Healthcare human factors engineering seeks to understand how people interact with the environment and technology within the healthcare system . It is one of the many methodologies and principles that can help inform us about the barriers and facilitators that we need to change to engender improvement .” that implementation methodology can play a role in facilitating better progress on HAI prevention .
“ So many things collided during the pandemic ,” Schaffzin says . “ Supply chains were disrupted and as a result , many clinical processes were changed . As an example , if you needed to place a line , you normally grabbed a kit ; with the pandemic , the kits were in short supply or non-existent and that meant you now had to gather the components yourself , and that creates little disruptions that distract you and potentially lead to a greater margin of error . Or sometimes you didn ’ t even have the components you needed and you had to make do with what you had , which was far from ideal . On top of that , COVID-related concerns like staffing and PPE shortages , and personal and family safety had so much going on in clinicians ’ heads , errors could and likely happen . I think that implementation methodology can help us get back on track with HAI prevention by simplifying processes and by making everything consistent . An important step toward improvement is standardization , and that ’ s what implementation theory can do . Post-pandemic , we now won ’ t have to be changing processes every 5 minutes like we did during COVID .”
Some experts have recommended human factors engineering be applied to healthcare processes to potentially change behavior .
“ Human factors engineering takes into consideration the needs of the staff by identifying barriers in implementation and then incorporates technology to meet those needs ,” Pettis explains . “ One example which has contributed to central line-associated bloodstream infections ( CLABSI ) reduction is the creation of insertion and maintenance bundles and in particular the creation of standardized insertion and maintenance kits which include all necessary items . Another example would be electronic hand hygiene monitoring systems that give an audio or visual reminder to staff when hand hygiene is not done . This comes close to being a ‘ forced function ’ which then leads to creating a habit ,” she says .
Adds Schaffzin , “ Healthcare human factors engineering seeks to understand how people interact with the environment and technology within the healthcare system . It is one of the many methodologies and principles that can help inform us about the barriers and facilitators that we need to change to engender improvement .”
As Trivedi and Schaffzin , et al . ( 2023 ) observe , “ Facilitators and barriers affect implementation to differing degrees . For example , an individual practitioner may oppose a change ( be a barrier ), but the supervisor may be able to facilitate to overcome the opposition . Alternatively , a practitioner may champion a change , but without the support of the leadership , they may be unable to initiate it . Additional influential factors include context , level of engagement , and reliability .”
“ The first step of implementation ,” Schaffzin explains , “ is to understand what the determinants are , what the barriers and facilitators are . The next step is to determine the method of measuring progress toward established goals .”
As Trivedi and Schaffzin , et al . ( 2023 ) note , “ Data are essential for implementation to establish baselines , identify opportunities , measure progress , and justify use of resources to organizational leaders . No single method or measure will work for all situations , and standardized measures often are not available . Different frameworks lend themselves to specific methodologies , but any chosen method must do the following : Be appropriate for the question ( s ) it seeks to answer ; and adhere to the method ’ s rules for data collection and analysis . As with any project , it may be prudent to review the analytic plan with an expert to ensure that data collected will yield a result .”
The authors explain that there are three general types of measures employed in implementation , as outlined by the Institute for Healthcare Improvement ( IHI ):
➊ Outcome measure : The ultimate goal of a project , such as reduced surgical site infections or improving antimicrobial susceptibility patterns .
➋ Process measure : The action taken to reach the desired outcome , such as adherence to a prevention bundle or compliance with hand hygiene standards .
➌ Balancing measure : An undesired outcome that could be caused by changing a system , such as increased staff absences due to dry skin from a hand hygiene product or due to side effects from a required vaccine .
Managing data is an essential component of any implementation project , but it can quickly become unwieldy for clinicians .
“ Data collection is labor intensive and therefore a challenge for most , if not all facilities ,” Pettis acknowledges . “ Electronic surveillance programs have streamlined the process . Staff turnover and shortages make surveillance very difficult . For data to resonate it must be reported on a frequent basis and ideally the numbers should be supported by actual stories of how these infections impact patients .”
“ I think this is where specific expertise in methodology is extremely important ,” Schaffzin remarks . “ Many analysts can put data into a chart , but they may or may not appreciate the quality or validity of the data , and they also don ’ t necessarily know the question that they ’ re asking . So , with data , you can get numbers , but meaningful data has validity , it ’ s reporting on the question that you are asking . There are many ways to get data from an EMR , but you must understand what the benefits and downsides are . For example , administrative coding for some conditions is good but it ’ s not 100 percent , and billing can differ from place to place and you must validate it first . I think that one of the best ways that institutions can support implementation work is in the areas of data collection and data reporting . Someone with expertise must review the data and not just say , ‘ Oh , here are
18 september 2023 • www . healthcarehygienemagazine . com