Brain Resource Used

Examples of Impact

Institutional Applications of HFE

Focusing attention

Decision making (no matter size of decision)

Sorting, classifying

Multitasking, interruption, then getting back on track

Maintaining goals and Updating working memory

Self-Regulation: Despite how treated, maintaining calm in setting of bleeding injury pain

Emotion Work: Dealing with bad outcomes, distressed patients and families FROM NASA TLX:

High mental demand

High temporal demand

High frustration

High effort

Lack of physical, cognitive and emotional restoration

· Reason for patient visit vs. Meaningful Use (MU), Screening questions.

· EMR clicks to find and achieve action. When to fit in educational mandatories.

· Lab result overload of their in-basket of EMR, from non-selectively copying in all clinicians associated with patient’s care, creating diffusion of responsibility risk of oversight.

· Interruption of nurses passing meds Interruption of clinicians in emergency room.

· EMR design requires multiple page interfaces before can do what intended. Clinical data stored in non-intuitive locations.

· Patient or family member threatening clinician. Series of many patients to see with severe injury or illness.

· Death in Operating Room, next case wheeled in, giving support to grieving families.

· Chaotic workflows, busy-work conflated with virtuous work of clinical calling. Fit in teaching, research.

· Shortened patient visits, push for high Relative Value Units (RVUs).

· Hospital purchased IV pumps from multiple vendors and operate differently.

· Effort required to work around the poor designs and workflows in order to do their best to take good care of patients.

· Writing the day’s clinical notes in the evening or weekends when home. Maintenance of Certification (MOC) requirements over and above what occurs in daily practice. Not able to be with significant other, children, friends or outside hobbies.

· Support staff do MU and screening questions. Patient entered data. Minimize Best Practice Alerts (BPAs) in Electronic Medical Record (EMR) which interrupt attention. Call attention to key issues but avoid demanding attention as BPAs do.

· Minimize EMR clicks. Institutional Mandatory Management system to support achievement during work time, satisfice requirements to what is needed to comply.

· Policy banner: “Clinician that orders test follows up on it”. Include ordering clinician name.

· Nursing medication room, cone of silence. System of pended staff questions for clinician to be addressed between tasks and not break train of thought.

· EMR Dashboards that create action pathways accessible from one page interface. Health Information Management team collaborate with clinicians for design of labelling information and its location.

· Close collaboration with Public Safety or Security team, de-escalation training. Surrounding culture of esprit de corps supporting each other tangibly, emotionally and informationally.

· Make debriefing routine, create peer support groups, and build institutional culture of expecting clinician to be able to take a break to recuperate.

· Leadership work with clinicians to create better workflows and get credit for all missions of the institution (e.g. teaching, patient care, research).

· Organizational structure for ongoing input from rank and file clinicians to improve workflows and work/life integration.

· Standardization of IV pump equipment across the institution. Participatory management of clinician input into device purchasing.

· Human Factor Based Leadership to understand how to reduce and prevent unnecessary efforts.

· Work outside of Work (WOW) campaign to reduce WOW. Optimize EMR usability, work with Risk Management, Billing, and Compliance and Patient Safety efforts to eliminate excessive documentation. As an institution, take on complexities of MOC with framework to creatively get credit for MOC requirements from common clinical and education activities that normally occur, double-purposing actions where possible.