Advancing PPE Use. Thoughts from a human factors engineer-physician. Matthew B. Weinger, MD

Transcription

1 Advancing PPE Use Thoughts from a human factors engineer-physician Matthew B. Weinger, MD Center for Research & Innovation in Systems Safety Vanderbilt University Medical Center VA Tennessee Valley Healthcare System

2 Disclosures Medical Director and equity holder in Ivenix, a start-up company developing a next generation infusion pump Human factors and forensic consultant for medical technology companies and hospitals 2

3 What is Human Factors? The formal study of human interactions with tools, devices, and systems to enhance safety, effectiveness, efficiency, and satisfaction Both physical & cognitive components Successfully applied in a wide range of domains (e.g., planes, kitchens, & defibrillators). Essential for understanding and redesigning tools and systems 3

4 Factors Affecting PPE Use Individual Task Environment Technology Team System Well, it s a delicate situation, sir Sophisticated firing system, hair-trigger mechanism, and Bob s wife just left him last night, so you know his mind s not into this 4

5 Contributors to Failure Inadequate knowledge Inadequate training Insufficient access Inadequate feedback (as well as incentives & enforcement) Insufficient organizational commitment Not part of everyday routine Production pressure Competing priorities 5

6 Other factors in N95 use Risk is largely invisible Risk is often imagined rather than real Unclear dose-response relationship How compliant vs. risk to me/patient and credibility Unclear why need annual fit testing My size hasn t changed for 30 years Inconvenient & a bit unpleasant 6

7 System Factors Leadership behavior Other organizational messaging Culture 7

8 Cultural Cynicism Perceived lack of evidence or efficacy Senseless requirements Behavioral inconsistency Shifting priorities...companies MUST LEARN TO EMBRACE CHANGE UH-OH. IT S ANOTHER MANAGE- MENT FAD WILL IT PASS QUICKLY OR WILL IT LINGER LIKE THE STENCH OF A DEAD WOODCHUCK UNDER THE PORCH? I THINK WE SHOULD DO A CHANGE NEWSLETTER WOODCHUCK 8

9 Hierarchy of Risk Mitigation Strategies* BEST Design to eliminate flaws Incorporate affordances and/or constraints in design to shape behavior Redesign, making use errors or potential failure modes more visible Add warnings or just-in-time guidance Costly WORST Provide/recommend more user training Change the labeling (e.g., intended use) Accept the risk and its consequences Cheap 9

10 Shortcomings of Training No real dedicated time Hard to make engaging and effective Must be effective for everyone Some trainees tune out, even become resentful Impact diluted by other training Not effective as the sole intervention! 10

11 In nuclear power, all licensed operators must train one week in every five weeks. Training is: Experiential Practical Has feedback Assessed 11

12 PACU Handover Improvement Project Mandatory webinar with posttest Two-hour inter-professional simulation-based training to repeatedly practice & debrief desired behaviors Electronic handover support tool Observation of actual handovers Practical feedback to individuals & to the study units Refresher training Weinger et al. Anesth Analg 121(4):957,

13 Sustained Behavior Change Sustained Behavior Change Weinger et al. Anesth Analg,

14 Use related design requirements Intuitive to put on & take off correctly Provides feedback if not on correctly Comfortable to wear for long periods Not affect breathing Does not degrade communication Not intimidating to patients & family Readily available (e.g., store in pocket for long periods without degradation) 14

15 Use related design principles Intuitive Effortless Desirable 15

16 User Centered Design Copyright 2013, Matthew B. Weinger, MD, Russ Beebe, and Vanderbilt University, All Rights Reserved. 16

17 Business Case? Can I make money? Innovation opportunities (filters, fit) Meet customer needs; exceed their expectations Able to distinguish self from existing & future competitors Low cost (materials, manufacturability, reusable vs. disposable, storage, etc.) Limited barriers to market entry 17

18 Summary of Path to Success Understand human behavior Understand clinical context & culture Take a multimodal approach Innovative new designs are critical How can we change the game? 18