Human Factors Simulation Lab Fact Sheet

High-fidelity simulation of human factors and their relation to quality of care and safety

The increasing attention to patient safety has produced considerable interest in the promise of new technologies in the health care arena as a potential contributor to patient safety. Yet, research findings from various domains have also demonstrated that some new health technologies can, in fact, increase rather than decrease errors in health care, because of the challenges that new technologies produce for the human beings that need to interact with the new technologies. This reality has produced a new domain of research focusing on simulated assessments of the interaction between putative new technologies for the health care setting and the providers who would be the users of the technologies in an applied setting. Beyond the assessment of human-technology interactions, this general domain of research also targets the study of the effects of fatigue, distraction, team communication and technology on health care provider performance.

An accepted six-step research template (for both low and high fidelity) will be followed by the leaders (Caird, Davies, White, Clinton, Carpendale, McLaughlin) of the human factor simulation research agenda to be conducted in relation to the W21C initiative. These steps include: 1) User selection (i.e. individuals who are representative of those who will use technologies in an applied setting); 2) task selection (i.e., identification of the specific tasks that users are to undertake with a specific technology in an applied setting; 3) scenario design (with attention to the range of scenarios to ensure that the scenarios selected represent the range of situations that are likely to be encountered in an applied setting; 4) selection of equipment and recording methods; 5) data collection using selected equipment; and 6) data analysis (a process that usually involves qualitative data analysis of coded transcripts and/or video images.

The unique features of the W21C ‘living laboratory’ permits high fidelity simulation (i.e. simulation that closely reproduces the real-world situations under study), because the steps of user selection, task selection, and scenario design (i.e. steps 1-3) will be driven by the ‘real-world’ clinical care and provider needs emanating from the W21C clinical care environment. Furthermore, the simulation lab construction and equipment sought through this infrastructure funding application will yield a sophisticated simulation laboratory that will permit the type of high fidelity simulation required to performing cutting-edge research into the human-technology interface.

We now proceed to describe a specific research initiative that will be undertaken in the simulation laboratory, to focus reviewers on the type of work that will be performed in this area. Medication delivery carts -- mobile carts that nurses move from area to area on hospital wards for medication delivery to patients at the point of care -- are an area of focus in the domains of safety and pharmacy services, as they have been recognized through Calgary Health Region usability engineering to be a source of errors in health care. Current versions of medication carts in use in Calgary Health Region hospitals are, for the most part, sophisticated storage carts, that in their current form do not have inherent capacity for point-of-care information flow to providers (e.g. prompts for providers to avoid errors of omission when dispensing medications, and/or alarms to notify providers if they are about to dispense a medication incorrectly). There is also concern that medication dispensing from medication delivery carts is particularly vulnerable to error when the process of dispensation is either interrupted or paused for any reason. In addressing these issues, the multi-disciplinary W21C research team will undertake multi-phase research into medication delivery carts that will begin with conduct of focus groups and one-on-one interviews involving providers to prioritize concerns around the design of these carts (i.e. their structural characteristics) and medication delivery performed from the carts (clinical process). This will then be followed by a process of hazard identification and validation through the identification and testing of perceived hazards in the W21C simulation facility. Once specific hazards are identified and validated as hazards, an iterative process of cart redesign and simulated evaluation will be undertaken in the simulation laboratory setting, followed by a phased evaluation of redesigned carts in the applied clinical setting (-- a sequence that exemplifies the power of our ‘living laboratory’ model for producing innovation in health care). The culmination of this research may produce W21C technology commercialization opportunities, if a re-engineered cart with proven benefits can be developed. It is also expected that this program of work may integrate other technologies being assessed in relation to W21C such as RFID/WiFi and/or modified smart cameras (i.e. the ‘coupled’ application of new technologies).

The work described above for medication delivery carts typifies the approach that will be taken to research into a variety of safety and error simulation scenarios. The W21C human factors team is composed of internationally recognized scholars in patient safety and human factors, and includes collaborators in the Faculties of Social Science (Caird), Medicine (Davies), Nursing (White, King), and Computer Science (Carpendale).