EFFECTIVENESS OF APPLYING HUMAN FACTORS AND ERGONOMICS MODEL DURING CRISIS SITUATION IN AN ICU SETTING

ABSTRACT

TOPIC Disaster Medicine TYPE Original Investigations PURPOSE: Healthcare crisis presents an opportunity to harvest extensive learning around optimizing the real-time support for physical, cognitive, and organizational work of healthcare staff in a rapidly transforming work setting. We aim to inform the 'service reset' program of healthcare services at Northern Health and Social Care Trust (NHSCT) in Northern Ireland during the Covid-19 crisis. METHODS: We retrospectively applied the systems engineering initiative for patient safety (SEIPS) model in-situ at the Intensive Care Unit (ICU) of the Antrim Area Hospital-NHSCT. A quality improvement and human factors professional during June 2020 shadowed and interviewed the ICU staff one-to-one, gathering qualitative data using the SEIPS model. The findings were analyzed using the human factors and ergonomics (HFE) approach to identify successful interventions during the Covid-19 healthcare crisis. RESULTS: HFE adaptations enabled the ICU to consistently run at 200% of its funded capacity during the healthcare crisis due to the Covid-19 surge. We found that HFE analysis learnings for efficient and safe day-to-day healthcare operations during the crisis were focused on five major domain elements of the SEIPS model work system, 1) person via upskilling through a buddy system by matching redeployed staff with experienced staff, medical simulations, and just-in-time training;staff motivation when seeing Covid-19 patients recover and discharged;providing access to psychological services for staff well-being;2) organization via teamwork with a compassionate leadership approach and virtual communication platforms;management supervisory style of shared leadership in and across clinical teams promoting the non-silo working;organizational quality improvement culture facilitating staff empowerment in collective decision making;3) tools and technologies by providing access to technology through increased electronic health record workstations and virtual ICU visits to ease patient care;standardizing medical devices to enhance staff familiarity;4) tasks by reducing cognitive workload via staff role-specific action cards, and stickers for staff identification;creating new teams;enhanced job autonomy through Covid-19 specific medication preparation areas;5) environment by focusing on healthcare work environment layout and human-centered workstation design to support 'work as done' instead of 'work as imagined.' CONCLUSIONS: Application of the HFE based design to support the frontline staff performance during a large-scale healthcare crisis yields an effective and efficient crisis response. CLINICAL IMPLICATIONS It is of great utility to consider human cognition and behavior as healthcare organizations redesign the services and operations during a crisis. Leaderships at high-stakes organizations should consider approaches to encourage and empower frontline staff for rapidly adaptive change during a healthcare crisis. DISCLOSURES No relevant relationships by Muhammad Hasan Abid, source=Web Response No relevant relationships by Muhammad Mohsin Abid, source=Web Response No relevant relationships by Iqbal Ratnani, source=Web Response No relevant relationships by Gill Smith, source=Web Response