 Hi everybody, this is Donna Crosser, Chief Clinical Officer at the Patient Safety Movement Foundation. Today we're here talking about the impact of human factors and ergonomics on health worker safety and we're joined by Dr. Kathleen Moser. Dr. Moser is emeritus professor of psychology at San Francisco State University and she's the president of the International Ergonomics Association as well as the founder and principal scientist at TeamScape LLC. Welcome Kathleen, thanks so much for joining us today. Thank you Donna. I wonder if you could tell us just a little bit about your background. My background is actually in organizational psychology with strong emphasis on human factors. I've been involved in human factors research mostly in aviation and space for many years and I'm working now as the president of the International Ergonomics Association which gives me a broad view of what what countries and societies are doing around the globe. Great, well thanks so much for joining us today. This is going to be a great conversation I know. For 20 years now we've been talking in healthcare about human factors and ergonomics but when we think about ergonomics a lot of times we think about body mechanics. Can you help us to define what those terms human factors and ergonomics means and how that differs from body mechanics? Well I would say that many people consider the terms to be equivalent and I consider that they are kind of interchangeable but in different countries different conventions have grown around the terms. In the US it's very common to think of ergonomics as the body mechanics and physiological part having to do with musculoskeletal disorders and with disorders of the body stresses and strains on the body and human factors is more on the side of cognition and teamwork and communication more psychosocial issues but one of the important things about the field is that it's broad and one of its tenets is that you have to consider both the musculoskeletal aspects as well as all of the psychosocial aspects if you're going to make any changes. So I usually refer to both terms human factors ergonomics or with the slash or with an n to emphasize the fact that you need to consider all aspects. Great so I wonder tell me how did this become you know a topic of discussion how how did this become such a big deal in the last 20 years and why? I think healthcare organizations have realized in the past two decades that human factors and ergonomics is critical to safety and healthcare both for the healthcare workers as well as for the patients. I think they've looked around at other domains and disciplines and seen the benefits of applying human factors and ergonomics and some of the interventions from these other fields have been taken and applied in healthcare. So for example the surgeon's checklist or other checklists are interventions that were initiated in in domains like aviation and they work to prevent errors and to avoid harm and so healthcare organizations have adopted those and taken them over because they see that they're affected. So one of the conferences I've gone to is saying that healthcare organizations are a little behind in adopting these things but they're catching up very rapidly. Yes we we have been doing quite a lot of catch up over the last 20 years in healthcare and in terms of safety. So what what are the some of the common gaps that you see in healthcare systems in terms of the way that that our systems are designed in our processes? What are the human factor and ergonomic gaps that you see? Well I would say that a common neglected factor for healthcare safety as in many other dynamic and sometimes high risk domains is the need for a holistic systems approach. So the work, the work processes, the characteristics of the organization and of the environment, excuse me the artifacts, the you know like machines, computers, records, checklists, all of those artifacts, all of these things have to be considered together in order to create a comprehensive system design and so the human factors ergonomic systems approach considers all of these things in all aspects of the patient journey and the healthcare system and moreover it's it's very important that organizations recognize that the safety of patients and the safety of healthcare workers and caregivers are interdependent. So the interactions between the healthcare workers and patients have to be considered and the system has to be designed to protect both sides of the worker-patient relationship. So for example a worker whose safety is compromised by by adverse working conditions that cause stress or lack of appropriate personal protection equipment or other suboptimal conditions may not be able to function well enough, may not be able to read the signals or choose the right medication or the dosage to keep patients safe. So it's all it's all part of the same system. I was just going to say that that that lack of looking at things in the context of a system is is probably something that really needs to be emphasized. Yes and we are we 100% agree with that here at the Patient Safety Movement Foundation and we advocate for and try to provide education for healthcare clinicians and administrators to do a better job of that but where does one begin? Like if you had a healthcare leader who said I really don't even know if we have any issues any gaps in our organization where would one begin to do an assessment of the organization to say? Well all of the things that I mentioned have to be considered as well as how decisions are made how the environment is set up including the displays of information whether it facilitates or hinders decisions and and actions and performance how handoffs are done all of those things. Training is very important for physical tasks such as lifting or moving or for information flow as well and and most important when you're starting these kinds of assessments is that everyone who is involved in the tasks in the system should participate in the assessment so the first thing you need to do is ask people and watch them and observe and see how things are being done and where you see glitches or gaps so everyone needs to be involved in the assessment as well as in the creation of solutions we call it participatory ergonomics so for participatory human factors and ergonomics so a key component of the systems approach that's common in human factors is the participation of everyone in the system and so I think that's where you would start you would start by looking at various levels and various participants and gathering information from them. Well so we all know how hard it is to change human behavior so do you have any specific recommendations you know let's just say a healthcare leader says yet you know what in Houston we have a problem we have done an assessment we found that we have gaps and they then are working very hard and diligently to improve the processes in the systems in which their health workers you know have to function. Do you have any recommendations about how to make that work stick and how to sustain it over time? How to make it stick so first you have to first you have to do it and you have to consider all those aspects in the design and do probably work systems analyses and those kinds of things and many organizations use systems models such as the SEIPS model have you heard of that one? It's a systems engineering initiative for patient safety and it was developed by Dr. Pascal Carrion at the University of Wisconsin and her colleagues and in this model the whole socio-technical work system the environment the tools the tasks the organization the persons is seen to produce work processes professional processes from caregivers collaborative processes between caregivers and patients and patient work and those shape the outcomes for patients as well as the others in the system you know and whether they're desirable or not and I think the important thing is to make the changes part of the culture and make the design facilitate the actions that you want to have. So one of the tenets of human factors in ergonomics is that it facilitates human performance as well as human well-being so the notion is that correct design will make things easier and better to do less error prone less subject to you know foibles or or distractions or whatever and so once once you've got the the environment and the artifacts and the design in there then the culture kind of establishes it and gets it ingrained in the people that are working there and it's very important to have a culture of learning if you're going to make something stick and a culture that goes back and and says okay we were doing this we thought this was the way to do things and we thought these processes would work but let's look and see is it working have we learned anything new and go back and it's it's an iterative constant learning process so that you're making sure that as technology changes or as tools change that you change the system to go along with what you've got so that you've really got something that that altogether functions at the optimal level and um and this is this will work for for healthcare workers as well as the outcomes for patients I think will be enhanced. Great well that's wonderful and any any last thoughts about what we can do overall using you know the concepts and human factors and ergonomics to improve health worker safety? I would say that that you need to consider the designs of the tools the designs of the technology and the displays and make sure that that the artifacts that are being used for healthcare workers are in line with human factors and ergonomics principles that they're well designed you know and that's some expert name to tell you that and look at what's there um need to look at the physical loading factors and the lifting of patients all of those things need to be considered um the placement and labeling of materials so they're easily located and identified so those kind of things going into the environment need to set up an environment that's conducive to good performance and also as I as I mentioned before and I would I would reiterate that the approach needs to be iterative needs to be a constantly continuously evaluated and refined so that you make sure that you've got the best thing always and it needs to be interaction focused so you're focusing on what are the relationships among the tasks and the workers and the patients not just what's sitting there or what you know what the task is but how does this task with this patient this kind of patient with this kind of technology how does it fit together and also it needs as we said before the participatory process needs to be integrative we need to integrate all the stakeholders and all the steps involved in the healthcare process agreed and that includes patients and families for patient safety so yes excellent well thank you so much for joining us today Kathleen we really enjoyed having you and I hope that we're able to have you back another time to talk about human factors and ergonomics because there's a lot to discuss in healthcare about this topic I agree thank you for the invitation it's been my pleasure