Improving guideline compliance and healthcare safety using human factors engineering: The case of Ebola
Year: 2018
Type: article
Abstract: Consistent compliance with evidence-based guidelines is critical for safe care.Yet, many patients in the United States (US) do not receive the recommended therapies.For example, healthcare-acquired infections can be largely prevented through consistent guideline compliance, but 1 of every 25 patients in US hospitals still develop these infections. 1 Guideline compliance is also important for healthcare worker (HCW) safety.According to the Bureau of Labor Statistics, HCWs have one of the highest rates of work-related illnesses and injuries among all private industry sector workers, with 552,600 cases reported in 2016 alone.2 Increased compliance with recommended safety guidelines could prevent many workrelated illnesses and injuries.The methods and skills to develop guidelines, such as evidence reviews and clinical wisdom, differ from the methods and skills to ensure that the guidelines are properly used and translated into practice, such as Human Factors Engineering (HFE).HFE is a science that draws from broad theories and methodologies and employs a systems perspective to improve human performance.It focuses on improving both individual well-being and the overall system performance.To accomplish this, HFE experts work with clinicians to investigate the characteristics of an innovation or task using multiple methods (e.g.observations, focus groups, simulations, task analysis).Experts then develop training and instructional materials, and recommend how to redesign the work system to support the clinicians' work.3 The 2014 Ebola outbreak highlights the importance of guideline compliance for patient and HCW safety.This epidemic devastated large regions of West Africa, killing more than 11,000 people, a disproportionate number were HCWs.The two Texas HCWs who became infected with the virus while caring for an Ebola patient raised concerns about safety and preparedness in the US.Compliance with recommended use of personal protective equipment (PPE) greatly reduces infection risk for HCWs.Consistent compliance has proven devilishly difficult, with compliance rates estimated to be under 50%.4,5 The most common approach to improve HCW compliance has been to review published guidelines, discuss potential consequences of non-compliance, and provide post reminders to be vigilant and careful.This well-intended approach is minimally effective, failing to consider the complexities of human behavior and to draw upon proven HFE principles.In response to the Ebola outbreak, the Centers for Disease Control and Prevention (CDC) issued guidelines for properly donning and doffing PPE to prevent Ebola virus infections among HCWs.6 Complying with these guidelines is complex and consequential.One slip or lapse can lead to infection, as HCWs discovered in Texas.Warning clinicians to be careful and strictly follow guidelines is, by itself, not a reliable approach.To provide more effective guidance, the CDC asked the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality to develop a web-based training program that complemented and clarified the newly published PPE guidelines.To develop the training modules, we formed a transdisciplinary team of 40 individuals with expertise in infection prevention, medicine, nursing, instructional design, videography, and HFE.The particularly innovative aspect of this training development effort was the systematic use of HFE principles and methods to help translate the PPE use guidelines into practice, given the realities and constraints of how care could be delivered for suspected
Institutions: Johns Hopkins University, Johns Hopkins Medicine
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2791627019