Proactive, Transdisciplinary Safer-System Redesign. A Field Report from the Hospital Frontline

Abstract

OCCUPATIONAL APPLICATIONS Safety science disciplines, such as Systems Engineering, Human Factors and Ergonomics, or Design Thinking, promise to deliver a breakthrough in proactive, safer systems redesign. But what does the work with clinicians look like when redesigning systems for safer, more effective patient-centered care? The Stanford Health Care Advancing Patient Safety Program is trailblazing by integrating safety science experts and systems designers into clinical practice. This application report provides an overview of the structure, the approach, and methodology, as well as the lessons learned of the program. Two use case examples of analyzing and redesigning complex clinical work systems—the safe administration of blood and blood products and the standardization of set-up and management of cerebrospinal fluid drainage systems—demonstrate the successful application of the human-centered design approach in clinical settings.

TECHNICAL ABSTRACT Background (or Rationale): Today, most healthcare systems can be described as “compliant organizations.” However, as the patient safety movement continues to prosper, many scholars have proposed to evolve from a reactive approach toward a more proactive one that better addresses risks for preventable harm. Purpose: Proactive organizations aim to achieve resilience. Stanford Health Care is trailblazing by integrating safety science experts into clinical practice who work in tandem with clinicians to proactively design work systems for safer, more effective, patient-centered care. Methods: Adapting the human-centered design approach, a transdisciplinary team of engineers, physicians, and nurses utilizes an array of methods and tools to identify and analyze systems-related issues proactively and comprehensively, to search for and test a variety of solutions, to select the best options, implement solutions successfully, and to monitor sustainability of improvement. Results: The team-conducted projects, e.g., to improve blood administration and to standardize set-up and management of cerebrospinal fluid drainage systems. Our accomplishments so far, include the systematic examination and comprehensive description of clinical work systems, their components and interactions, successful collaboration with clinical and support services throughout the organization, and the redesign of IT systems, medical devices, and nursing procedures. The efforts also led to price reductions by 50% for a single medical device. Since the completion of the projects, we have had no related adverse patient event, no associated litigation, and the nursing and service-quality indicators are within the satisfactory target range. Conclusions: The SHC Advancing Patient Safety Program is a novel endeavor that analyzes systems issues in an organization-wide manner, executes improvement work in a comprehensive and integrated fashion, is a conduit for innovation, and is a medium for breaking through boundaries and silos thus fostering deeper collaboration among disciplines.

KEYWORDS:

• organizational ergonomics
• proactive patient safety
• systems analysis
• systems thinking
• system friendliness
• sociotechnical systems
• usability and acceptability

DISCLOSURE OF POTENTIAL CONFLICT OF INTEREST

No potential conflicts of interest were disclosed.

ACKNOWLEDGMENTS

The authors wish to thank all Stanford Health Care Clinical Champions for reviewing the data and providing their expertise and insights. We also want to thank all interviewees and improvement leads for their openness and support.

ETHICS STATEMENT

Stanford University's Institutional Review Board determined that, based on OHRP and FDA regulations and guidance, this study did not meet the Federal definition of research or clinical investigation and therefore was exempt from further submission requirements.

Notes

¹ An abstract of this work was previously published (Podtschaske, Salazar, & Rao, 2017).

Additional information

Funding

All authors have been funded through the Stanford Health Care Advancing Patient Safety Program.