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400777 Leadership for Quality And Safety in Health Care: Human Factors

Aim:

Aim of assessment This assessment item provides students with the opportunity to demonstrate their understanding of the relationship that exists between human factors, workplace performance and quality and safety in healthcare. Discussion and critique must be informed by evidence from the literature.

Assessment Task:

This assessment task requires students to respond to the following assessment 2 critical appraisal essay task:

Informed by evidence from the literature,

1. identify human factors that impact on work performance and then

2.critically analyse the relationship between these and quality and safety in healthcare provision

Answer:

Introduction

According to a description disseminated by the World Health Organization, human factors is an umbrella term and refers to organizational, environmental, and job factors, as well as individual and human characteristics that exert an influence on performance and conduct at the workplace, in a manner that impacts safety and health of the employees (Holden et al., 2013). Processes leading to abnormal complications was the most common adverse event (52%), followed by adverse impacts of medicaments, drugs and biological substances (37%). Furthermore, there were 547,000 hospitalisation reports in 2013-2014 that accounted for an estimated 6.7 events per 100 hospitalisations in public healthcare agencies (AIHW, 2016). Urging the healthcare professionals to be more careful or try harder does not prevent errors. Similarly, efforts for enhancing patient care through education has fleeting and minor improvements (Henriksen, Dayton, Keyes & Carayon, 2008). Therefore, the aim of this assignment is to explore the association between workplace performance, human factors, and quality and safety in healthcare contexts. The essay will recognise the human factors that create an impact on work performance. This section will be succeeded by a critical examination of the relationship between the aforementioned factors and quality and safety.

Human factors in healthcare

Care coordination staff, patients and the informal caregivers play a significant character in the delivery of healthcare services. According to Heiden, Holden, Alder, Bodke and Boustani (2017) emotional demands of the patients, poor job satisfaction of the healthcare professionals, delay in delivery of care, distraction from caring for the patients, duplicate work, and poor working conditions were the most prevalent human factors that existed in the healthcare setting. Moreover, it was also elucidated by the researchers that development of rapport and therapeutic association between the caregivers and patients was one of the most significant facilitators of work performance. Overloading of patients due to shortage of healthcare staff is a major human factor that creates an influence on workplace performance. It has also been postulated by Rusnock, Maxheimer, Oyama and Valencia (2017) that poor competence in handling issues related to patient load is a significant problem in medical centres and there are concerns related to the quality of care provided to the patients. Moreover, workload metrics such as, high average workload, idle time and overload time worsen with an increase in patient load. The maximum negative impacts are experienced by the nurses and healthcare technicians with an increase in the number of patient admission.

There is extensive evidence for the fact that employee organizational commitment (EOC) creates an influence on organisational and individual performance. Baird, Tung and Yu (2019) found that lack of adequate facilities and poor commitment of the healthcare professionals towards the vision and goals of the organisation negatively affects the association between operational effectiveness and patient care. On the other hand, Cogin, Ng and Lee (2016) stated that behavioural control acts as a significant human factor that governs the performance of allied health workers, nurses and junior doctors. More emphasis on transactional human resource doings and poor level of investment in the staff results in negative and poor job attitude. These eventually result in frustration and low morale amid the healthcare professionals that prevents them from delivering care in a manner that is in accordance to the standards and norms of the hospital. Hence, inappropriate behavioural control often confines the aptitude of the healthcare managers to encourage and motivate their staff.

An engaged staff demonstrate more passionate and sincere bond with the workplace, are willing and energetic and exhibit excellent performance. These employees do not run away from their responsibilities and take all possible efforts for specialising in their domain. The impact of employee engagement on work performance was elaborated by Kartal (2018) who stated that poor level of engagement of healthcare professionals with their work resulted in substantial alienation and created a negative impact on their performance. Moreover, it was found that healthcare professionals who display vigour are better able to enhance their performance. In contrast, manifestation of meaninglessness and powerlessness often decreased their competencies and performance. Hence, the findings support that the amount of commitment of the healthcare professionals creates a significant and positive influence on the performance of staffs. Consequently, with the aim of enhancing the work performance of the employees, it is essential to upsurge the level of desirability of the job.

It has often been postulated that the human factor of team dynamics governs the work role performance of healthcare professionals who are employed in the mental health units. Fleury, Grenier, Bamvita, Markon and Chiocchio (2018) supported the statement by stating that younger age of the healthcare professionals demonstrates a significant positive association with work role performance. Moreover, presence of familiarity between the co-workers generally helps in knowledge sharing, interprofessional collaboration, and fosters team support. Hence, lack of association between team members and absence of managers who can optimise the emergent states of a team prevents the professionals from delivering care in a manner that enhances the health outcomes of the patients.

The focus of healthcare organisations is not merely restricted to implementation of effective techniques or equipment, but relies on employee empowerment. Kuria, Namusonge and Iravo (2016) highlighted the fact that presence of poor leadership skills is a major factor that results in lack of obligation of the healthcare workers. This directly leads to loss of patient lives in the hospitals, besides deteriorating the health outcomes for many. While transformational leadership inspires the healthcare professionals to accomplish the intended visions of the organisation and also fosters employee participation, transactional leadership is common in organisation. This type of leadership restricts the healthcare manager to manifest reward-based behaviour, which does not create any positive impact in the long run. Moreover, healthcare managers who have laissez-faire characteristic do not always get involved in the operations of the organisation, thereby leading to poor job satisfaction amid the employees. Therefore, it is evident from the literature discussed above that human factors exert an ineffaceable consequence on healthcare performance. According to WEAHSN (2010) executive and non-executive healthcare managers and executives play a crucial headship character in patient security and in endorsing familiarity of different human factors from the meeting room to the bedside. Thus, in order to enhance patient health and safety, a positive safety culture must be developed. The staff must be comfortable in discussing about patient safety events and must be treated fairly. Moreover, the organisation must also be committed for learning safety lessons and learning from the previous incidents of adverse events. Hence, lack of necessary leadership skills is an additional human factor that deteriorates the healthcare performance.

Link between human factors, work performance, and patient safety and quality- Understanding and awareness about human factors is not merely restricted to gaining familiarity of the employees, and refers to the fascinating discipline of interrelated components and behaviour that facilitate measurable enhancements through procedural and cultural change. According to Cafazzo and St-Cyr (2012) lean methods and checklists have been recognised as Human Factors Engineering (HFE) in the domain of healthcare. They stated that healthcare systems are constructs of human intervention, thus any error occurring during their use is accredited to the design of the healthcare system. Few of the major human factors that are related with errors in the delivery of healthcare service are namely, cognition, fatigue, training, visual and audible noise, consistency, workflow competence, and interruptions during work. It has often been found that poor lighting often results in misreading and misinterpretation of medical orders by nurses. Presence of personal conflict typically inhibits critical communication between healthcare professionals. Another significant human factor is poor ergonomics such as, poorly installed sink that often leads to inadequate adherence of the nurses to hand hygiene. Sirriyeh, Lawton, Gardner and Armitage (2010) also cited that psychological repercussions of medical error on healthcare professionals include self-doubt, shame, guilt and anxiety. Hence, delivery of care that leads to medical error elicits substantial psychological response on the involved professional.

News excerpts of damaging radiation therapy, healthcare-acquired infections, catheter and tubing misconnections, and imprecise results from diagnostic examinations are usually reported by mass media. Gurses, Ozok and Pronovost (2012) stated that physical workload, inadequate training programs, poor job design, and mental workload affects the healthcare professionals and prevents them from following the standards of care delivery, thus threatening patient health and safety. It was suggested that patient rooms must be designed to decrease fall incidents, and the placement and number of sinks must be assessed to increase hand-hygiene compliance. Some other strategies that could enhance patient safety and quality were developing decision support tools, enhanced discharged planning, using health information technology, and ensuring adequate lighting. Thus, poor cognitive, physical, and macro ergonomics affects patient safety.

Humans are imperfect and demonstrate a characteristic propensity for making errors, consequently take all possible efforts for preventing inaccuracies and adverse incidents. Gluyas and Hookham (2016) discussed the impact of human factor on patient health and safety by elucidating an incident that involved the demise of a child at a hospital, owing to human factors. Incorrect placement of bed bumpers and failure to complete the nursing care plan appropriately were some of the factors involved. Moreover, large number of patient admissions, busy ward and evening shift prevented the healthcare professionals to care in an appropriate manner for the child, eventually leading to death. Therefore, it was the amalgamation of underlying letdowns that generated the error-aggravating circumstances and eventually occasioned a non-existence of satisfactory patient intensive care. In addition, the team nursing method wanted both the nurses to involve in consistent and effective communication to comprehend their roles and responsibilities. The design and usefulness of health equipment is significant for reducing the probability of an error. Moreover, staff must also have the non-technical skill of situation awareness in order to comprehend the events occurring. Another major human factor was lack of care plan completion. All of these aforementioned factors increased error potential of the incident and directly threatened the health and security of the patient.

Human factors are occasionally confused with the concept of patient protection owing to the fact that it is infrequently commenced to discover aesthetic subjects, process or workstation design. According to Fryer (2013) active problems are commonly encountered by nurses, working at the frontline, however latent issues that lead to errors typically arise during the care planning phases. Human factors frequently manifest in the form of a sequence of events, conditions, and occurrences where violation of healthcare conduct and active error is the end product. Vicissitudes in one factor typically results in incidental variations in other procedures within the care delivery system, subsequently reducing the effectiveness of the healthcare professionals. Effective recommendations that have been found to reduce the threat to patient health and safety are changes in physical design of the workplace, usability assessment prior to the purchase of medical equipment, elimination of unnecessary steps, and tangible participation of the leaders for supporting patient safety. On the other hand, Carayon et al. (2014) also stated that with the aim of increasing patient safety and enhancing excellence of healthcare delivered, it is necessary for the healthcare professionals to redesign the existing system with the use of the SEIPS model. Some of the major attributes of the SEIPS model that create a positive impact on patient safety and health are namely, (i) explanation of the workplace system and its interrelating essentials, (ii) combination of the excellence of patient care prototype (1978), (iii) documentation of care procedures being predisposed to the work system, (iv) incorporation of patient health outcomes and employee performance, and (v) response loops between outcomes and processes.

The same was affirmed by Patel and Kannampallil (2014) who specified that the early accomplishment of health information technology implementation and usage has been moderated by the snowballing figure of news on its unintentional outcomes, probable for faults and obstructing operative performance. While the quality improvement projects generally rely on a particular department for improving handoff or decreasing infection, application of human factors engineering can help in understanding the needs of the stakeholders and work practices, thus recognising the underlying sources of cognitive load and error. It is imperative for healthcare organisations to identify the prominence of human factor-associated healthcare system restructure to patient safety and quality of care and, and capitalise funds and assets to incorporate it in health development activities (Xie & Carayon, 2015).

Conclusion

To conclude, human factors encompass a plethora of elements namely, task, workload, workplace design, leadership and resources, policies, programs, competency and skill of the workers, employee attitude, risk tolerance, and personality. Notwithstanding the qualification and the desire to deliver excellent services to patients, healthcare professionals often encounter challenges in the form of below par designed equipment, fragmented system, and uncoordinated care process. Often the systems are constructed in a manner that fails to account for how the individuals interact in the workplace setting. Adverse health events increase the length of hospitalisation and also lead to poor health outcomes and also increase the treatment costs. Hence, redesigning of human factor founded healthcare system has the probability of improving excellence of care and patient protection.

References

Australian Institute of Health and Welfare 2016. (2016). Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW. Retrieved from https://www.aihw.gov.au/getmedia/3876a585-9a48-4553-8939-59711f1aa573/ah16-6-14-safety-quality-australian-hospitals.pdf.aspx 

Baird, K. M., Tung, A., & Yu, Y. (2019). Employee organizational commitment and hospital performance. Health care management review, 44(3), 206-215. doi: 10.1097/HMR.0000000000000181

Cafazzo, J.A., & St-Cyr, O. (2012). From discovery to design: The evolution of human factors in health care. Healthcare Quarterly, 15 (Special Issue), 24-29. doi:10.12927/hcq.2012.22845.

Carayon, P., Tosha, B. Wetterneck, A., Rivera-Rodriguez J., Schoofs Hundt, A., Hoonakkera, P., Holden, R.,  & Gurses, A. P. (2014). Human factors systems approach to healthcare quality and patient safety. Applied Ergonomics, 45(1), 14–25, doi:10.1016/j.apergo.2013.04.023.         

Cogin, J. A., Ng, J. L., & Lee, I. (2016). Controlling healthcare professionals: how human resource management influences job attitudes and operational efficiency. Human resources for health, 14(1), 55. doi:10.1186/s12960-016-0149-0

Fleury, M. J., Grenier, G., Bamvita, J. M., Markon, M. P., & Chiocchio, F. (2018). Variables associated with perceived work role performance among mental healthcare professionals: The importance of team dynamics. European Journal for Person Centered Healthcare, 6(3), 413-423. https://douglas.research.mcgill.ca/variables-associated-perceived-work-role-performance-among-mental-healthcare-professionals

Fryer, L. A. (2013). Human factors in nursing: The time is now. Australian Journal of Advanced Nursing (Online), 30(2), 56-65. Retrieved from https://search.informit.com.au/documentSummary;dn=088490536520068;res=IELHEA.

Gluyas, H., & Hookham, E. M. (2016). Human factors and the death of a child in hospital: A case review. Nursing Standard 30(31), 46-51. https://search.proquest.com/openview/b921f16952dd937bec7f8d2fa0e4d617/1?pq-origsite=gscholar&cbl=2042228

Gurses, A. P., Ozok, A. A., & Pronovost, P. J. (2012). Time to accelerate integration of human factors and ergonomics in patient safety. BMJ Quality & Safety, 21(4), 347.  PMID: 22129929 DOI: 10.1136/bmjqs-2011-000421 

Heiden, S. M., Holden, R. J., Alder, C. A., Bodke, K., & Boustani, M. (2017). Human factors in mental healthcare: A work system analysis of a community-based program for older adults with depression and dementia. Applied ergonomics, 64, 27-40. https://doi.org/10.1016/j.apergo.2017.05.002 

Henriksen, K., Dayton, E., Keyes, M. A., & Carayon, P. (2008). Chapter 5. Understanding Adverse Events: A Human Factors Framework Human Factors—What Is It. Saf. Qual. An Evidence-Based Handb. Nurses. Rockville: Agency for Healthcare Research and Quality–US Department of Health and Human Services, 67-86. https://www.ncbi.nlm.nih.gov/books/NBK2666/

Holden, R. J., Carayon, P., Gurses, A. P., Hoonakker, P., Schoofs Hundt, A., Ozok, A. A., & Rivera-Rodriguez, A. J. (2013). SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics, 56(11), 1669-1686, DOI: 10.1080/00140139.2013.838643

Kartal, N. (2018). Evaluating the relationship between work engagement, work alienation and work performance of healthcare professionals. International Journal of Healthcare Management, 11(3), 251-259. https://doi.org/10.1080/20479700.2018.1453969

Kuria, L. K., Namusonge, G. S., & Iravo, M. (2016). Effect of Leadership on Organizational Performance in the Health Sector in Kenya. International Journal of Scientific and Research Publications, 6(7), 658-663. https://s3.amazonaws.com/academia.edu.documents/49540665/ijsrp-p55961.pdf?response-content-disposition=inline%3B%20filename%3DEffect_of_Leadership_on_Organizational_P.pdf&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAIWOWYYGZ2Y53UL3A%2F20191107%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20191107T064129Z&X-Amz-Expires=3600&X-Amz-SignedHeaders=host&X-Amz-Signature=5760c1c1868b38f90698ebe9326bdaceaa7724281596acf76eb4037e2b44e04d

Patel, V. L., & Kannampallil, T. G. (2014). Human Factors and Health Information Technology: Current Challenges and Future Directions. Yearbook of Medical Informatics, 15(9), 58-66. doi: 10.15265/IY-2014-0005.

Rusnock, C. F., Maxheimer, E. W., Oyama, K. F., & Valencia, V. V. (2017). Simulation-Based Evaluation of the Effects of Patient Load on Mental Workload of Healthcare Staff. Simulation in Healthcare, 12(4), 260-267. doi: 10.1097/SIH.0000000000000248

Sirriyeh, R., Lawton, R., Gardner, P., & Armitage, G. (2010). Coping with medical error: A systematic review of papers to assess the effects of involvement in medical errors on healthcare professionals' psychological well-being. Quality and Safety in Health Care, 19(6), e43. doi:10.1136/qshc.2009.035253              

West of England Academic Health Science Network. (2010). Implementing HUMAN FACTORS in healthcare. Retrieved from https://www.weahsn.net/wp-content/uploads/Human-Factors-How-to-Guide-v1.2.pdf

Xie, A., & Carayon, P. (2015). A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety. Ergonomics, 58(1), 33-49, doi: 10.1080/00140139.2014.959070.

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