Presentation
Embedding Human Factors in Healthcare: Lessons Learned in a Surgical Sterile Processing Department
DescriptionSterile Processing Department (SPDs) must clean, maintain, store, and organize surgical instruments which are delivered to Operating Rooms (ORs). Ensuring thousands of tools and devices needed for surgeries each day reach the right OR at the right time involves regular coordination across the SPD, OR, and Courier Network. Our five-year AHRQ-funded study builds in a series of systems analyses, observations, and interviews which examined the SPD work system and its interdependent relationship with the OR and Courier Network. We used the Systems Engineering Initiative for Patient Safety (SEIPS) 101 tools to map the journey of a tray through its cycle of use and reprocessing, described the people and tasks involved in that journey, and examined the organizational factors which affect it. We used the Systemic Contributors and Adaptations Diagramming (SCAD) technique as an operational health management tool to better understand how people adapted under often conflicting pressures, giving us insights into how they navigated tradeoffs, especially as the system was stretched to its limits. We utilized Abstraction Networks (joint application development tools) to visualize workflows, establish system architectures, and structure our knowledge elicitation to better understand how people searched for information and determined the state of the SPD work system. We developed a coordination-costs matrix to investigate how organizational coordination affects adaptive capacity and continued system function. Finally, we conducted modified IMPActS workshops as an operational health management approach to quickly bring multiple roles with diverse perspectives together to reveal potential shortcomings or unintended consequences for proposed interventions. Utilizing all these tools allowed us to explore the system through multiple lenses, affording discoveries and insights that would have otherwise stayed hidden. This allowed us to explore relationships between the SPD, OR, and Courier Network which function together to support surgical care, develop ideas for systemic improvements, and begin applying systems engineering principles to initiate organizational workplace interventions. Here, we report our efforts to deploy and evaluate multiple interventions in a simultaneous micro-macro approach to benefit the quality, safety and efficiency of patient care.
The instrument reprocessing work system is highly complex and dependent on a multitude of interactions between factors such as scheduling, staffing, quality assurance, and the delivery of care as it is coordinated between the SPD, OR, Courier Network and other departments. Tasks being performed in different departments may affect one another throughout tray preparation, usage, and delivery processes, even though the departments involved are traditionally thought of as separate. Multiple professional teams are involved in the journey of a surgical tray between the SPD, OR, and Courier Network, and each is essential to its maintenance and preparation for incoming patients. Deeper investigation of each department revealed additional complexity, illustrating that even relatively simple tasks can have far-reaching systemic effects. As we developed our understanding of the instrument reprocessing system and its organizational structure, we noted substantial decision making and implementation challenges faced by leadership when deploying quality improvement initiatives. Additionally, we identified a key need for more effective ways to implement workplace interventions and maintain sustainable change through improved understanding of the sterile processing organizational system. To address these challenges, we initiated a series of co-designed interventions aimed at improving organizational standardization, enhancing shared awareness, reducing cognitive workload, and addressing departmental goals.
Observations, interviews, workplace surveys and participation in team and leadership meetings were used to identify ideas for improvement across the departments, resulting in approximately 60 possible interventions which were organized into major themes (instrument and tray management, system of work, organization) and minor themes (inventory, tray tracking and storage, work environment, tools and technology, workflow, coordination and shared awareness, staffing, and ongoing quality improvement). Approaching idea prioritization and implementation involved overcoming several challenges including frequent changes in leadership, departmental time and budgetary constraints, limited understanding of systems engineering concepts among healthcare professionals, and organizational inertia. These obstacles have been progressively addressed through engagement activities with frontline staff, participation in leadership and quality improvement meetings, development of personal relationships with leaders and key team members, situational monitoring, and active participation in ongoing improvement efforts.
Engagement activities involved a series of in-person ad-hoc meetings in SPD workspaces to facilitate participation and a departmental survey to explore wider ideas and opinions about improvement themes, culminating in an ongoing intervention co-design workshop which was designed to help address implementation aspects such as resource and budgetary constraints. Participation in weekly SPD leadership meetings helped develop relationships and engage influential frontline staff, offering opportunities to present and explain systems concepts so that changes in leadership or team composition could have a reduced impact on organizational knowledge. Attending monthly Quality Improvement meetings helped our team participate in discussions about departmental successes and challenges, provided insights into the availability and limitations of performance data, and offered context for if, when, and how those data inform decision making. Through a specific request from SPD leadership which facilitated departmental engagement, a shift handoff checklist intervention was developed and refined through iterative staff feedback prior to its deployment across multiple SPD units with spread, reconfiguration for different units, and use monitoring, which is ongoing. This work has also created opportunities for the development of improved data displays (coordination and shared system awareness), computer simulation modeling of tray movements (systems modeling and departmental budgeting), enhanced approaches to team decision making, operational briefings (system functional health and awareness), workspace configurations, and a generalized approach to continuous improvement. Thus, ongoing interventions are being explored in multiple modalities at both the micro-level (shift handoff checklists, workspace improvements) and the macro-level (team co-design workshops, data displays, computer simulation modeling, operational briefings).
In contrast with traditional views about individual-based solutions to workplace challenges in hospital environments, we suggest that optimizing daily operations and planning for future challenges in instrument reprocessing requires a complete understanding of the systemic complexity and interdependence involved in surgical care. We also note that the use of systems engineering approaches can help provide multiple ways to address organizational challenges, and that co-design opportunities may benefit the implementation of quality initiatives. Therefore, proposed workplace solutions focused on individual workers, teams or departments may still fail to address larger systemic issues. This, in turn, has also provided the opportunity to move beyond find-and-fix approaches towards the application of Cognitive Systems and Resilience Engineering through our partners at Ohio State and Clemson University, and to contribute to theoretical developments in those fields by examining how organizational coordination underpins adaptive capacities, departmental resilience, and continued system function.
The lessons learned from our work have direct implications for healthcare leaders, human factors professionals, and clinical teams seeking to improve the safety, efficiency, and quality of care. First, we recommend designing quality initiatives which are scoped to support departmental and organizational goals. Second, initiatives should be adapted to efforts and systems already in place in the organization to enhance their likelihood of success. Finally, developing positive relationships with departmental leaders and team members can help human factors professionals gain support, advocate for funding, and facilitate co-design and collaboration.
By utilizing systems engineering frameworks to describe and understand surgical instrument reprocessing, develop and deploy co-designed interventions, and evaluate their potential effectiveness, we have continued assisting healthcare teams and decision-makers to improve the efficiency of healthcare delivery and ultimately benefit patient care. Insights offered through lessons learned from a simultaneous multi-level approach to organizational improvement may substantially enhance understanding of complex organizational problems throughout the hospital system which facilitates management, decision making, development of workplace interventions and ultimately leads to direct benefits for healthcare institutions and improvement in the quality of patient care.
The instrument reprocessing work system is highly complex and dependent on a multitude of interactions between factors such as scheduling, staffing, quality assurance, and the delivery of care as it is coordinated between the SPD, OR, Courier Network and other departments. Tasks being performed in different departments may affect one another throughout tray preparation, usage, and delivery processes, even though the departments involved are traditionally thought of as separate. Multiple professional teams are involved in the journey of a surgical tray between the SPD, OR, and Courier Network, and each is essential to its maintenance and preparation for incoming patients. Deeper investigation of each department revealed additional complexity, illustrating that even relatively simple tasks can have far-reaching systemic effects. As we developed our understanding of the instrument reprocessing system and its organizational structure, we noted substantial decision making and implementation challenges faced by leadership when deploying quality improvement initiatives. Additionally, we identified a key need for more effective ways to implement workplace interventions and maintain sustainable change through improved understanding of the sterile processing organizational system. To address these challenges, we initiated a series of co-designed interventions aimed at improving organizational standardization, enhancing shared awareness, reducing cognitive workload, and addressing departmental goals.
Observations, interviews, workplace surveys and participation in team and leadership meetings were used to identify ideas for improvement across the departments, resulting in approximately 60 possible interventions which were organized into major themes (instrument and tray management, system of work, organization) and minor themes (inventory, tray tracking and storage, work environment, tools and technology, workflow, coordination and shared awareness, staffing, and ongoing quality improvement). Approaching idea prioritization and implementation involved overcoming several challenges including frequent changes in leadership, departmental time and budgetary constraints, limited understanding of systems engineering concepts among healthcare professionals, and organizational inertia. These obstacles have been progressively addressed through engagement activities with frontline staff, participation in leadership and quality improvement meetings, development of personal relationships with leaders and key team members, situational monitoring, and active participation in ongoing improvement efforts.
Engagement activities involved a series of in-person ad-hoc meetings in SPD workspaces to facilitate participation and a departmental survey to explore wider ideas and opinions about improvement themes, culminating in an ongoing intervention co-design workshop which was designed to help address implementation aspects such as resource and budgetary constraints. Participation in weekly SPD leadership meetings helped develop relationships and engage influential frontline staff, offering opportunities to present and explain systems concepts so that changes in leadership or team composition could have a reduced impact on organizational knowledge. Attending monthly Quality Improvement meetings helped our team participate in discussions about departmental successes and challenges, provided insights into the availability and limitations of performance data, and offered context for if, when, and how those data inform decision making. Through a specific request from SPD leadership which facilitated departmental engagement, a shift handoff checklist intervention was developed and refined through iterative staff feedback prior to its deployment across multiple SPD units with spread, reconfiguration for different units, and use monitoring, which is ongoing. This work has also created opportunities for the development of improved data displays (coordination and shared system awareness), computer simulation modeling of tray movements (systems modeling and departmental budgeting), enhanced approaches to team decision making, operational briefings (system functional health and awareness), workspace configurations, and a generalized approach to continuous improvement. Thus, ongoing interventions are being explored in multiple modalities at both the micro-level (shift handoff checklists, workspace improvements) and the macro-level (team co-design workshops, data displays, computer simulation modeling, operational briefings).
In contrast with traditional views about individual-based solutions to workplace challenges in hospital environments, we suggest that optimizing daily operations and planning for future challenges in instrument reprocessing requires a complete understanding of the systemic complexity and interdependence involved in surgical care. We also note that the use of systems engineering approaches can help provide multiple ways to address organizational challenges, and that co-design opportunities may benefit the implementation of quality initiatives. Therefore, proposed workplace solutions focused on individual workers, teams or departments may still fail to address larger systemic issues. This, in turn, has also provided the opportunity to move beyond find-and-fix approaches towards the application of Cognitive Systems and Resilience Engineering through our partners at Ohio State and Clemson University, and to contribute to theoretical developments in those fields by examining how organizational coordination underpins adaptive capacities, departmental resilience, and continued system function.
The lessons learned from our work have direct implications for healthcare leaders, human factors professionals, and clinical teams seeking to improve the safety, efficiency, and quality of care. First, we recommend designing quality initiatives which are scoped to support departmental and organizational goals. Second, initiatives should be adapted to efforts and systems already in place in the organization to enhance their likelihood of success. Finally, developing positive relationships with departmental leaders and team members can help human factors professionals gain support, advocate for funding, and facilitate co-design and collaboration.
By utilizing systems engineering frameworks to describe and understand surgical instrument reprocessing, develop and deploy co-designed interventions, and evaluate their potential effectiveness, we have continued assisting healthcare teams and decision-makers to improve the efficiency of healthcare delivery and ultimately benefit patient care. Insights offered through lessons learned from a simultaneous multi-level approach to organizational improvement may substantially enhance understanding of complex organizational problems throughout the hospital system which facilitates management, decision making, development of workplace interventions and ultimately leads to direct benefits for healthcare institutions and improvement in the quality of patient care.
Event Type
Oral Presentations
TimeWednesday, March 2510:30am - 11:00am EDT
LocationMurray Hill East
Patient Safety Research and Initiatives