Exploring the role of human factors in healthcare: primary care examples

Human factors—often referred to as ergonomics—is an interdisciplinary field of study that focuses on understanding the interactions between humans and the systems, tools, products, environments, and processes they use or interact with. The primary goal of human factors is to design and optimize these elements to maximize human performance, well-being, safety, and overall efficiency. Human factors research is particularly relevant in healthcare, a uniquely complex sector that requires deeply personalized care journeys for patients. A human factors approach has the potential to improve the overall quality, efficiency, and experience of care for clinicians and patients alike.

Human factors design and engineering are particularly relevant in healthcare for a variety of reasons:

• The complexity of the healthcare system: Care pathways are complex and nonlinear, involving numerous stakeholders, intricate workflows, complex data and decision makin together with advanced technologies. Frameworks of human factors in healthcare help define, simplify, and optimize these systems.
• Patient Safety: Ensuring patient safety is paramount in healthcare. Human factors principles can reduce the likelihood of errors, such as medication mix-ups or miscommunications, which can have life-threatening consequences.
• Provider Well-being: Healthcare professionals often face high-stress levels, heavy workloads, and a growing list of tasks related to data input and documentation. Human factors can improve work environments, simplify technology experiences, reduce stressors, and help combat clinician burnout.
• Technological Advancements: The integration of advanced technologies, such as electronic health records (EHRs) and telemedicine, requires careful design to ensure usability and effectiveness.

Even within the broader healthcare sector, primary care is particularly well positioned to benefit from human factors research. Primary care contributes greatly to the overall health and well-being of the population, and within the United States, it is the most highly utilized type of care.

Unlike sub-specialties that may have more typical care pathways based on the type and severity of the condition, primary care contains nearly endless care situations and modalities. As Ötleş et al explain:

Primary care also represents the first stop for most patients seeking care for a general or specific health need, which means that effective and efficient systems for treatment, diagnosis, and referral are key to overall health outcomes. Managing care teams and patient information between the primary care setting (which may include a diverse care team of doctors, nurses, lab technicians, etc.) and other care settings (such as specialist care centers, hospitals, and imaging centers) requires immense care coordination.

In order to appropriately design or implement healthcare systems, deep knowledge of the medical domain, workflows, and care delivery best practices are crucial. As Ötleş et al explain:

Human factors are based on the premise that systems should be designed and built around the needs and behaviors of people, rather than the other way around. However, in healthcare, we often see that clinicians are trained to adapt the practice of medicine to fit new technology, data, and policy requirements rather than these requirements being designed around the reality of clinical workflows and patient care best practices.

Human factors research and frameworks are well suited to address the complex needs of primary care, which involve three distinct but overlapping areas of system design: physical, cognitive, and organizational. “Applied with the input of clinicians, staff, patients, and other stakeholders, [Human Factors] can guide research, policy, technology development, and system implementation to improve the safety and efficiency of primary care delivery for patients and their caregiver teams,” explain Ötleş et al. “The opportunities for improving primary care are immense – but if, and only if, the interventions are designed based on an in-depth understanding of primary care delivery and are tested for effectiveness and unintended consequences.”

Take the following examples:

Human factors methods can be used to understand the cognitive load and thought process required when meeting with a patient. By mapping cognitive requirements, teams can better design technology interfaces such as EHR systems to match and avoid confusion or undue cognitive burden during and after in-person interactions with patients. This may also have impacts on the ways that policies are enacted which require certain documentation and recording of data without a clear understanding of how this will add to the clinician workload.

The introduction of important new technology systems has in many cases led to a feeling that providers are forming less genuine connection with patients during the appointment. Human factors can be used to analyze what data or information must really be manually recorded during the appointment and shift to more open-ended patient interactions. There may also be changes to how technology is used in an appointment setting—for instance ensuring that a clinician does not have to turn away from the patient in order to take notes or finding ways to let clinician and patient review patient information on a screen together.

When designing physical and virtual care delivery spaces, it’s important to create room for discussion and collaboration among providers. Face-to-face dialogue can be more meaningful than asynchronous digital  communication and as such, human factors can be used to understand where collaborative discussion is most important in work processes and how to design spaces (whether physical or digital) for these discussions to take place.

The Systems Engineering Initiative for Patient Safety (SEIPS) model is a powerful framework for applying human factors principles in healthcare. It was developed to address the intricate relationships between healthcare professionals, technology, tasks, and the work environment. The SEIPS model consists of five key components:

1. Individuals: This component focuses on the knowledge, skills, and abilities of healthcare providers and how they interact with their tasks and the environment. It considers factors such as training, cognitive load, and work-related stress.
2. Tasks: Tasks encompass the activities healthcare providers perform, from diagnosis to treatment. The SEIPS model examines task allocation, sequencing, and the cognitive demands placed on providers.
3. Tools and Technology: This component assesses the impact of technology, including EHR systems, medical devices, and communication tools, on healthcare processes and outcomes.
4. Environment: The physical and organizational aspects of the healthcare setting are crucial. It includes factors such as the layout of the facility, lighting, noise levels, and the availability of necessary resources.
5. Organization: The SEIPS model recognizes that the culture, policies, and management practices within healthcare organizations profoundly affect patient safety and care quality.

In the dynamic world of healthcare, the application of human factors design and engineering frameworks, such as the SEIPS model, can be a game-changer in improving primary care. By focusing on user-centered design, workflow optimization, error reduction, and provider well-being, healthcare organizations can enhance patient safety, streamline operations, and ultimately deliver higher-quality care. As technology continues to reshape the healthcare landscape, the role of human factors in shaping the future of primary care cannot be underestimated.