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The cognitive load experienced by humans is an important factor affecting their performance. Cognitive overload or underload may result in suboptimal human performance and may compromise safety in emerging human-in-the-loop systems. In driving, cognitive overload, due to various secondary tasks, such as texting, results in driver distraction. On the other hand, cognitive underload may result in fatigue. In automated manufacturing systems, a distracted operator may be prone to muscle injuries. Similar outcomes are possible in many other fields of human performance such as aviation, healthcare, and learning environments. The challenge with such human-centred applications is that the cognitive load is not directly measurable. Only the change in cognitive load is measured indirectly through various physiological, behavioural, performance-based and subjective means. A method to objectively assess the performance of such diverse measures of cognitive load is lacking in the literature. In this paper, a performance metric for the comparison of different measures to determine the cognitive workload is proposed in terms of the signal-to-noise ratio. Using this performance metric, several measures of cognitive load, that fall under the four broad groups were compared on the same scale for their ability to measure changes in cognitive load. Using the proposed metrics, the cognitive load measures were compared based on data collected from 28 participants while they underwent n -back tasks of varying difficulty. The results show that the proposed performance evaluation method can be useful to individually assess different measures of cognitive load. [ABSTRACT FROM AUTHOR]

Due to the large number of falls that occur in hospital settings, inpatient fall prevention is a topic of great interest to patients and health care providers. The use of electronic decision support that tailors fall prevention strategy to patient-specific risk factors, known as Fall T.I.P.S (Tailoring Interventions for Patient Safety), has proven to be an effective approach for decreasing hospital falls. A paper version of the Fall T.I.P.S toolkit was developed primarily for hospitals that do not have the resources to implement the electronic solution; however, more work is needed to optimize the effectiveness of the paper version of this tool. We examined the use of human factors techniques in the redesign of the existing paper fall prevention tool with the goal of increasing ease of use and decreasing inpatient falls. The inclusion of patients and clinical staff in the redesign of the existing tool was done to increase adoption of the tool and fall prevention best practices. The redesigned paper Fall T.I.P.S toolkit showcased a built in clinical decision support system and increased ease of use over the existing version. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has challenged organizations to adapt under uncertainty and time pressure, with no pre-existing protocols or guidelines available. For organizations to learn to adapt effectively, there is a need to understand the perspectives of the frontline workforce involved in everyday operations. This study implemented a survey-tool to elicit narratives of successful adaptation based on the lived experiences frontline radiology staff at a large multispecialty pediatric hospital. Fifty-eight members of the radiology frontline staff responded to the tool between July and October of 2020. Qualitative analysis of the free-text data revealed five categories of themes that underpinned adaptive capacity of the radiology department during the pandemic: information flow, attitudes and initiative, new and adjusted workflows, availability and utilization of resources, and collaboration and teamwork. Enablers of adaptive capacity included timely and clear communication about procedures and policies from the leadership to frontline staff, and revised workflows with flexible work arrangements, such as remote patient screening. Responses to multiple choice questions in the tool helped identify the main categories of challenges faced by staff, factors that enabled successful adaptation, and resources used. The study demonstrates the use of a survey-tool to proactively identify frontline adaptations. The paper also reports a system-wide intervention resulting directly from a discovery enabled by the findings based on the use of RETIPS in the radiology department. In general, the tool could be used in concert with existing learning mechanisms, such as safety event reporting systems, to inform leadership-level decisions to support adaptive capacity. • A proactive learning tool was implemented in a pediatric radiology deparment for workers to share narratives of adaptation at the start of the COVID-19 pandemic. • Fifty eight responses were received between July and October of 2020 that provided information on how staff at various organizational levels were coping with an unprecedented situation. • Analysis of the responses revealed exemplars and patterns relating to cross-level information flows, worker initiatives, adapted workflows, utilization of resources, and collaboration and coordination of work. • Organization Learning: based on findings relating to the efficacy of timely communications to staff, the radiology leadership expanded the scope of their regular information dissemination to include key operational groups. • The tool is presented as part of a framework for proactive learning to support organizational adaptive capacity. [ABSTRACT FROM AUTHOR]

This paper: identifies personal and contextual factors that influence customer experience when service failures occur in rail transport; what is being conveyed through that factor (e.g. older age being used to convey vulnerability); and the implications for future service design. The results are from a thematic analysis of free-text rail passenger complaints (n = 516) reporting service failures that impacted on customer experience. The study differs from existing research on the pertinent personal and contextual factors for public transport service provision in that it: focuses on the passenger experience resulting from specific incidents (rather than evaluative, overall assessments of satisfaction), generates the factors inductively from the data (rather than a-priori) and uses detailed qualitative cases (rather than quantitative survey data). The findings (1) identify some similar factors to those used in previous research and uncover some new factors for both person and context, (2) provide an understanding of what they mean in terms of the passenger experience and (3) indicate how the factors might need to be measured if they are to be used by the rail industry. The paper concludes by using the outcome of an industry-based validation exercise to describe how the findings could be used in future rail services, namely: predicting where the customer experience is going to be sub-optimal, prioritising responses to particular circumstances, and designing services to better meet customer's needs. This exploratory research is timely, given the need for a more passenger-centric approach to service design and future developments such as smart-ticketing, which could potentially enable greater understanding of who is using the rail network and for what journeys. [ABSTRACT FROM AUTHOR]

This paper deals with developing and assessing the training of physicians to deliver a difficult diagnosis to patients. The training is provided by a web-based self-training package. This online training emphasizes the structural, functional and relational dimensions of interviews delivering a serious diagnosis, and a logical set of recommendations for behavior towards the patient. The content is illustrated by numerous delivery interview sequences that are described and for which commentary is provided. This online package was expected to enable physicians to acquire new skills and change their mental picture of diagnosis delivery. Here we discuss the assessment of training in managing the delivery of a serious diagnosis. The approach taken and the methods used to measure knowledge and skills are presented. [ABSTRACT FROM AUTHOR]

Development of adaptive aids to support human performance in complex systems is a cornerstone of human factors. Research in this area has led to a diversity of ideas regarding potential activation methods. However, little guidance has been provided on how to select among aid activation methods, and this lack of guidance could hinder adaptive aid development and deployment. Within the current paper, we review available methods of aid activation and describe a process for developing and validating adaptive aiding systems. We focus on supporting system designers who wish to select the ideal aid activation method for an intended application. The process that we recommend is an empirical approach to evaluate the feasibility, costs, and benefits of various potential methods of aid activation. This methodological framework will support practitioners making critical decisions about the design of aiding systems. [ABSTRACT FROM AUTHOR]

Descriptions of resilient performance in healthcare services usually emphasize the role of skills and knowledge of caregivers. At the same time, the human factors discipline often frames digital technologies as sources of brittleness. This paper presents an exploratory investigation of the upside of ten digital technologies derived from Healthcare 4.0 (H4.0) in terms of their perceived contribution to six healthcare services and the four abilities of resilient healthcare: monitor, anticipate, respond, and learn. This contribution was assessed through a multinational survey conducted with 109 experts. Emergency rooms (ERs) and intensive care units (ICUs) stood out as the most benefited by H4.0 technologies. That is consistent with the high complexity of those services, which demand resilient performance. Four H4.0 technologies were top ranked regarding their impacts on the resilience of those services. They are further explored in follow-up interviews with ER and ICU professionals from hospitals in emerging and developed economies to collect examples of applications in their routines. [ABSTRACT FROM AUTHOR]

Resilience principles show promise for improving the quality of healthcare, but there is a need for further theoretical development to include all levels and scales of activity across the whole healthcare system. Many existing models based on engineering concepts do not adequately address the prominence of social, cultural and organisational factors in healthcare work. Promising theoretical developments include the four resilience potentials, the CARE model and the Moments of Resilience Model, but they are all under specified and in need of further elaboration. This paper presents the Integrated Resilience Attributes Framework in which these three theoretical perspectives are integrated to provide examples of anticipating, responding, monitoring and learning at different scales of time and space. The framework is intended to guide researchers in researching resilience, especially the linkages between resilience at different scales of time and space across the whole healthcare system. [ABSTRACT FROM AUTHOR]

The prevalence of musculoskeletal (MSK) symptoms in radiographers is high, similar to other healthcare occupations that involve high levels of physical exertion (e.g. patient handling; grasping and moving equipment). Reports of interventions to reduce MSK discomfort in radiographers are limited. A participatory approach was used to investigate daily challenges, needs, and opportunities for developing interventions to address exposures to many of the risk factors that contribute to MSK symptoms in radiographers. In this paper, we present the expressed needs of experienced radiographers (including assistance with patient handling, security, supportive design of equipment and work spaces), along with their evaluations of several intervention concepts intended to address some of those needs. We also report results from tests of three prototype interventions stemming from this participatory process that demonstrate the potential for new engineering control concepts to reduce the physical effort associated with some of the most common tasks radiographers perform. [ABSTRACT FROM AUTHOR]

In this paper we study the working conditions of Community Health Workers in performing house calls within low-income, violent communities in order to understand the challenges in delivering primary care in developing countries. We conducted field studies in two primary healthcare clinics and telephone surveys for 5 months in 2017 within systematic sample of 1690 community health workers based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. A number of 759 interviews were completed, approximately 50% of the sample, 86% men and 14% women. Most participants are 30-39 years old (35%), followed by 27% of 40-49 years old participants. Results show that exposure to territorial violence and environmental or health-related diseases significantly affects CHWs. Moreover, CHWs have to develop a significant set of skills to cope with aspects of the territory, and those skills are not present in their training. As community health workers work on the sharp end of the healthcare system, responsible for outreaching, community education, counseling, and social support, our study presents contributions to government and management levels on working conditions inside communities, constraints in assistance, and difficulties in implementing primary care policies. [ABSTRACT FROM AUTHOR]