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Adherence to standard and transmission-based precautions in the computed tomography (CT) setting is central to effective infection prevention and control (IPC), yet there is limited evidence about medical imaging (MI) professionals' self-reported predictors of IPC breaches. This is the second of a two-part series on IPC in the CT setting. Part 1 reported on Australian baseline data relating to intravenous contrast media administration and power injectors. Part 2 presents Australian radiographers' and radiology nurses' perceptions of clinical situations that reduce adherence to standard and transmission-based precautions in CT. A self-administered survey was distributed to Australian radiographers and radiology nurses working in CT. Responses to an open-ended question "If I was to not adhere to the standard and transmission-based precautions in the CT department, it is most likely when ..." was analysed using inductive coding for themes, followed by deductive analysis mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) model. Study participants (n = 136) were radiographers (n = 119; 87.5%) and nurses (n = 17; 12.5%). 'Four themes were derived from the inductive analysis: (1) high-risk working conditions, (2) compliance with good practice, (3) attitudes and practice, and (4) quality of communication. Deductive analysis, using the SEIPS domains revealed that predominant issues related to 'Tasks' (43.7%) and 'Organisation' (30.6%) followed by issues related to 'Person' (16.9%), 'Tools and technology' (6.9%) and 'Environment' (1.9%). Multi-faceted pressures on radiology staff may compromise adherence to standard and transmission-based precautions in CT. Task difficulty, time pressures whilst undertaking tasks, and reduced staffing could lead to lower adherence to standard and transmission-based precautions. Future studies that focus on evaluation of 'Tasks' and 'Organisation' domains of the SEIPS model may provide further insights to non-adherence behaviours in MI. [ABSTRACT FROM AUTHOR]

Aim: To describe factors that prevent patient safety incidents in connection with the radiological examination from the radiographer's perspective. Background: Radiology plays an important role in the care chain and involves diagnostic examinations and treatments using various radiation sources and different techniques. Risks for patient safety incidents exist in every phase of a radiological examination. Appropriate use of medical imaging requires a multidisciplinary approach involving staff of different categories to meet the medical objectives and the patient's care needs. In accordance with a Safety‐II approach, it is therefore important to understand why things go right and ensure that they do by supporting the conditions for right things to happen. Design: A qualitative study with a descriptive design. Methods: Semi‐structured interviews were conducted with 17 radiographers. The data were analysed using theoretical thematic analysis based on the Systems Engineering Initiative for Patient Safety model. Results: The analysis yielded 20 sub‐themes, which describe different success factors contributing to patient safety. Conclusion: Proactive work should focus on collaboration and sharing the necessary knowledge, internally and externally, for care in connection with the radiological examination. The radiological and peri‐radiographic knowledge should include monitoring the patient's safety needs before, during and after the radiological examination. The referring clinician has a central role in writing relevant referrals and the radiographer's competence is crucial in monitoring the patient's safety needs. A good patient safety culture is required and working with standards is important. [ABSTRACT FROM AUTHOR]

Medical Informatics brings methods and solutions that could support reducing healthcare’s ecological footprint. Initial frameworks for Green Medical Informatics solutions are available, however these do not address organizational and human factors. Including these factors in evaluation or analysis of (technical) interventions aimed at making healthcare more sustainable, is essential for improving usability as well as effectiveness of these interventions. Interviews with healthcare professionals from Dutch hospitals led to preliminary insights into which organizational and human factors impact the implementation and adoption of sustainable solutions. Results indicate that forming multi-disciplinary teams is considered an important factor for realizing intended outcomes in terms of reducing carbon emissions and waste. Some other key factors mentioned are formalizing tasks, allocating budget and time, creating awareness and changing protocols to promote sustainable diagnosis and treatment procedures. [ABSTRACT FROM AUTHOR]

Introduction: Occupational fatigue is one of the harmful factors in many work environments, including health centers, which can have adverse effects on the health and safety of staff. This study was designed and conducted to determine the relationship between occupational fatigue and elements of the systems engineering model for patient safety in nurses. Material and Methods: This descriptive correlational study was conducted with the participation of 457 nurses of Shahid Beheshti University of Medical Sciences in 2018. Dimensions of fatigue were assessed by a Multidimensional Fatigue Inventory (MFI) and Systems Engineering Initiative for Patient Safety (SEIPS) model’s elements using the SEIPS model’s questionnaire. Validity was examined using the Lawshe method; calculating Content Validity Ratio (CVR) and Content Validity Index (CVI) was approved through the confirmation of experts. Reliability was assessed using the intraclass correlation coefficient (ICC) and Cronbach’s alpha. Data analysis was performed using SPSS version 21 Results: The findings of this study indicated that the highest score of fatigue was related to the general fatigue dimension with an average of 12.86 and SD of 3.23, and the lowest score was related to the reduction of the motivation dimension with an average of 9.11 and SD of 3.66. In this study, no significant relationship was observed between demographic characteristics and fatigue dimensions, but a significant relationship was observed between the dimensions of fatigue with the element of organization, task, technology/tools, and physical environment. Conclusion: The results of this study showed that fatigue in nurses was moderate, and the factors of the work system play a greater role in the occurrence of fatigue than demographic factors. Therefore, planning to improve the work system can help reduce fatigue in nurses.

Abstract Introduction Telemedicine use in nursing homes (NHs) expanded during the COVID-19 pandemic. The objectives of this study were to characterize plans to continue telemedicine among newly adopting NHs and identify factors limiting its use after COVID-19. Methods Key informants from 9 Wisconsin NHs that adopted telemedicine during COVID-19 were recruited. Semi-structured interviews and surveys were employed to identify participant perceptions about the value of telemedicine, implementation challenges encountered, and plans and barriers to sustaining its delivery after COVID-19. Directed content analysis and a deductive thematic approach using the Systems Engineering Initiative for Patient Safety (SEIPS) model was used during analyses. Quantitative and qualitative data were integrated to identify participant views on the value of telemedicine and the tools and work system enhancements needed to make telemedicine easier and more effective. Results All participating NHs indicated a preference to continue telemedicine after COVID-19. Urgent assessments of resident change-in-condition and cognitively based sub-specialty consultations were identified as the encounter types most amenable to telemedicine. Reductions in resident off-site encounters and minimization of resident therapy interruptions were identified as major benefits of telemedicine. Twelve work system enhancements needed to better sustain telemedicine were identified, including improvements to: 1) equipment/IT infrastructure; 2) scheduling; 3) information exchange; and 4) telemedicine facilitators. Discussion NHs that adopted telemedicine during COVID-19 wish to continue its use. However, interventions that enhance the integration of telemedicine into NH and off-site clinic work systems require changes to existing regulations and reimbursement models to sustain its utilization after COVID-19.

Background: The COVID‐19 pandemic has forced nursing homes to adapt new models of care in response to the evolving crisis including rapid implementation of telehealth services. The purpose of our study was to investigate implementation of telehealth in nursing homes amidst the COVID‐19 pandemic using a human factors model. Methods: Using a mixed methods design, we conducted a secondary analysis of data from a national survey of nursing home administrative leaders (n = 204). Using six survey questions, we calculated a total telehealth score (range 0–42). Descriptive statistics and paired sample t‐test were used to explore the change in telehealth in two consecutive years (2019–2021). Next, we conducted semi‐structured interviews with (n = 21) administrators and clinicians to assess differences in implementation according to extent of telehealth use. Results: The mean telehealth score in year 1 was 12.11 (SD = 9.85) and year 2 was 19.25 (SD = 11.25). There was a significant difference in telehealth scores from year 1 to year 2 (t = 6.83, p < 0.000). While 64% of nursing homes reported higher telehealth scores in year 2 compared to year 1, over 32% reported a decline. Qualitative analysis revealed facilitators of telehealth including training, use of integrated equipment, having staff present for the visit, and using telehealth for different types of visits. Barriers included using smart phones to conduct the visit, billing, interoperability and staffing. Conclusion: Training, adaptation of work processes to support communication, and restructuring teams and tasks are the result of interactions between system components that could improve usability and sustainability of telehealth in nursing homes. [ABSTRACT FROM AUTHOR]

The objective of this study was to measure organization factors that can influence the ability of nursing staff to prevent and detect ADEs in public hospitals using Systems Engineering Initiative for Patient Safety (SEIPS) model. Methods: This was a multi-center cross-sectional study. The study included a self-administered paper-based survey which was distributed and collected between October through December 2019. The study participants were nurses from 11 public hospitals located in two Iraqi provinces. Binary logistic regression was used to measure the relationship between the independent SEIPS factors (persons, organizations, tools, tasks, and environments) and the incidence of ADEs (outcome variable). Results: The study recruited 603 nurses (68.3% men) from 11 public hospitals across two provinces. Less than half (48.8%) of the nurses received enough training to detect ADEs, 43.1% had adequate experience to detect ADEs, and 69.8% had to report ADEs in a special record. More than three-quarters (78.4%) believed that their jobs need fast work. Two of the five SEIPS model domains had significant negative association with the incidence of ADEs including organization (nurse-physician collaboration) and nurse experience in ADE detection. Conclusions: Nursing staff face several challenges to prevent and minimize ADEs including shortages in nurses, inadequate nurse experience in ADE detection, no training for ADE detection was received, fear of reporting ADEs, and a lack in monitoring equipment. Increasing nurse/patient ratio and providing more monitoring equipment and training courses can minimize ADEs and enhance their detection.

• Internet hospital patient safety is a complex systems engineering issue. • Constructing an indicator system for patient safety risk factors based on SEIPS model. • Establishment of a hierarchical structure for the patient safety risk. • Using the Dematel-ISM method to analyze the influencing mechanism between risk factors. • Identifying key risks and root cause factors for patient safety in internet hospitals. The purpose of this study was to identify key risk factors and their interrelationships for patient safety in internet hospitals from a system perspective, using mixed methods of qualitative and quantitative analysis. This study constructed a comprehensive indicator system of patient safety risk factors in internet hospitals by qualitative analysis using the Patient Safety Systems (SEIPS) model as a framework. Risk factors were initially identified through a literature review and subsequently refined using a Delphi survey involving 24 experts related to internet hospitals in China. The identified indicators were quantitatively analyzed to determine key risk factors and their influencing mechanism using the Decision Making Trial and Evaluation Laboratory (DEMATEL) and Interpretive Structural Modeling (ISM) methods. The qualitative analysis established a patient safety risk factor indicator system for internet hospitals, comprising 23 elements across six dimensions. Quantitative analysis employing the DEMATEL-ISM approach revealed that risk management has the highest centrality. Among cause factors, task complexity exerts the most significant impact on other factors, while network information security exhibits the highest absolute value among result factors. Risk factors are categorized into three levels: surface, deep, and root factors, with task complexity, legal and regulatory, and guidance policy being the root factors at the foundation of the system. Our study offered a systemic perspective on analyzing risk factors for patient safety in internet hospitals. Policymakers and managers of internet hospitals should take advantage of the interrelationships among these factors to mitigate patient safety risks by effectively controlling key factors. In the rapidly evolving landscape of internet hospitals, ensuring patient safety is paramount. This study aimed to comprehensively identify and understand key risk factors influencing patient safety within these digital healthcare platforms. Using mixed methods of qualitative and quantitative analysis, the study examined the intricate interplay of factors affecting patient safety. Our methodology involved constructing a risk factors indicator system based on the Patient Safety Systems (SEIPS) model. By employing the integrated Decision-Making Trial and Evaluation Laboratory along with the Interpretive Structural Modeling method, we unveiled the core risk factors and their intricate relationships. Recognizing the interconnectivity of these factors allows us to develop effective risk mitigation strategies that enhance patient safety in internet hospitals. This study encourages stakeholders to leverage the dynamic relationships among these factors to ensure safer online healthcare experiences for patients. [ABSTRACT FROM AUTHOR]

Introduction: Telemedicine use in nursing homes (NHs) expanded during the COVID-19 pandemic. The objectives of this study were to characterize plans to continue telemedicine among newly adopting NHs and identify factors limiting its use after COVID-19. Methods: Key informants from 9 Wisconsin NHs that adopted telemedicine during COVID-19 were recruited. Semi-structured interviews and surveys were employed to identify participant perceptions about the value of telemedicine, implementation challenges encountered, and plans and barriers to sustaining its delivery after COVID-19. Directed content analysis and a deductive thematic approach using the Systems Engineering Initiative for Patient Safety (SEIPS) model was used during analyses. Quantitative and qualitative data were integrated to identify participant views on the value of telemedicine and the tools and work system enhancements needed to make telemedicine easier and more effective. Results: All participating NHs indicated a preference to continue telemedicine after COVID-19. Urgent assessments of resident change-in-condition and cognitively based sub-specialty consultations were identified as the encounter types most amenable to telemedicine. Reductions in resident off-site encounters and minimization of resident therapy interruptions were identified as major benefits of telemedicine. Twelve work system enhancements needed to better sustain telemedicine were identified, including improvements to: 1) equipment/IT infrastructure; 2) scheduling; 3) information exchange; and 4) telemedicine facilitators. Discussion: NHs that adopted telemedicine during COVID-19 wish to continue its use. However, interventions that enhance the integration of telemedicine into NH and off-site clinic work systems require changes to existing regulations and reimbursement models to sustain its utilization after COVID-19. [ABSTRACT FROM AUTHOR]

The objective of this study was to measure organization factors that can influence the ability of nursing staff to prevent and detect ADEs in public hospitals using Systems Engineering Initiative for Patient Safety (SEIPS) model. This was a multi-center cross-sectional study. The study included a self-administered paper-based survey which was distributed and collected between October through December 2019. The study participants were nurses from 11 public hospitals located in two Iraqi provinces. Binary logistic regression was used to measure the relationship between the independent SEIPS factors (persons, organizations, tools, tasks, and environments) and the incidence of ADEs (outcome variable). The study recruited 603 nurses (68.3% men) from 11 public hospitals across two provinces. Less than half (48.8%) of the nurses received enough training to detect ADEs, 43.1% had adequate experience to detect ADEs, and 69.8% had to report ADEs in a special record. More than three-quarters (78.4%) believed that their jobs need fast work. Two of the five SEIPS model domains had significant negative association with the incidence of ADEs including organization (nurse-physician collaboration) and nurse experience in ADE detection. Nursing staff face several challenges to prevent and minimize ADEs including shortages in nurses, inadequate nurse experience in ADE detection, no training for ADE detection was received, fear of reporting ADEs, and a lack in monitoring equipment. Increasing nurse/patient ratio and providing more monitoring equipment and training courses can minimize ADEs and enhance their detection. [ABSTRACT FROM AUTHOR]

BACKGROUND: Due to their physically and mentally demanding job, nurses are exposed to high risk of fatigue and musculoskeletal disorders, through which their work ability could be adversely affected. OBJECTIVE: This study aims to identify factors influencing nurses' work ability by using a macroergonomic model. METHODS: Descriptive and qualitative analyses were carried out in two phases of the study. First, 41 nurses of the cardiac intensive care unit in a military hospital in Iran filled in the work ability questionnaire (WAI). In the second phase, in order to identify factors influencing work ability of the nurses, a semi-structural interview within the framework of the System Engineering Initiative for Patient Safety (SEIPS) model was conducted. Consequently, data were analysed and compared by multiple experts using directed content analysis method. RESULTS: The mean work ability of the nurses was 40.01±4.05 (good work ability). 22 themes were identified through the directed content analysis and they were classified in 5 categories of the SEIPS model including environment, tools and technology, task, person, and organization. CONCLUSIONS: Using a macroergonomic approach proved to be valuable in identifying factors influencing work ability of nurses. These factors should be considered by managers and HFE practitioners designing intervention programs to improve nurses' work ability. [ABSTRACT FROM AUTHOR]

Background: The expansion in terms of available treatment options and models of care has led to a growing global momentum for outpatient antimicrobial therapy (OPAT) services. A systematic review was undertaken to explore Human Factors aspects relating to OPAT service delivery and to evaluate whether OPAT is amenable to description using the Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model.Method: Following a preliminary search, a search string was applied to four databases, including Medline, Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts and PsychINFO. Inclusion criteria ensured only articles published after the year 2000 and written in English were accepted. The methodological quality of studies was assessed by three reviewers. Narrative synthesis was performed to uncover the key interactions between work system entities which underpin OPAT processes and outcomes as described using the SEIPS 2.0 model.Results: A total of twenty-seven studies were deemed eligible for the final review. Of these, most described sample populations representative of the population under study, while duration of the studies varied from a few months to years. Some studies evaluated a single model of care whilst others evaluated all three currently available models. The breadth and scope of the studies included enabled extraction of rich Human Factors data describing barriers and enablers to service provision.Conclusion: OPAT is a service which offers significant benefits to both patients and care providers. These benefits include patient satisfaction and wellbeing, as well as financial performance. OPAT is a complex sociotechnical system, and a systems approach may offer the opportunity to enhance system design, maximising system performance. This review demonstrates that the service can be better understood using the SEIPS 2.0 model to identify key work system interactions that support performance. [ABSTRACT FROM AUTHOR]

Background and Objective: Medication errors in nursing homes are highly prevalent and occur in different stages of the medicines pathway. The application of the SEIPS (System Engineering Initiative for Patient Safety) model facilitates the identification of work system factors that contribute to errors. Therefore, the aim of our research was to investigate in-depth the medicines pathway in nursing homes by using the SEIPS model and to develop a set of key activities and aggregated key interventions to be used as a basis for quality-improvement strategies.Methods: A variety of qualitative methods, including observations, semi-structured interviews, the development of a flowchart, an expert meeting and a working symposium, were used to identify processes and work system components. Key interventions and activities were developed in three rounds (one development and two validation rounds) across the different research methods to fine-tune the defined key interventions and activities.Results: Our analysis revealed a large variety of tasks as well as persons elements, aspects related to technology and tools, organisational factors and environmental elements that all interact and influence the medicines pathway. The large number of tasks could be linked to eight overarching processes: prescribing, purchase and ordering, delivery, storage, preparation, administration, monitoring and (re-)admission. After three rounds (one development and two validation rounds), a final set of 137 key activities and 27 aggregated key interventions, concretising the eight processes, was obtained.Conclusion: The in-depth analysis of processes within the medicines pathway in nursing homes resulted in a set of key activities and aggregated key interventions which may serve as a basis for the nursing home sector and policy makers to enhance a safe and efficient medicines pathway. [ABSTRACT FROM AUTHOR]

Background and Objectives: Patient safety is a global concern that can be influenced by the components of working system in medical settings. The present study was carried out to investigate the relationship between the working systems of nursing staff with patients’ safety in Zanjan hospitals in 2014. Materials and Methods: In this cross-sectional study, nurses were recruited to the study using stratified random sampling method. Regarding working systems, a modified questionnaire of the Carayon and Honaker was used to collect data. The questionnaire was arranged on a Likert type 5-score scale. The validity of the questionnaire was confirmed using the experts’ viewpoints and the reliability was confirmed using the Cronbrachchr('39')s alpha coefficient (0.89). The standard questionnaire of the World Health Organization was used to collect data on patients’ safety. We used the structural equation modeling in the LISREL to analyze the data. Results: Components of the system played an important role in patient safety. With probability of 99% (except for one component), there was a significant relationship between the working system and patients safety. Conclusion: Regarding the results of this study, components of working systems influenced patient safety in health care centers. To improve patientchr('39')s safety in hospitals, attention should be paid to all components of a working system to prioritize its components.

Purpose Medication safety and error reduction has been studied in acute and long-term care settings, but little research is found in the literature regarding mental health settings. Because mental health settings are complex, medication administration is vulnerable to a variety of errors from transcription to administration. The purpose of this study was to analyze critical factors related to a mental health work system structure and processes that threaten safe medication administration practices. Background The Systems Engineering Initiative for Patient Safety (SEIPS) model provides a framework to analyze factors affecting medication safety. The model approach analyzes the work system concepts of technology , tasks , persons , environment , and organization to guide the collection of data. Methods In the study, the Lean methodology tools were used to identify vulnerabilities in the system that could be targeted later for improvement activities. The project director completed face-to-face interviews, asked nurses to record disruptions in a log, and administered a questionnaire to nursing staff. The project director also conducted medication chart reviews and recorded medication errors using a standardized taxonomy for errors that allowed categorization of the prevalent types of medication errors. Results Results of the study revealed disruptions during the medication process, pharmacology training needs, and documentation processes as the primary opportunities for improvement. The project engaged nurses to identify sustainable quality improvement strategies to improve patient safety. Conclusion The mental health setting carries challenges for safe medication administration practices. Through analysis of the structure, process, and outcomes of medication administration, opportunities for quality improvement and sustainable interventions were identified, including minimizing the number of distractions during medication administration, training nurses on psychotropic medications, and improving the documentation system. A task force was created to analyze the descriptive data and to establish objectives aimed at improving efficiency of the work system and care process involved in medication administration at the end of the project. [ABSTRACT FROM AUTHOR]

Objectives The objectives of this review were to identify the work system factors influencing medication safety measures [adverse drug events (ADEs), adverse drug reactions, or medication errors (MEs)], to determine the incidence of ADEs, and describe the most common ADEs in nursing homes (NHs). Methods A comprehensive literature review was conducted using PubMed and CINAHL to identify studies investigating factors that influence ADEs, adverse drug reactions, and MEs in NHs and skilled nursing facilities. An initial search identified related studies over 3 decades (1985-2016). Studies were classified according to Systems Engineering Initiative for Patient Safety model factors. Results Sixty studies were included in this review, which identifies 5 categories of work system factors affecting medication safety in NHs: persons (resident and staff), organization, tools and technology, tasks, and environment. The personal characteristics of NH residents included age, number and types of scheduled medications, and number and types of comorbidities. In addition, inadequate nursing staff medication knowledge and training are usually associated with administration MEs. Organizational factors include interprofessional collaboration, physician and pharmacist accessibility, and staff/resident ratio. A high staff number plays an essential role in preventing MEs and fracture incidents. The technology (barcode medication system) and tools (ME-reporting systems, ADE trigger tool, and potentially inappropriate medication criteria) can enhance the detection of MEs and ADEs. Workload and time pressure negatively impact NH staff task performance. Use of an ADE trigger tool by healthcare providers enhanced the ability to identify ADEs more than 50-fold over 6 months. Several environmental characteristics such as staff distraction and interruption negatively influence medication safety in NHs. The incidence rates of ADEs in NHs ranged from 1.89 to 10.8 per 100 resident-months. The most common ADEs were bleeding, thromboembolic events, hypoglycemia, falls, and constipation. Conclusions The Systems Engineering Initiative for Patient Safety model is a useful framework for investigating the factors contributing to ADEs. Multiple work-system factors affect the medication safety of NH residents. A comprehensive study is needed to quantify the influence of various work-system factors on ADEs in NHs. [ABSTRACT FROM AUTHOR]

Patients with Clostridium difficile infection (CDI) are placed in contact precautions. We surveyed 31 visitors of CDI patients to understand their compliance, knowledge, and perceptions of contact precautions. Although most visitors knew where to find the required personal protective equipment, only 42% were fully compliant with gown and gloves. Family members accounted for 90% of visitors, and roughly half of the reasons given for not gowning were related to a lack of perceived risk for family members. Nursing staff are fundamental sources of personal protective equipment (PPE) information for visitors; however, we found variation in staff communication regarding need for visitor PPE use. [ABSTRACT FROM AUTHOR]

Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified 12 projects representing 23 studies and addressing different physical, cognitive and organisational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care. Practitioner Summary:Existing evidence shows that HFE-based healthcare system redesign has the potential to improve quality of care and patient safety. Healthcare organisations need to recognise the importance of HFE-based healthcare system redesign to quality of care and patient safety, and invest resources to integrate HFE in healthcare improvement activities. [ABSTRACT FROM PUBLISHER]

Abstract: Human factors systems approaches are critical for improving healthcare quality and patient safety. The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is a human factors systems approach that has been successfully applied in healthcare research and practice. Several research and practical applications of the SEIPS model are described. Important implications of the SEIPS model for healthcare system and process redesign are highlighted. Principles for redesigning healthcare systems using the SEIPS model are described. Balancing the work system and encouraging the active and adaptive role of workers are key principles for improving healthcare quality and patient safety. [Copyright &y& Elsevier]

Healthcare practitioners, patient safety leaders, educators and researchers increasingly recognise the value of human factors/ergonomics and make use of the discipline's person-centred models of sociotechnical systems. This paper first reviews one of the most widely used healthcare human factors systems models, the Systems Engineering Initiative for Patient Safety (SEIPS) model, and then introduces an extended model, ‘SEIPS 2.0’. SEIPS 2.0 incorporates three novel concepts into the original model: configuration, engagement and adaptation. The concept ofconfigurationhighlights the dynamic, hierarchical and interactive properties of sociotechnical systems, making it possible to depict how health-related performance is shaped at ‘a moment in time’.Engagementconveys that various individuals and teams can perform health-related activities separately and collaboratively. Engaged individuals often include patients, family caregivers and other non-professionals.Adaptationis introduced as a feedback mechanism that explains how dynamic systems evolve in planned and unplanned ways. Key implications and future directions for human factors research in healthcare are discussed. Practitioner Summary: SEIPS 2.0 is a new human factors/ergonomics framework for studying and improving health and healthcare. It describes how sociotechnical systems shape health-related work done by professionals and non-professionals, independently and collaboratively. Work processes, in turn, shape patient, professional and organisational outcomes. Work systems and processes undergo planned and unplanned adaptations. [ABSTRACT FROM AUTHOR]

The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is described and selected research and practical applications are presented. [ABSTRACT FROM AUTHOR]

Objective: Cystic fibrosis (CF) is a genetic disease that requires complex, lifelong treatment regimens to maintain health and reduce disease progression. The aims of this study were 1) to gain the perspectives of multiple health professions to understand medication and well-being challenges of people living with CF; and 2) to apply the Systems Engineering Initiative for Patient Safety (SEIPS) model to further identify opportunities for pharmacists to support people with CF., Methods: Health care professionals were recruited from a Cystic Fibrosis Center in the Midwest, to participate in audio-recorded semistructured interviews. Topics examined during the interviews included medication education for patients as well as experiences with outpatient, specialty, and community pharmacists. The themes assessed during the pharmacist interviews included support for people living with CF, preferences in conducting medication education, and pharmacist-specific counseling. Interview transcripts were thematically analyzed into categories to determine major themes. Prevalent codes were categorized into 5 major themes guided by the SEIPS model. Interrater reliability was strong (kappa = 0.94)., Results: Five major themes were identified: 1) patient tasks; 2) external environment; 3) organizational conditions; 4) patient medication education; and 5) pharmacists' roles and tasks. Professionals identified the importance of the pharmacist on the multidisciplinary CF care team to enhance patient-centered care for people living with CF., Conclusions: This study highlights health care professionals' views on the unique skillset that pharmacists add to the care team, including a reduction in medication errors, improved adherence, and overall enhanced patient care., Competing Interests: Disclosures. The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis., (Copyright. Pediatric Pharmacy Association. All rights reserved. For permissions, email: mhelms@pediatricpharmacy.org 2022.)

The US Institute of Medicine and healthcare experts have called for new approaches to manage healthcare quality problems. In this chapter, we focus on macroergonomics, a branch of human factors and ergonomics that is based on the systems approach and considers the organizational and sociotechnical context of work activities and processes. Selected macroergonomic approaches to healthcare quality and patient safety are described such as the SEIPS model of work system and patient safety and the model of healthcare professional performance. Focused reviews on job stress and burnout, workload, interruptions, patient-centered care, health IT and medical devices, violations, and care coordination provide examples of macroergonomics contributions to healthcare quality and patient safety. Healthcare systems and processes clearly need to be systematically redesigned; examples of macroergonomic approaches, principles and methods for healthcare system redesign are described. Further research linking macroergonomics and care processes/patient outcomes is needed. Other needs for macroergonomics research are highlighted, including understanding the link between worker outcomes (e.g., safety and well-being) and patient outcomes (e.g., patient safety), and macroergonomics of patient-centered care and care coordination.

Unlabelled: Handovers permeate healthcare delivery systems. They are critical for patient safety and continuity of care, but also for logistics and clinical efficiency. Poor handovers can cause reduced efficiency, delayed discharge or time to operation, and contributes to patient harm. The Objective was to conduct a human factors assessment (HFA) using a systems approach to study the handover process at an Orthopaedic unit, determine barriers to information transfer, and suggest improvements. A direct observation model was used to help provide insights on the evening handover process. A Systems Engineering Initiative for Patient Safety (SEIPS) model was used to provide a framework. A total of ten handover sessions were observed and the junior doctors were interviewed using a semi-structured approach. Participants had two chief centres of complaint: workspace and environmental issues (such as a small, hot, uncomfortable room), and the lack of the junior house officer at handover leading to 'signal loss' with respect to sick patients who may not be handed over fully. The process also lacked standardisation and structure compounding the potential loss of information., Conclusion: Good handover remains a cornerstone of safe and effective clinical practice and continuity of care. This study has shown how an HFA can be useful in determining problems with the handover process locally. It suggests an approach for improvement and recommends better training at all levels in this aspect of patient care.