Shawna J. Perry

Evidence points to the critical importance of creating a positive clinical experience to maintain a well-functioning healthcare system. Despite its importance, there is little guidance on how to assess clinical user experience. While there does not yet appear to be consensus on critical domains of clinical experience, most components that appear in...

Objective To synthesize evidence and identify gaps in the literature on environmental cleaning and disinfection in the operating room based on a human factors and systems engineering approach guided by the Systems Engineering Initiative for Patient Safety (SEIPS) model. Design A systematic scoping review. Methods Following the Preferred Reporting...

Creating and communicating effective safety protocols is important to the well-being of healthcare workers, patients, and all who interact with health systems. Although protocols have been used to support healthcare teams in providing care for decades, there is limited consensus about what constitutes an effective protocol (Myburgh, 2008). In fact,...

Background: Environmental cleaning is critical in preventing pathogen transmission and potential consecutive healthcare-acquired infections. In operating rooms (ORs), multiple invasive procedures increase the infectious risk for patients, making proper cleaning and disinfection of environmental surfaces of paramount importance. A human-factors engi...

Dr. Richard Cook was a physician, educator, scholar, and researcher. He was a brilliant thinker and writer. Richard's CV lists 41 peer reviewed publications, 39 conference proceedings, 6 technical reports, 30 books/book chapters that were cited about 10,000 times (as of September 2022). Richard has excelled in multiple careers and was remarkably gi...

Effective and practical infection prevention and control (IPC) processes and protocols are vital to safety of patients and health care workers (HCWs) as well as improving public health. This interdisciplinary panel, composed of experts in IPC, public health, medicine, and human factors engineering (HFE), will discuss the urgent need for developing...

Background: Emergency departments (EDs) are complex, sociotechnical, high-paced, safety-critical work systems that have been disproportionately affected by the COVID-19 pandemic. Despite training, consistent compliance with recommended PPE use during COVID-19 pandemic has been challenging. Healthcare workers (HCWs) have had adapt to overcome these...

Background: Infection prevention and control (IPC) protocols and guidelines are important quality management tools for educating care professionals and standardizing care processes. However, most of the actual care (ie, work as done) differ from protocol recommendations (ie, work as imagined). No tool or set of criteria has been established for how...

Background : The effectiveness of PPE in preventing self-contamination of healthcare workers (HCWs) and transmission of pathogens (airborne and contact) in the emergency department (ED) is highly dependent on consistent, appropriate use of and other interactions (eg, storing, cleaning, etc) with the PPE. Pre–COVID-19 studies focused primarily on in...

Human Factors and ergonomics (HFE) expertise continues to have difficulty integrating its experts into healthcare. This persistent disconnect is compounded by unique aspects of healthcare as an institution, industry and work system. Clinically-embedded HFE practitioners, a new HFE sub-specialty, are a conduit for addressing substantive mismatches b...

Introduction Understanding and managing clinician workload is important for clinician (nurses, physicians and advanced practice providers) occupational health as well as patient safety. Efforts have been made on developing strategies for managing clinician workload by improving patient assignment. The goal of the current study is to use electronic...

This book presents simulation as an essential, powerful tool to develop the best possible healthcare system for patients. It provides vital insights into the necessary steps for supporting and enhancing medical care through the simulation methodology. Organized into four sections, the book begins with a discussion on the overarching principles of...

Over the last 15 years, healthcare delivery has experienced enormous changes across every aspect of clinical care, both for participants in it and affiliated stakeholders. The plethora and breadth of these changes and ongoing struggles with their incorporation into the work of healthcare begs the question: In 2035, what emerging innovations and con...

A human factors and ergonomics (HFE) systems approach offers a model for adjusting work systems and care processes in response to a health care crisis such as COVID-19. Using the SEIPS model of work system and patient safety, we describe various work system barriers and facilitators experienced by health care workers during the COVID-19 crisis. We...

Background The current state of scientific knowledge regarding communication between emergency medicine (EM) providers indicates that communication is critical to safe and effective patient care. Objectives In this study, we identified communication needs of EM nurses and physicians; in particular, what information should be conveyed, when, how, a...

The mechanics of writing a research proposal are addressed elsewhere in this text (see Chap. 33). In this chapter we will address the factors that are relevant to the successful funding of a grant proposal. The scientific basis of a research proposal is paramount, but other factors, often termed ‘grantsmanship’, influence reviewers’ perceptions and...

Patients and families play a role in the safety of care provided across clinical settings, highlighting the need to understand clinician perspectives and experiences related to their engagement. Through a panel discussion entitled, The Patient in Patient Safety: Clinicians’ Experiences Engaging Patients as Partners in Safety, we elicited clinician...

This research is a first stage in developing a method for modeling the clinician workload associated with an emergency medicine patient in order to display workload for purposes of managing clinician workload and emergency department (ED) flow. We proposed a multi-stage approach of predicting patient-related drivers of clinician’s workload in the e...

Background Hospital emergency departments (EDs) are dynamic environments, involving coordination and shared decision making by staff who care for multiple patients simultaneously. While computerized information systems have been widely adopted in such clinical environments, serious issues have been raised related to their usability and effectivenes...

OCCUPATIONAL APPLICATION Understanding and managing clinician workload is important both for the occupational health of clinicians and for the safety of patients. This study describes the integration of a new display concept for visualizing emergency medicine physician and nurse workload into a live electronic health record along with an investigat...

In 2016, we examined the connection between naturalistic decision making and the trend toward best practice compliance; we used evidence-based medicine (EBM) in health care as an exemplar. Paul Falzer’s lead paper in this issue describes the historical underpinnings of how and why EBM came into vogue in health care. Falzer also highlights the epist...

We describe the patterns and content of nurse to physician verbal conversations in three emergency departments (EDs) with electronic health records. Emergency medicine physicians and nurses were observed for 2 h periods. Researchers used paper notes to document the characteristics (e.g., partners involved, location of communication, who initiated c...

Developing novel interfaces for high-risk situations, such as the Emergency Department, requires a sufficient quantity of detailed patient data to support usability and evaluation activities, yet patient privacy restrictions often prevent the use of actual patient data for these activities. We developed a synthetic dataset to provide a suitable alt...

This article presents an evaluation of novel display concepts for an emergency department information system (EDIS) designed using cognitive systems engineering methods. EDISs assist emergency medicine staff with tracking patient care and ED resource allocation. Participants performed patient planning and orientation tasks using the EDIS displays a...

There is a growing popularity of data-driven best practices in a variety of fields. Although we applaud the impulse to replace anecdotes with evidence, it is important to appreciate some of the cognitive constraints on promulgating best practices to be used by practitioners. We use the evidence-based medicine (EBM) framework that has become popular...

The objective of this work was to assess the functional utility of new display concepts for an emergency department information system created using cognitive systems engineering methods, by comparing them to similar displays currently in use. The display concepts were compared to standard displays in a clinical simulation study during which nurse-...

There has been momentum to quickly develop health information technology (IT), but these developments may not result in the expected benefits if the IT is not designed to support caregivers. This research aimed to create an interface for emergency department tracking and control using cognitive systems engineering methods. Comparison of the novel d...

In this panel, various researchers describe their macroergonomics research in healthcare with a particular focus on their use and adaptation of the SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety (Carayon et al., 2006; Carayon et al., 2014). The panel discussion addresses questions on the past, pres...

Purpose The purpose of this chapter is to highlight some of the critical multiteam system (MTS) issues that are faced in healthcare by utilizing case studies that illustrate the transition of a patient through the healthcare system and suggest a possible approach to studying these issues. Design/methodology/approach The approach taken by the autho...

This paper presents the results of a usability evaluation conducted of an electronic Emergency Department information system (EDIS) prototype that was designed using a cognitive system engineering (CSE) approach. Participants were asked to complete tasks using the EDIS prototype, while thinking aloud about their interactions with the displays. Part...

Despite the complexity of sociotechnical systems such as health care, the critical embedded element—human beings—is often minimized or ignored during the design phases of improvement efforts. The human is frequently considered only after an implementation has not gone well, while the relationships of workers to one another within the work system ar...

The healthcare work system contains many constraints resulting from changes in workflow and system structure. The panel reflects on challenges in the healthcare work system human factors researchers can address to improve patient safety. The panelists address: (1) the growing complexities in healthcare and patient safety from the provider and patie...

Health IT systems are often designed without a sufficient understanding of the clinical activities they are intended to support; thus desired benefits in quality of care, safety, and efficiency may not accrue. We present the second part of a multi-phase study which utilizes cognitive systems engineering (CSE) methods to design and test novel user i...

Simulation-based training (SBT) is commonly integrated into medical education. This panel examines current uses of SBT in undergraduate, graduate, and continuing medical education and addresses the advantages and different considerations for each. Furthermore, we consider how SBT within the different levels of medical education can inform practices...

Handoff communication is one of the most typical clinical communication mechanisms in a healthcare setting to transfer information and responsibilities of the care provider. Handoff communication is varied across settings, provider type, and even within a clinical unit. Information technology has the capability to support handoff communication, wit...

Given the growing interest in understanding and improving handovers, a deeper understanding of exactly how to create the most effective handover is necessary. This unique symposium will emphasize the distinction between salience and comprehensiveness in handover communications across multiple acute care settings. The discussion panel brings togethe...

Clinical work is accomplished by complex, highly distributed, joint cognitive systems, and involves high levels of uncertainty and ambiguity. Hospital emergency departments (EDs) in particular must adapt to uncertainty, ambiguity and change on a variety of different temporal scales. Many of these adaptations are unofficial, in part because they can...

Information technology is rapidly being developed and implemented for health care environments, often as a replacement for paper based or other manual tools. One example of this transition is the replacement of large dry-erase boards, used in emergency departments (ED) for tracking patient locations and clinical care, with computerized patient-trac...

The need for 24 times 7 × 365 service in emergency departments (EDs) requires physicians and other health professionals to work in temporally delimited shifts. Handoffs between on-coming and off-going workers at shift changes are used to bridge gaps in care and to prepare the on-coming party to assume the ongoing work of care safely and effectively...

Patient status boards play an important role in coordinating and communicating about patient care in hospital emergency departments (EDs). Status boards are transitioning from dry-erase whiteboards to electronic systems. Although electronic systems may preserve some surface features of the manual artifacts, important affordances of the manual techn...

This article presents a simulation architecture for a patient tracking system simulator to study caregiver performance in emergency departments (EDs). The architecture integrates discrete event simulation modeling with clinical patient information. Evaluation components for electronic patient tracking system displays are also described. A simulatio...

There is a generally promoted view in healthcare that information technology (IT) will be a panacea for the various crises in that industry, from improving patient safety to reducing costs and expanding availability of care. This study was based in a busy emergency department (ED) in a large urban area in the USA and describes a PRA-based assessmen...

Abstract Introduction Patient safety has received significant press and funding for advancement since the landmark Institute of Medicine report in 1999. However, the difficult process of fostering cultural change in medicine requires that new educational methods, curricula, and assessment tools be instituted at the earliest possible opportunity in...

Manual status boards, which are used in many emergency departments to track patient and ED status information, are being replaced with electronic patient tracking systems. Such technology transitions can be challenging for the users and can produce undesirable consequences if the new technologies are not properly designed and tested. Understanding...

The proposed Macroergonomics and Patient Safety panel will address the particular challenges of technology in critical care and emergency medicine and patient safety. Critical care technology remains a driving force in American health care facilities, yet little human factors and systems engineering information is available to improve the design an...

Motivation - Healthcare are rapidly replacing manual with computerized artefacts for many reasons, but the impact on users of the technology is often assumed to be neutral. Approach - Three presentations of the increasingly more intensive use of computer technology in healthcare will be discussed by panelists and audience to explore the problem spa...

Motivation - Why and how do expert unexpectedly change from their original plan in dynamic, uncertain settings? Research approach - Critical event interviews of practitioners self-reporting cases of sudden plan changes. Findings - Sudden plan changes developed in much the same manner as an expert's initial plan in recognition-primed decision-making...

The proposed Macroergonomics and Patient Safety panel will address the particular challenges of healthcare information technology (HIT) and Patient Safety. The development of information technology in health care remains a driving force in American health care facilities, yet little human factors and systems engineering information is available to...

Clinical work is accomplished by complex, highly distributed, joint cognitive systems, and involves high levels of uncertain and ambiguity. Hospital emergency departments in particular must adapt to uncertainty, ambiguity, and change on a variety of different time scales. Many of these adaptations are unofficial, in part because they cannot be spec...

Today's emergency departments (ED) could not function without a patient tracking system of some kind, manual or electronic. Manual patient tracking systems such as "whiteboards" are large, dry erase, manually updated status boards used as information tracking devices in most EDs. Although it is expected that manual whiteboard systems will completel...

Emergency Departments (EDs) use medication administration systems that are optimized to perform resiliently in the environment of dynamic, short-term care. In contrast, medical wards use a different medication administration system, optimized to perform resiliently in the environment of longer term, in-hospital care. The problem of overcrowding in...

Discussions about enhancing the safety of transitions in health care have been disjointed. Respected health care researchers, noting handoffs to be variable in content and process, view improving handoffs as “low-hanging fruit” that can be easily gathered by reducing variability through standardization in a variety of ways. In contrast, human facto...

Pressures for improved safety and performance in healthcare often are addressed by the imposition of tighter control over processes directed at producing "perfect performance of work." A series of near-miss incidents related to a routine hospital procedure demonstrates how these efforts can yield unintended and unappreciated consequences, undermini...

Typical hospital emergency departments (ED) use patient status boards as information tracking devices for providing safe care by supporting shared memory, latent processes, collaboration, shared cognition, communication and coordination. Traditionally, status boards are large, manually updated dry erase "whiteboards." Though electronic patient trac...

Emergency Departments (EDs) are open systems that routinely cope with highly variable and uncertain inputs. This paper will use two critical incidents to explore system adaptations to demand, complexity, unpredictability, and other threats to performance. We then relate the observations to three recently proposed graphical representations of organi...

The objective of the study was to identify the cognitive properties of manual status boards that make them useful to staff in Accident and Emergency Departments (A & E). Naturalistic observations and semi-structured interviews with A & E staff were used. Status boards are the central coordinating artefacts in A & Es. They are densely encoded in idi...

Large, easily viewed status boards are commonly used in some healthcare settings such as emergency departments, operating theaters, intensive care units, and inpatient wards. Because these artefacts were developed by front-line users, and have little to no supervisory or regulatory control, they offer valuable insights into the theories of work and...

Although proponents of advanced information technology argue that automation can improve the reliability of health care delivery, the results of introducing new technology into complex systems are mixed. The complexity of the health care workplace creates vulnerabilities and problems for system designers. In particular, some forms of failure emerge...

Implementation of information technology (IT) in healthcare has increased with little attention paid to the consequences of system failures. This qualitative study assesses the organizational understanding of IT vulnerabilities, the potential consequences of failure and system recovery capabilities within a large healthcare facility. Fifty nine per...

Emergency Departments (EDs) are open systems that routinely cope with highly variable and uncertain inputs. This paper will use two critical incidents to explore worker adaptations to complexity and unpredictability, and the organizational interpretation of threats to performance. We use the concept of resilience state space and state transitions t...

Emergency medicine is largely a communicative activity, and medical mishaps that occur in this context are too often the result of vulnerable communication processes. In this year-long qualitative study of two academic emergency departments, an interdisciplinary research team identified four such processes: triage, testing and evaluation, handoffs,...

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Although proponents of advanced information technology argue that automation can improve the reliability of health care delivery, the results of introducing new technology into complex systems are mixed. The new forms of failure that accompany automation challenge technical workers, often demanding novel approaches to recovering from failure and re...

In health care organizations, the division of labor and a need for continuous, 24-hour treatment subjects patients to multiple transitions in care. These transitions, or “handovers,” are potential points of failure that have seen very little study. We observed transitions of care in five hospital emergency departments as part of a larger study on s...

The need for 24-hour emergency care requires emergency department (ED) staff to work in shifts. We observed shift transitions in 5 EDs as part of a study on safety in emergency care. We found the observable characteristics of shift transitions to be highly variable across institutions and dynamically variable within shift change episodes. However,...

In healthcare systems, division of labor and the need for continuous, 24 hour care subjects patients to multiple transitions in care. These transitions, or turnovers, are potential points of failure but have not been intensively studied. We observed care transitions in 5 EDs as part of a study on safety in emergency care and found that very differe...

Although human factors engineering (HFE) is considered only in relationship to the design of medical devices or information systems technology, human factors issues arise in many aspects of work in health care organizations. HFE ANALYSIS: In one scenario, the resuscitation stretcher would not pass through the ED door closest to radiology. Many clin...

The need for 24-hour emergency care requires emergency department (ED) staff to work in shifts. Shift changes have long been viewed as risky times, for failures in the transfer of information, authority, or responsibility care can result in adverse events. We observed shift transitions in the ED as part of a study on safety in emergency care. We fo...

Emergency departments (EDs) are complex, high tempo, high risk work environments that require dynamic sharing of information across a group of caregivers. EDs commonly use status boards as tools to facilitate this sharing. Manual status boards have been replaced in some institutions by electronic ones, for a variety of reasons. We contrast the use...

Although health care rapidly adopts technologic advances from other fields, it has been slow to incorporate well-established principles from human factors engineering into the health care workplace. This article demonstrates some of those principles by analyzing an all too routine clinical event from a human factors point of view. Review of this ca...

Residency programs only are not challenged with developing competent emergency clinicians, but should strive to develop caring, empathetic, and community-minded physicians. An exercise was designed to help residents experience emergency department (ED) visits from the patient's perspective. This study occurred in emergency medicine residency progra...

[Wears RL, Janiak B, Moorhead JC, Kellermann AL, Yeh CS, Rice MM, Jay G, Perry SJ, Woolard R. Human error in medicine: promise and pitfalls, part 2. Ann Emerg Med. August 2000;36:142-144.]

[Wears RL, Janiak B, Moorhead JC, Kellermann AL, Yeh CS, Rice MM, Jay G, Perry SJ, Woolard RJ. Human error in medicine: promise and pitfalls, part 1. Ann Emerg Med. July 2000;36:58-60.]

The work of healthcare is performed in a guild fashion with few instances of simultaneous cooperative work that crosses traditional boundaries of responsibility and authority. The following is a case of resilient performance during a medical crisis, in which several individuals from unrelated specialties who had never before worked to-gether cooper...

The emergency department is a complex, highly adaptive system that operates in the face of uncertainty and limited resources. Field observations of an emergency department were conducted to investigate properties of resilience and adaptive challenge. A specific case was explored in order to make generalizations about the classes of adaptive challen...

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