Problem solving in healthcare can be innovative. It can also be about just adding more paperwork.
Mia McLanders on how collaborative, systems-level interventions can support resilience and adaptability in everyday practice, in this highlight from the 2022 PAC Conference.
Speaker biography:
Mia is the Human Factors Research Lead at the Clinical Skills Development Centre, Queensland Health. She holds appointments with the Safety Science Innovation Lab at Griffith University and the Cognitive Engineering Research Group at The University of Queensland. Her work spans a range of clinical areas, focusing on decision support and system redesign. Mia received the Ian Jacobs Fellowship Award by the Australian Resuscitation Council, and a Resilience Engineering Association's Young Talent award, for her work with neonatal resuscitation teams. She won the Human Factors and Ergonomics Society's Alphonse Chapanis award for her work on patient monitoring displays.
Insights:
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- Human Factors and Non-Technical Skills:
Human factors encompass more than just non-technical skills; they include a broader systems view that can enhance quality improvement initiatives.
Effective problem-solving in healthcare should involve systematic, system-level changes rather than just adding more policies, procedures, and paperwork to address issues.
- Avoiding Additive Problem Solving:
The presenter uses a humorous example involving a dehumidifier and plants to illustrate how additive solutions can become overly complex and ineffective.
In healthcare, similar patterns occur where solutions are continually added to avoid adverse events without addressing the underlying system-level issues.
- Focus on System-Level Change:
Adverse events and unwanted outcomes often lead to reactive interventions like additional training or policy changes, which are among the weakest recommendations for reducing risk.
There is a need to move from person-centered solutions to system-level changes to create more effective and resilient healthcare systems.
- Work Variability and Adaptation:
A graph representing the variability of work highlights that most work happens within normal ranges, but healthcare interventions often focus on the extremes, especially adverse events.
Effective systems should support clinicians to adapt and be resilient to everyday practice variability.
- Practical Examples of Human Factors Applications:
Training for Shoulder Dystocia: Utilising 3D animations significantly decreased the mental workload of trainees and improved their performance compared to traditional 2D images and text.
Decision Support Tool for Genetic Testing: A tool designed to help nephrologists order the correct genetic tests improved clinical outcomes by providing clear, perceptually grouped instructions and consistent layout.
Teamwork in Neonatal Resuscitation: An intervention bundle, including a rotating procedural shelf and an equipment turntable, improved teamwork by addressing physical workflow, equipment layout, and team coordination.
- Emphasis on Resilience and System Support:
Systems and processes should be designed to support clinicians in dealing with the full range of variability in clinical practice.
Examples from different clinical areas show how practical, system-level changes can significantly enhance performance, reduce mental workload, and improve patient outcomes.
- Interdisciplinary and Iterative Approach:
Successful interventions often involve co-design with the end users (clinicians) and multiple iterations based on testing and feedback.
Collaboration with subject matter experts and the use of decision support tools tailored to specific clinical needs are crucial for effective implementation.
These takeaways underscore the importance of human factors in healthcare and the need for systematic approaches to improve clinical practice and patient safety.
From the 2022 APLS Paediatric Acute Care Conference in Melbourne.