. Go HERE to access this useful reference document.
Terminology - within the discipline the terms 'human factors' and 'ergonomics' are used interchangeably. Some may think of 'ergonomics' as the more physical applications, and some that 'human factors' is the more work organisational or psychological applications, but in fact both terms refer to the same discipline. And just as in health, HFE professionals may specialise in different areas. We are comfortable with being referred to as 'clinical human factors professionals' and 'health ergonomists' and many other variations!
How HFE can help
Healthcare and social assistance was identified in WorkSafe/ACC Harm Reduction Action Plans from 2016 (and in similar documents historically) as a sector associated with high rates of injury and cost, with the common injuries being musculoskeletal disorders and injuries associated with slips, trips and falls. Harm reduction plans driven from WorkSafe and ACC target reduction of injury. There is also increasing knowledge of the psychosocial risks and organisational stress that healthcare workers may be exposed to in their work. HFE professionals are key players in effecting reduced work-related health harm to healthcare workers, and HEC's members have a particular interest and expertise in the application of HFE in this field. This application may see HEC members supporting health and safety groups within DHB's to address risks to workers.
Other agencies such as the Health Quality and Safety Commission have a particular focus on patient safety outcomes, with quality improvement and adverse event review processes common in New Zealand's health services. HFE professionals have much to offer incident investigation processes within the complex systems that characterise health care, in order to improve patient care outcomes. This application may see HEC members working alongside adverse event review teams to strengthen the findings of these investigations, and to identify appropriate recommendations - via systematic evaluation of the complex socio-technical systems that provide healthcare.
Understanding and applying a systems approach is a fundamental concept of HFE. Systems can be defined as a set of inter-related activities or entities and range form micro-systems (e.g. people performing single tasks or using tools) through to meso-systems (e.g. people working as part of a team or organisation) to complex, overlapping socio-technical macro-systems (e.g. ambulance services linking with acute care and long-term care services, and linking with other emergency services). It is through understanding the interactions that occur and by adopting a 'systems approach' that effective solutions may be identified.
Focus areas may include:
HEC will enable society members to extend their own knowledge, support each other, and to collaborate. Profile-raising will occur through targeted learning events such as webinars, study days and conferences, and through networking and relationship building with key agencies and decision-makers. HEC members may be approached to run workshops for the healthcare sector.
HFESNZ Human Factors in Healthcare Symposium
18 September 2019, Marion Davis Library, Auckland Hospital
The inaugural HFESNZ Human Factors in Healthcare Symposium proved to be a big success in terms of fulfilling a main aim of the Healthcare Ergonomics Cluster (HEC) which was to raise the profile of human factors in healthcare in NZ and advance understanding about human factors/ergonomics (HFE) applications within healthcare. The Marion Davis Library, sited within the Auckland DHB, proved to be an ideal venue as it made the Symposium accessible for clinical staff to attend - as we hoped it would. A total of 74 delegates attended the event, coming from wide backgrounds and professional groups including human factors specialists, clinicians, senior managers, healthcare quality, and health and safety practitioners.
Support from ACC meant that we were fortunate to have two speakers from the UK presenting on key topic areas concerning HFE and healthcare. Dr Alexandra Lang considered the application of a systems approach within a healthcare context and Saskia Fursland presented on integrating human factors into healthcare safety investigations. Each speaker delivered a keynote and an interactive masterclass session with both exceptional in terms of the knowledge and experience they brought to their subject areas. All sessions were presented in an interesting and engaging way which combined with personable and authentic speakers for a winning combination.
Dr Alexandra Lang delivered the first keynote and spoke about a vision in which Human Factors / Ergonomics is placed at the heart of safety by design – where attention is given to helping people do the right thing intuitively and making it impossible or hard to do the wrong thing. Alex is an Honorary Associate Professor in Healthcare Human Factors at the University of Nottingham with an additional part time role at the Nottingham University Hospital Trust. She drew on her extensive experience in her presentation. Alex’s masterclass focused on the healthcare service in New Zealand and encouraged participants to think how human factors (HF) integration could be promoted and encouraged in a local context using examples of procurement, education and improvement interventions. This provided an opportunity to consider key concepts in healthcare HF as well as how HF capacity could be developed within the healthcare sector.
Following this, Saskia Fursland presented on the application of HF in accident investigations, which is currently a topic of much interest in NZ healthcare. Saskia is an accredited Aviation Psychologist and National Investigator at the Healthcare Safety Investigation Branch (UK) and conducts independent patient safety investigations into clinical incidents. One of the key messages from Saskia’s masterclass was acknowledging that a shift had occurred with movement away from focusing on individual behaviour in Root Cause Analysis (RCA) and linear cause methods to applying a broader systems approach when undertaking accident investigations. Saskia led an enjoyable interactive session in which participants explored aspects of the investigation process including the collection of evidence for analysis and the basis of subsequent recommendations to improve patient safety and staff wellbeing.
Following the masterclass sessions, Associate Professor Felicity Lamm and Dr Danae Anderson from the Centre for Occupational Health and Safety Research at AUT led an expert panel discussion again in an interactive format to explore key issues and opportunities in developing a combined strategy by which to move HFE forwards within healthcare. In addition to Alex and Saskia, the panel included Caroline Tilah, HQSC’s manager for patient safety who has a background (and passion) in quality improvement; Ginette Spence, an ACC project manager specialised in health and customer related products and Dr Carl Horsley, an intensivist in the Critical Care Complex at Middlemore Hospital, with an interest in resilient healthcare and Safety II within clinical work. Each panel member presented three key challenges and/or opportunities in managing human factors in the health sector and what they felt needed to happen to effect positive change within healthcare - which made for an enjoyable and thought-provoking discussion.
A small token of appreciation was given to those who had contributed to the symposium, which concluded on acknowledgement of the value that is to be gained from working together to implement HFE applications within healthcare. The day finished strongly with new relationships formed and existing networks strengthened, providing a platform on which we can build future events. There was a sense that we are at the beginning of an exciting journey, so if you have an interest in healthcare ergonomics please make contact and come and join us.
The HFESNZ 21st Conference continued over the next two days, with the healthcare theme continuing through day one. See HFESNZ 2019 Conference for more information.
Human Factors in Healthcare Symposium - Proceedings