Human factors has been largely ignored by healthcare information technology over the past few decades. In our rush to automate, vendors and software designers did the minimum to make their products usable. However, as staff challenges rock the healthcare industry, greater attention is being paid to the impact that technology has on staff. Human factors is now in the spotlight.
On the next HCLDR tweetchat on March 7th at 8:30pm ET guest host Andre Kushniruk, PhD @AndreKushniruk will be leading the community in a discussion on Human Factors. Below is a wonderful blog from Kushniruk to provide context for that discussion.
Special thank you to Canadian College of Healthcare Leaders @CCHL_CCLS for helping to make this discussion possible.
By Andre Kushniruk, PhD
Increased automation and use of information technologies has the potential to modernize, streamline and improve healthcare, leading to improved patient outcomes. Huge amounts of money and resources have been expended in the design, development and deployment of a wide range of health information technologies and digital health applications. This has included electronic health records, clinical decision support systems, and a myriad of applications designed for use by patients and lay people. The range of systems and applications, as well as the range of users has grown and continues to increase exponentially.
However, despite the effort to deploy useful and usable systems and applications, there are reports of end user dissatisfaction with many of these systems and applications. This has been reported by all types of users from clinical to management to patients and lay people and it is a global phenomena. Indeed many systems have failed to be adopted due to a lack of usability, insufficient training and also reports that some systems may actually end up being safety issues when deployed in complex hospital and clinical settings. This is despite the large amounts of money, effort and resources that has gone towards increased automation with the ultimate goal of improving healthcare.
Lack of consideration of human factors in their design and deployment is perhaps the single most critical reason behind many of these user issues. This includes the need for better understanding the needs of end users of healthcare IT, which can include health professionals as well as patients and lay people who may be interacting with portals, health apps and many other applications. Indeed statistics from the field of software and usability engineering have shown that lack of user involvement in design and deployment of systems is typically the largest single factor implicated in the failure of IT projects . No where is this more the case than in healthcare.
To address the above issues, there is much we can learn from the study of human factors, which is a field focussed on the study of understanding the relationship amongst humans and the tools they used. As a subfield of human factors, human-computer interaction (HCI) is now a well developed field with a range of practical methods and design approaches for analyzing and improving the interaction among humans and information technology . These approaches (which have been applied in a range of other domains) can be used to develop more useful and usable health information systems. However, there is clearly a knowledge gap between expertise in HCI and the application of its principles and methods to improving the usability of healthcare information systems.
Over the past several decades, we have advocated for increased awareness of what some of the methods and approaches from HCI at all organizational levels, from the system implementation groups to the C-suite of all healthcare organizations responsible for healthcare IT. There are a wide range of methods that can be applied throughout the development life cycle of healthcare information systems, including interviews, observation, usability testing, and user tracking to name a few. Many of these methods can applied early on from analysis through to design and implementation of new healthcare IT . There is a need not only for human factors practitioners, but also for healthcare managers and decision makers to become more aware of and more fully understand some of these approaches, including their advantages and limitations (and when to select from the many possible approaches). In addition, a number of approaches from the study of HCI in healthcare can be applied to ensure the selection and procurement of vendor-based systems that better match the buying organization, ultimately leading to increased system adoption, end user satisfaction and economic benefits .
It is critical that the ultimate users of systems and all relevant stakeholders (e.g. doctors, nurses, patients, IT staff, hospital management etc.) be involved in the design and deployment decisions of systems in order to increase the likelihood of adoption. Human factor issues and concerns such as end users’ level of understanding of systems, e-health literacy, information needs, workflow and training needs as well as the capabilities, desires and goals of end users need to be more fully illuminated and understood in our healthcare IT projects and digital health initiatives.
Greater understanding and consideration of human factors will lead to much improved chances of successful system adoption and ultimately better return on investment. Along these lines, we have found that involving users in the process of deploying healthcare IT leads to greater involvement and stakeholder perception of ownership in healthcare IT projects . In addition, allowing users to provide input and feedback early and throughout the design, implementation and deployment of systems in healthcare has been shown to be improved and to lead to more usable systems and higher likelihood of adoption .
To advance the fields of human factors to improve healthcare, methods and approaches from human factors work need to be more fully disseminated and better understood by all involved (including all levels of management) in digital health endeavours in healthcare.
To discuss some of these issues you are invited to join the HCLDR Tweetchat on Tuesday, March 7 at 8:30 EST (for your local time click here) where we will consider the following topics/questions:
- What aspects of information technology in healthcare do you feel needs to be improved the most for clinicians or for patients?
- What tactics or methods have you found to be effective in gathering product/usability/human-factors feedback – especially for healthcare staff – Surveys? Interviews with stakeholders? Focus groups? Usability testing?
- What can leaders do to better demonstrate that they take human-factors and feedback from their staff seriously, particularly as it relates to system safety?
- What approaches have worked in other sectors that may work in healthcare?
About the Author
Andre Kushniruk, PhD, is Director and Professor of the School of Health Information Science at the University of Victoria. Dr. Kushniruk conducts research in a number of areas including evaluation of the effects of technology, human-computer interaction in healthcare and other domains as well as cognitive science. His work is known internationally and he has published widely in the area of health informatics. He focuses on developing new methods for the evaluation of information technology and studying human-computer interaction in healthcare and he has been a key researcher on a number of national and international collaborative projects.
- Kujala, S. (2003). User involvement: a review of the benefits and challenges. Behaviour & information technology, 22(1), 1-16.
- Kushniruk, A., & Borycki, E. (2022, November). Human factors in healthcare IT: Management considerations and trends. In Healthcare Management Forum (p. 08404704221139219). Sage CA: Los Angeles, CA: SAGE Publications.
- Kushniruk, A. W., & Patel, V. L. (2004). Cognitive and usability engineering methods for the evaluation of clinical information systems. Journal of biomedical informatics, 37(1), 56-76.
- Kushniruk, A., Beuscart-Zephir, M.C., Grzes, A., Borycki, E., Watbled, L., Kannry, J. (2010). Increasing the safety of healthcare information systems through improved procurement: Toward a framework for selection of safe healthcare systems. Healthcare Quarterly, 13:53-8.
- Kushniruk, A., & Nøhr, C. (2016). Participatory design, user involvement and health IT evaluation. Studies in Health Technology and Informatics222, 139-151.
Human factors in healthcare IT: Management considerations and trends – Andre Kushniruk, PhD
Healthcare Management Forum, March 2023, All about health informatics and features articles about many aspects of digital health today.
Event listing (with participation instructions): HMF Tweetchat – Human factors in healthcare information technology design