Background The daily tasks of hospital personnel are regularly interrupted. Unexpected breaks in work patterns act as supplementary cognitive burdens on health workers (hence the term stressors) and can lead to errors because they break up the logical flow of clinical tasks.
Purpose To examine whether the introduction of Health Information Technology (HIT) (CytoAdmin – a scanning system for matching patients to their chemotherapy treatment protocols) to a cancer outpatient unit had any immediate effect on stressors, with the broader aim of then reducing their types and frequency.
Materials and Methods Based on techniques drawn from the field of Human Factors and Ergonomics (HF&E) , we established a protocol for carrying out ergonomic evaluation and measuring stressors. The System Engineering Initiative for Patient Safety model was our guiding principle . The protocol covered all tasks in the unit and included field observations, listing stressors (number, type) observed during the introduction of the HIT, and suggesting process redesign methodologies.
Results During the first 6 days of CytoAdmin’s introduction, we carried out 31½ hours of observation of stressors and identified 89 different types (2.7 stressors/hour). The HIT itself generated 21 new stressors (24% of the total). Amongst these were the insufficient number of computers needed to complete tasks, technical hardware problems and the inclusion of scanning in a well-established daily care routine. Ergonomic redesign of workflows allowed us to neutralise all new stressors. Other major stressors were telephone calls (13 types of stressors, 15%), followed by consulting a physician (9 types, 10%).
Conclusions The introduction of this HIT increased the number of stressors by creating new ones. The HF&E system developed was efficient at detecting new stressors, redesigning the process and eliminating them. Although these methodologies are time-consuming, ergonomic evaluations are essential for the satisfactory and safe use of newly-introduced HIT.
Carayon P. (Editor) Handbook of Human Factors and Ergonomics in Health Care and Patient Safety, 2nd edition, Lawrence Erlbaum Associates, Hillsdale, NJ, 2012.
Carayon P, et al, Work system design for patient safety: The SEIPS model. Qual Saf Health Care 2006;15(1):50–58
No conflict of interest.