It is time to talk about people: a human-centered healthcare system

Meghan M Searl, Lea Borgi, Zeina Chemali, Meghan M Searl, Lea Borgi, Zeina Chemali

Abstract

Examining vulnerabilities within our current healthcare system we propose borrowing two tools from the fields of engineering and design: a) Reason's system approach 1 and b) User-centered design 23. Both approaches are human-centered in that they consider common patterns of human behavior when analyzing systems to identify problems and generate solutions. This paper examines these two human-centered approaches in the context of healthcare. We argue that maintaining a human-centered orientation in clinical care, research, training, and governance is critical to the evolution of an effective and sustainable healthcare system.

References

    1. Reason JT. Human error. Cambridge England; New York: Cambridge University Press; 1990.
    1. Norman DA. The psychology of everyday things. New York: Basic Books; 1988.
    1. Norman DA, Draper SW. User centered system design: new perspectives on human-computer interaction. Hillsdale, N.J.: L. Erlbaum Associates; 1986.
    1. Reason J. Human error: models and management. BMJ. 2000;320:768–770. doi: 10.1136/bmj.320.7237.768.
    1. Karsh B-T, Alper SJ. Advances in Patient Safety: From Research to Implementation. Vol. 2. Rockville, MD: Agency for Healthcare Research and Quality; 2005. Work system analysis: the key to understanding health care systems; pp. 337–348.
    1. Leape LL. A systems analysis approach to medical error. J Eval Clin Pract. 1997;3:213–222. doi: 10.1046/j.1365-2753.1997.00006.x.
    1. Millenson ML. Pushing the profession: how the news media turned patient safety into a priority. Qual Saf Health Care. 2002;11:57–63. doi: 10.1136/qhc.11.1.57.
    1. Larson EB. Measuring, monitoring, and reducing medical harm from a systems perspective: a medical director's personal reflections. Acad Med. 2002;77:993–1000. doi: 10.1097/00001888-200210000-00010.
    1. Cox PM Jr, D'Amato S, Tillotson DJ. Reducing medication errors. Am J Med Qual. 2001;16:81–86. doi: 10.1177/106286060101600302.
    1. Meaney M. From a culture of blame to a culture of safety--the role of institutional ethics committees. Bioethics Forum. 2001;17:32–42.
    1. Collins ME, Block SD, Arnold RM, Christakis NA. On the prospects for a blame-free medical culture. Soc Sci Med. 2009;69:1287–1290. doi: 10.1016/j.socscimed.2009.08.033.
    1. Khatri N, Brown GD, Hicks LL. From a blame culture to a just culture in health care. Health Care Manage Rev. 2009;34:312–322.
    1. Cohen MM, Eustis MA, Gribbins RE. Changing the culture of patient safety: leadership's role in health care quality improvement. Jt Comm J Qual Saf. 2003;29:329–335.
    1. Zhang J. Human-centered computing in health information systems. Part 1: analysis and design. J Biomed Inform. 2005;38:1–3. doi: 10.1016/j.jbi.2004.12.002.
    1. Institute of Medicine (U.S.). Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academy Press; 2001. Committee on Quality of Health Care in America.
    1. Gustafson DH, Robinson TN, Ansley D, Adler L, Brennan PF. Consumers and evaluation of interactive health communication applications. The Science Panel on Interactive Communication and Health. Am J Prev Med. 1999;16:23–29. doi: 10.1016/S0749-3797(98)00104-4.
    1. Dabbs Ade V, Myers BA, Mc Curry KR, Dunbar-Jacob J, Hawkins RP, Begey A, Dew MA. User-centered design and interactive health technologies for patients. Comput Inform Nurs. 2009;27:175–183. doi: 10.1097/NCN.0b013e31819f7c7c.
    1. Ariely D. Predictably irrational: the hidden forces that shape our decisions. 1. New York, NY: Harper; 2008.
    1. Thaler RH, Sunstein CR. Nudge: improving decisions about health, wealth, and happiness. New Haven: Yale University Press; 2008.
    1. Tversky A, Kahneman D. Judgment under Uncertainty: Heuristics and Biases. Science. 1974;185:1124–1131. doi: 10.1126/science.185.4157.1124.
    1. Regehr G, Norman GR. Issues in cognitive psychology: implications for professional education. Acad Med. 1996;71:988–1001. doi: 10.1097/00001888-199609000-00015.
    1. Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2008;121:S2–23. doi: 10.1016/j.amjmed.2008.01.001.
    1. Wu AW, Folkman S, McPhee SJ, Lo B. Do house officers learn from their mistakes? JAMA. 1991;265:2089–2094. doi: 10.1001/jama.265.16.2089.
    1. Senay I, Kaphingst KA. Anchoring-and-adjustment bias in communication of disease risk. Med Decis Making. 2009;29:193–201. doi: 10.1177/0272989X08327395.
    1. Vickrey BG, Samuels MA, Ropper AH. How neurologists think: A cognitive psychology perspective on missed diagnoses. Ann Neurol. 2010;67:425–433.
    1. Redelmeier DA. Improving patient care. The cognitive psychology of missed diagnoses. Ann Intern Med. 2005;142:115–120.
    1. Woolf SH, Kamerow DB. Testing for uncommon conditions. The heroic search for positive test results. Arch Intern Med. 1990;150:2451–2458. doi: 10.1001/archinte.150.12.2451.
    1. Oppenheimer DM. Spontaneous discounting of availability in frequency judgment tasks. Psychol Sci. 2004;15:100–105. doi: 10.1111/j.0963-7214.2004.01502005.x.
    1. Tversky A, Kahneman D. Availability: a heuristic for judging frequency and probability. Cognitive Psychology. 1973;5:207–232. doi: 10.1016/0010-0285(73)90033-9.
    1. Salem-Schatz SR, Avorn J, Soumerai SB. Influence of clinical knowledge, organizational context, and practice style on transfusion decision making. Implications for practice change strategies. JAMA. 1990;264:476–483. doi: 10.1001/jama.264.4.476.
    1. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78:775–780. doi: 10.1097/00001888-200308000-00003.
    1. Wason PC. Reasoning about a rule. Q J Exp Psychol. 1968;20:273–281. doi: 10.1080/14640746808400161.
    1. Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science. 1981;211:453–458. doi: 10.1126/science.7455683.
    1. Cartmill RS, Thornton JG. Effect of presentation of partogram information on obstetric decision-making. Lancet. 1992;339:1520–1522. doi: 10.1016/0140-6736(92)91275-D.
    1. McNeil BJ, Pauker SG, Sox HC Jr, Tversky A. On the elicitation of preferences for alternative therapies. N Engl J Med. 1982;306:1259–1262. doi: 10.1056/NEJM198205273062103.
    1. Hineline PN. A self-interpretive behavior analysis. Am Psychol. 1992;47:1274–1286. doi: 10.1037/0003-066X.47.11.1274.
    1. Ross L. In: Advances in experimental social psychology. Berkowitz L, editor. Vol. 10. New York: Academic Press; 1977. The intuitive psychologist and his shortcomings: Distortions in the attribution process. full_text.
    1. Fischoff B, Beyth R. I knew it would happen: Remembered probabilities of once-future things. Organizational Behavior and Human Performance. 1975;13:1–16. doi: 10.1016/0030-5073(75)90002-1.
    1. Van Rooy D, Van Overwalle F, Vanhoomissen T, Labiouse C, French R. A recurrent connectionist model of group biases. Psychol Rev. 2003;110:536–563. doi: 10.1037/0033-295X.110.3.536.
    1. Chapman LJ, Chapman JP. Genesis of popular but erroneous psychodiagnostic observations. J Abnorm Psychol. 1967;72:193–204. doi: 10.1037/h0024670.
    1. Tajfel H. Cognitive aspects of prejudice. J Biosoc Sci. 1969. pp. 173–191.
    1. Brewer M. In-group bias in the minimal intergroup situation: A cognitive-motivational analysis. Psychological Bulletin. 1979;86:307–324. doi: 10.1037/0033-2909.86.2.307.
    1. Fischoff B, Slovic P, Lichtenstein S. Knowing with certainty: The appropriateness of extreme confidence. Journal of Experimental Psychology: Human Perception and Performance. 1977;3:552–564. doi: 10.1037/0096-1523.3.4.552.
    1. Berner ES, Maisiak RS, Heuderbert GR, Young KR. , JrClinician performance and prominence of diagnoses displayed by a clinical diagnostic decision support system. AMIA Annu Symp Proc. 2003. pp. 76–80.
    1. McSherry D. Avoiding premature closure in sequential diagnosis. Artif Intell Med. 1997;10:269–283. doi: 10.1016/S0933-3657(97)00396-5.
    1. Payne VL, Crowley RS. Assessing the use of cognitive heuristic representativeness in clinical reasoning. AMIA Annu Symp Proc. 2008. pp. 571–575.
    1. Hoff T, Pohl H, Bartfield J. Implementing Safety Cultures in Medicine: What We Learn by Watching Physicians. Advances in Patient Safety. 2003;1:15–38.
    1. Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79:186–194. doi: 10.1097/00001888-200402000-00019.
    1. Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand. 2009;53:143–151. doi: 10.1111/j.1399-6576.2008.01717.x.
    1. Powell SM. Creating a systems approach to patient safety through better teamwork. Biomed Instrum Technol. 2006;40:205–207. doi: 10.2345/i0899-8205-40-3-205.1.
    1. Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care. 2004;13(Suppl 1):i85–90. doi: 10.1136/qshc.2004.010033.
    1. Mathieu JE, Heffner TS, Goodwin GF, Salas E, Cannon-Bowers JA. The influence of shared mental models on team process and performance. J Appl Psychol. 2000;85:273–283. doi: 10.1037/0021-9010.85.2.273.
    1. Graber ML. Taking steps towards a safer future: measures to promote timely and accurate medical diagnosis. Am J Med. 2008;121:S43–46. doi: 10.1016/j.amjmed.2008.02.006.
    1. Sluiter JK, Bos AP, Tol D, Calff M, Krijnen M, Frings-Dresen MH. Is staff well-being and communication enhanced by multidisciplinary work shift evaluations? Intensive Care Med. 2005;31:1409–1414. doi: 10.1007/s00134-005-2769-z.
    1. Entin EE, Serfaty D. Adaptive Team Coordination. Human Factors. 1999;41:312–325. doi: 10.1518/001872099779591196.
    1. Leventhal H, Weinman J, Leventhal EA, Phillips LA. Health Psychology: the Search for Pathways between Behavior and Health. Annu Rev Psychol. 2008;59:477–505. doi: 10.1146/annurev.psych.59.103006.093643.
    1. Prochaska JO, DiClemente CC. Stages of change in the modification of problem behaviors. Prog Behav Modif. 1992;28:183–218.
    1. Reason J. Safety in the operating theatre - Part 2: human error and organisational failure. Qual Saf Health Care. 2005;14:56–60.
    1. Chowdhury FA, Nashef L, Elwes RD. Misdiagnosis in epilepsy: a review and recognition of diagnostic uncertainty. Eur J Neurol. 2008;15:1034–1042. doi: 10.1111/j.1468-1331.2008.02260.x.
    1. Rinkus S, Johnson-Throop KA, Zhang J. Designing a knowledge management system for distributed activities: a human centered approach. AMIA Annu Symp Proc. 2003. pp. 559–563.
    1. Jones J, Harris M, Bagley-Thompson C, Root J. Development of user-centered interfaces to search the knowledge resources of the Virginia Henderson International Nursing Library. AMIA Annu Symp Proc. 2003. p. 884.
    1. Kinzie MB, Cohn WF, Julian MF, Knaus WA. A user-centered model for web site design: needs assessment, user interface design, and rapid prototyping. J Am Med Inform Assoc. 2002;9:320–330. doi: 10.1197/jamia.M0822.
    1. Campbell R, Ash J. Comparing bedside information tools: a user-centered, task-oriented approach. AMIA Annu Symp Proc. 2005. pp. 101–105.
    1. Poon EG, Keohane CA, Yoon CS, Ditmore M, Bane A, Levtzion-Korach O, Moniz T, Rothschild JM, Kachalia AB, Hayes J. et al.Effect of bar-code technology on the safety of medication administration. N Engl J Med. 2010;362:1698–1707. doi: 10.1056/NEJMsa0907115.
    1. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC. et al.A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491–499. doi: 10.1056/NEJMsa0810119.
    1. Behkami NA, Dorr DA. User centered design in complex healthcare workflows: the case of care coordination and care management redesign. AMIA Annu Symp Proc. 2009;2009:39–43.
    1. Kreis C, Gorman P. Word frequency analysis of dictated clinical data: a user-centered approach to the design of a structured data entry interface. Proc AMIA Annu Fall Symp. 1997. pp. 724–728.
    1. Johnson CM, Johnson TR, Zhang J. A user-centered framework for redesigning health care interfaces. J Biomed Inform. 2005;38:75–87. doi: 10.1016/j.jbi.2004.11.005.
    1. DeShazo JP, Turner AM. An interactive and user-centered computer system to predict physician's disease judgments in discharge summaries. J Biomed Inform. 2010;43:218–223. doi: 10.1016/j.jbi.2009.08.016.
    1. Nemeth C, O'Connor M, Klock PA, Cook R. Discovering Healthcare Cognition: The Use of Cognitive Artifacts to Reveal Cognitive Work. Organization Studies. 2006;27:1011–1035. doi: 10.1177/0170840606065708.
    1. Gao T, Kim MI, White D, Alm AM. Iterative user-centered design of a next generation patient monitoring system for emergency medical response. AMIA Annu Symp Proc. 2006. pp. 284–288.
    1. Taylor DP, Bray BE, Staggers N, Olson RJ. User-centered development of a Web-based preschool vision screening tool. AMIA Annu Symp Proc. 2003. pp. 654–658.
    1. Xie Z, Suki D, Graham S, Sawaya R. Design a usable protocol screening database: the user-centered approach. AMIA Annu Symp Proc. 2005. p. 1161.
    1. Atkinson NL, Saperstein SL, Desmond SM, Gold RS, Billing AS, Tian J. Rural eHealth nutrition education for limited-income families: an iterative and user-centered design approach. J Med Internet Res. 2009;11:e21. doi: 10.2196/jmir.1148.
    1. Catarci T, De Giovanni L, Gabrielli S, Kimani S, Mirabella V. Scaffolding the design of accessible eLearning content: a user-centered approach and cognitive perspective. Cogn Process. 2008;9:209–216. doi: 10.1007/s10339-008-0213-3.
    1. Bae J, Wolpin S, Kim E, Lee S, Yoon S, An K. Development of a user-centered health information service system for depressive symptom management. Nurs Health Sci. 2009;11:185–193. doi: 10.1111/j.1442-2018.2009.00454.x.
    1. Glasgow RE, Christiansen S, Smith KS, Stevens VJ, Toobert DJ. Development and implementation of an integrated, multi-modality, user-centered interactive dietary change program. Health Educ Res. 2009;24:461–471. doi: 10.1093/her/cyn042.
    1. Arsand E, Demiris G. User-centered methods for designing patient-centric self-help tools. Inform Health Soc Care. 2008;33:158–169. doi: 10.1080/17538150802457562.
    1. Braithwaite J, Runciman WB, Merry AF. Towards safer, better healthcare: harnessing the natural properties of complex sociotechnical systems. Qual Saf Health Care. 2009;18:37–41. doi: 10.1136/qshc.2007.023317.
    1. Wilf-Miron R, Lewenhoff I, Benyamini Z, Aviram A. From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care. Qual Saf Health Care. 2003;12:35–39. doi: 10.1136/qhc.12.1.35.
    1. Rex JH, Turnbull JE, Allen SJ, Vande Voorde K, Luther K. Systematic root cause analysis of adverse drug events in a tertiary referral hospital. Jt Comm J Qual Improv. 2000;26:563–575.
    1. Sherman H, Castro G, Fletcher M, Hatlie M, Hibbert P, Jakob R, Koss R, Lewalle P, Loeb J, Perneger T. et al.Towards an International Classification for Patient Safety: the conceptual framework. Int J Qual Health Care. 2009;21:2–8. doi: 10.1093/intqhc/mzn054.

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