Human Factors in Healthcare Blog

In my last two postings, I provided some non-traditional advice about how to hire someone for a human factors engineering and design/safety job.  A reminder of the five jobs that contained attributes helpful for an HFE and Medicine specialist:

1. Bartender
2. Bean-packing plant safety manager
3. Lifeguard
4. Set designer
5. Wilderness survival expert

The #3 job, lifeguard, is easy for me to relate to;  I was a lifeguard at a quarry lake for 2.5 summers.  During my time there, two people drowned at this lake – both times I happened to be off.  Nevertheless, we “pulled” many kids and adults out of situations where they were drowning or near drowning (N=30-40 per summer).  It was an old, deep quarry that was very crowded and full of many people who could barely swim – but tried anyway.

What does this have to do with skills and knowledge to be a HFE and device/healthcare expert? 

It all starts with the training.  Nearly 30% of lifeguard training is learning how to use “judo” moves to escape the clutches of a frantic, grab-at-anything drowning person.  This frenzy is not nearly the same as designers and engineers whose prototype is “drowning”, but there are parallels.  We learned some of this at a how-to-be-a-consultant workshop I took at Usability Professional Association (UPA).  The “master” consultant went through several resistance strategies we would encounter from product designers who felt threatened – and how to “wrestle” our way out of their “clutches”.

Secondly, drowning or near-drowning does not look like what you see on TV.  Major human factors engineering design flaws are often not what you think (or just common sense).  There is very little splashing and waving.   Major HFE design flaws are often subtle or hide.  In both cases, you not only need to train yourself about these counterintuitive ways of monitoring the situation, you need to be able to teach others. 

Third, lifeguards very quickly learn that their job is a lot of being tested, being drilled, and regular practice.  Hands-on, lots of feedback, peer input, and building a thick skin.  Its not boot camp or military, but often close.  Applying HFE in the hectic healthcare or device development arena requires you have that thick skin.  You also need to develop it in your design, marketing, engineering, and management colleagues.  HFE is about high contact, hands-on, and lots and lots of testing.  Building thick skin requires repetition, tack yes, but repetition.

Next, we look at  the job of “set designer” (huh?!)

Years ago, the most common question I got was, “where do I go to learn more about human factors engineering?”  The the length and breadth of my answer did evolve as more workshops and books (including our own) came on the scene.  Funny, very few people thought it was funny when I said that they could go back to school and get a masters degree in HFE in just a few short years!  I was only partially kidding, since I knew that some of the design or safety questions they would tackle could easily be major essay questions on graduate level tests – or even research theses.

Many people now ask different questions:  who should I hire?  where can I find them?  [These are harder questions, so I reminisce about the old days of the easier questions above.]  The question arises frequently enough, that we devoted part of a chapter in our recent book to this.

Simply stated, it is only a small problem to find people with masters degrees or PhDs in human factors engineering.  That is not enough.  They need one or more other qualities.  Below, and in the next 4 postings, I will describe and give examples of some of those needed qualities for an HFE and Medicine specialist:

1. Bartender
2. Bean-packing plant safety manager
3. Lifeguard
4. Set designer
5. Wilderness survival expert

Skills of a bartender (or, if you will, ombudsman) are key!  Your HFE will need to be able to listen, and listen, and listen.  Those 40 minutes of seemingly irrelevant stories are the needed lead-in for a patient to reveal the real problem they have with the device or medication delivery system.  The HFE needs to be trusted by the usability test participant clinicians when they see “interesting” usage of devices or medications.  They should have a ready supply of (NON-ALCOHOLIC) drinks and other pleasantries to set the stage for stressful design meetings.  Sometimes, especially during “last call”, they need to summon jaw-dropping honesty about bad things that might happen if the product goes “out” - and be willing to stand up to peer pressure.  Finally, be prepared to help out with lots of jobs, clean up messes, and know how to fix things on “the fly”.

A few weeks ago I was teaching about human factors engineering to a group of hospitalists at the Society for Hospital Medicine meeting.  Many of the hospitalists (physicians focused on delivering care mostly in hospitals) in the audience had a minor or major role in making things safer in thier organization.  Some had no idea about human factors engineering, or had heard it described as the study of factors that make us flawed humans. 

Personally, I like my former co-worker’s definition that focuses on ergonomics.  Since his early days at NASA was around engineers building new crew capsules, he defined human factors engineers as ”the group of people who measure people’s butt cheeks to design the seat so it fits!”

I have tried many methods to introduce HFE to novices, but the two main methods are interactive exercises and demonstrations that put people in position of seeing things that were previously underappreciated.  An exercise I tried for the first time at the SHM meeting was to have two groups of 2 people try to find the location of an AED.  The scenario was that I suffered a heart attack and they had called 911 and were pursuing an AED that they believed was mounted on the wall somewhere in the hotel conference center. [previously, I have written about signage for AEDs].

On each team, one person was assigned to find the AED and think aloud about their plan and other thoughts.  The other person was to record those words and actions – especially where the searcher was looking and resources they sought to find the AED.  The room had exits to different hallways for each team to began searching. 

In short, one person immediately asked hotel personnel, who did not know.  Then they asked conference information desk, who pointed across the middle, large hallway to the easily visible AED sign and wall storage unit.  The other person just had instincts to look centrally in the 400 foot main hallway, and was correct.  Neither used their smart phone, their map included in the conference agenda book, or other tools you might consider if not in a hurry – or, where they in a conference room answering questions in a laid back inteview.  There are a few studies on so-called wayfinding for designing hallway signs, but I have not seen any for searching and finding AEDs?  Do any of you know of some?

Interestingly, when someone did look at the hotel map, it provided locations of three things (besides room numbers-names):

1. Bathrooms
2. ATMs
3. Where you were allowed to smoke

In debriefing the two physicians who were frantically looking for the AED, they did provide one CAUTION to me about doing this exercise again:  make sure the people looking for the AED tell the information desk or other personnel that it is an EXERCISE, and no need to call 911!

Last Saturday I emceed and judged a design competition that was organized by an interprofessional student group called Institute for Healthcare Improvement – Open School (IHI-OS) Michigan Chapter.  Five teams of 4-5 students had watched the hemodialysis device in use, interviewed operators, and read about the pros and cons of having people living with kidney failure use this in their home.  Yes, attach their veins and arteries to a blood-pumping and blood-filtering machine for several hours, 3-4 times per week…

The rules of the competition (criteria for judging) were deceptively simple: clearly identify some design-related problems; suggest and prototype a solution, and make it innovative and user-centered.  Get your medical student, public health student, engineering student, and business student team members to do all that in 105 minutes and you win invaluable prizes (glory, fame, Sears gift card!).

I will leave the details of the event to the student group’s Blog.  For my part the 3 hours on a Saturday afternoon was some of the most fun and engaging in a long time.  Sure, I use design exercises when teaching students or educating engineers about HFE and safety.  But, to actually have the groups do 90% of the work without my help or others — and come up with 5 or 6 breakthrough ideas was really cool. 

Lots of people write about the necessity and wonderfulness of multi-professional teams.  Sounds good…but, it’s often a hassle to create and manage these teams.  Device companies AND hospitals have some mixed teams, but they also have lots of homogenous departments (e.g., biomedical, pharmacy, accounting, etc.).  On this day, and for this application, the mixed mental models seemed to cook up some nice designs.  Concrete ideas to address the solitude, scariness, or tedium of having your arterial system mated with a plastic and metal machine for hours.  Cleverness about giving more mobility and efficiency to the person living with kidney failure, as well as the partner who is sharing the triumphs and set-backs of longer term care situations.

If I suffer a steak-induced illness, I want these teams looking into addressing my cardiac, football-watching, and kid-scolding needs.

- John