Convergence: Breaking Down Barriers Between Disciplines

Laparoscopic surgery often results in static, uncomfortable arm and upper body postures, which lead to high stress on the surgeons' upper extremities. To counteract this, an interaction-based arm assistance system has been developed to physically unload the surgeon’s upper extremities during laparoscopic procedures. This is achieved by actively supporting the forearms with a supporting force following the natural movements without restrictions. The release of the forearms from the system is achieved by a rapid vertical movement of the arms. The assistance system is controlled exclusively by a form fit and frictional connection of the forearms. Within the scope of this research project, the interface parameter form of the forearm rest is therefore investigated on the basis of five anthropomorphic shape variants of the form with dynamic and static tasks. The study shows an influence of percentile-adapted forms on the usability of forearm supports at an arm assistance system. The form percentile results in no correlation to the objective parameters examined in this study: the number of errors or errors per second. There are differences in the perception of comfort by different subject percentiles. The post-study survey shows that subjects prefer form percentiles close to their own forearm percentile and, on the other hand, find forms that are too large or small uncomfortable. Design recommendations and dimensional recommendations for the design of open anthropomorphic forms for the interaction with arm assistance systems are derived from the results.

Studies on finger kinematics, especially the range of motion (RoM) measurements, are essential to understand the use of finger joints and the pathology of related disease. Limited literatures compared the active RoM (A-RoM) of finger joints with either their functional RoM (F-RoM) or passive RoM (p-RoM) using different measuring protocols and tools. This study aims to provide an overall comparison including all three types of RoMs. We measured A-RoM, F-RoM, and P-RoM, using a dynamic measurement system. Our goal is to investigate the relationships among the three RoMs by comparing their extreme rotation angles. The results suggested that P-RoM was the largest motion range, and F-RoM can exceed their A-RoM. The F-RoM of distal-interphalangeal joints may rotated 8–20° more than their A-RoM, mainly during precise and power manipulations. Besides to A-RoM, knowledge of F-RoM and P-RoM are also important for a comprehensive understanding for clinical practice, and thus, to support the optimization and evaluation of treatment devices for finger joint, such as implant replacement.

For many health care professionals, transferring patients poses a substantial risk to develop musculoskeletal disorders. Reducing manual handling during these patient transfers by proper use of adequate tools can lower the number of injuries and the duration of unavailability for work. A challenging case for patient positioning is seen in spine surgery in the procedure that is known as proning: after sedation, the patient is rolled over and then positioned onto supporting thoraco-pelvic supports (the prone position). This way of patient positioning is normally carried out manually, where the patient is either tilted or lifted. In this study, we compare three proning methods: working with inflatables (one for the proning and another one for the prone position), manually lifting and manually tilting the patient onto the thoraco-pelvic supports. Surface electromyography of the m. erector spinae and the m. trapezius pars descendens is used to evaluate the effect of using inflatables for proning and prone positioning in neurosurgical procedures. Prone positioning with inflatables generally results in less strain (lower median as well as peak surface electromyography results) compared to positioning without inflatables. Compared to manual lifting the results where significant for all investigated muscles. Compared to manual tilting the results show also significantly lower muscle strain, except for the peak strain in the lower back. From the comparison between both manual methods (lifting and tilting), no preference can be expressed for either method.

Cognitive ergonomics implies understanding how people make decisions, and how to design safer systems for the people involved. Understanding how experts in medication safety management think and make decisions, give a new vision of how to design safer systems. A study was achieved for characterizing ergonomic cognitive and metacognitive processes developed by some experts in medication safety (pharmacists, doctors, nurses) solving problems related to unsafe medication (prescription, preparation, dispensing, and administration). Using a “think aloud” methodology was possible to identify how the experts think and which are the principles to have in mind for designing safer medication management processes. We found that the experts think about the goal in a task, balancing how to keep a Patient out of risk against it, this requires planning and developing task-oriented thinking in mitigating every risk rather than just performing the task. While monitoring the task, experts reflect on whether the patient is responding in the same way as would be expected. Any alteration of the medication’s therapeutic effect may be the result of a possible mistake. They find a better way of controlling the task by taking alternative decisions using their knowledge and previous experiences for developing their task. Using a critical mindset, they modify their actions dynamically in the process. Finally, evaluation includes a metacognition process to identify improvement opportunities, which could be used in situations they might face later. Using cognitive and metacognitive process descriptions is possible to design a safer medication system.

Medication label design is among the frequent contributing factors to medication errors in clinical practice settings. Several safety organisations have published recommendations on the design of optimal medication labels. Objectives: This study aims to uncover perceptions of the new labelling design developed under those recommendations by a pharmaceutical company compared to its existing labels and characterise participants’ opinions of usability and medication safety. Method: A descriptive study using a structured version of the focus group method was undertaken. A convenience sample of twelve pharmacists and eight nurses with experience in medication management and working at two critical hospital departments (emergency and intensive care unit) were recruited and participated in four focus groups. Group discussions were audio recorded and thematically analysed. Results: Several positive opinions on the new labelling were identified, from less effort in identifying critical information due to the use of colour, enhanced contrast and tall lettering for LASA medicines to improvements in participants’ perceived safety. However, also feedback was received for those labelling features that still need improvement. This study provides evidence of the effectiveness of adopting the human-centred design principles suggested by medication safety agencies.

The objective is to determine the level of exposure of workers to ergonomic risk through the application of the Handling and Assistance to Hospitalized Patient Tool (MAPHO). This is a descriptive cross-sectional study in a General Critical Unit of a private philanthropic hospital in the state of São Paulo. The study was carried out through the evaluation of the environment, work tools, dependency profile, and aspects of work organization. A medium level of exposure of workers to ergonomic risk was determined, through the score obtained in the tool, mainly arising from the absence of employee training and an insufficient number of assistive devices for lifting patients. The study confirmed the importance of health institutions investing in the acquisition of an adequate number of auxiliary devices for patient handling, in the adequate training of the nursing team, and inadequate storage places for them in order to collaborate with occupational health. It is understood that this study will help in the elaboration of proposals for a local intervention directed to the critical information pointed out by the tool.

A multi-disciplinary team of professionals applied ergonomic tools, and principles to investigate reports of musculoskeletal injuries among Medical Radiation Technologists (MRT), working in a designated X-ray imaging suite in an academic acute care hospital. Following this investigation, a proposal was submitted for the purchase of new X-ray equipment. This study demonstrates how end-users applied ergonomic and human factor principles during the new equipment selection process.

At the start of the COVID-19 pandemic, Intensive Care Units (ICUs) admitted an unusually high number of patients suffering from the most severe respiratory effect of the disease. The clinicians worked in teams in a context where resources were limited, and efficient resource management was key to ensure on-time healthcare delivery. Our team of researchers adopted the situation awareness (SA) model to design a SA-oriented dashboard. The main research objective was to improve clinicians’ situation awareness, through the visualization of resource management key indicators to perceive on what is going on, comprehend its meaning and project future actions. A total of 17 clinicians participated to the dashboard design. We used the conceptual framework of the staff-stuff-space-system-of-care (4S) factors to resource management in critical care. A user-centred design method allowed to define the dashboard key indicators from the clinicians’ situation awareness goals (perceive, comprehend, project) and 4S information requirements. However, the outcomes revealed that little was known on how the 4S factors to the clinician situation awareness contributed to a shared sensemaking and to clinical decision-making among the team members. We found a core factor to a shared sensemaking identified as “health Status at bedside”. This 5th “S” factor informs the clinician team on both the 4S (staff-stuff-space-system regulation) resources in used and the clinical condition at bedside. From then, we identified the 5S factors as the drivers of the clinicians’ cognitive processes in critical care. We synthesized the research outcomes in the Situation Awareness and Shared Sensemaking Decision Model (SASS). We conclude by suggesting that much can be gained from the evaluation of the SASS model in critical care.

Effective governance necessitates going beyond compliance with rules, regulations and procedures; particularly as adverse events are generally the result of a combination of human, organisational, technological, and economic factors. This study explores the use of socio-technical systems analysis (STSA) in an Artificial Intelligence (AI) platform called Access-Risk-Knowledge (ARK) to go beyond established accountability frameworks by linking evidence, outcomes, and accountability. The aim of the ARK-Virus project was to use the ARK Platform to support mindful risk governance of infection prevention and control (IPC) for healthcare organisations during the COVID-19 pandemic. ARK was deployed across three healthcare organisations: a fire and ambulance service, an outpatient dialysis unit, and a large acute hospital. Each organisation conducted an IPC case study, the three of which were then compiled into a synthesis project. A set of guidance principles for a pandemic preparedness strategy were proposed using the synthesis project findings. A Community of Practice (CoP) enabled the successful deployment of ARK, including intense interdisciplinary collaboration and was facilitated by practitioner-researchers in the implementing organisations. Data governance methods and tools supported a whole organisation and multi-organisation approach to risk. This first full implementation trial of the ARK platform deployed dedicated STSA within a semantically structured AI framework, demonstrating accountable risk management that addresses the complex antecedents of risk, links to evidence, and has the potential for managing the full cycle of risk mitigation and improvement.

This paper describes early results of a small qualitative study investigating the potential impact of shopping loyalty card data (SLCD) in the diagnostic pathway for ovarian cancer. There is early evidence that pharmaceutical products such as pain relief and medications for irritable bowel syndrome and bloating are bought by women to manage the early symptoms of ovarian cancer. Designed to be a formative interview study, two General Practitioners (GPs) in England were recruited to discuss the current pathway of ovarian cancer from a primary care perspective and to consider the value and impact of SLCD in medical decision making, and its potential role in supporting improved referral times and patient outcomes. The findings indicate a potential role for SLCD, specifically in extending the diagnostic pathway to support earlier health information seeking and consultation with GPs. Communication with patients about this would need considering in regards to well established understanding about personal health behaviors and the wider system of primary and community care.

Patient satisfaction is becoming increasingly viewed as a key component of high-quality care. The literature has shown relationships between high patient satisfaction and improved patient and hospital outcomes, including profitability (Kelley et al. 2014; Richter and Muhlestein 2017). During their journey, patients are often accompanied by a significant other, family member or friend (care partner) when they go to a medical setting to receive care. Although very important in the patient work system, we know relatively little about who these care partners are and how they experience the care the patient receives. In this study, we examine the experience of care partners of older patients who present to the emergency department (ED) with a fall.

Economic studies have shown that living in poverty may produce a subjective feeling of scarcity, which affects people's cognitive functions and decision-making. Understanding this mechanism could inform healthcare designers on designing inclusive health interventions by considering the psychological scarcity and limited cognitive resources of impoverished individuals. We conducted a psychological experiment to test the impact of psychological scarcity on cognitive function and health decisions of rural residents in China. We randomly assign participants to two financial scenarios (hard vs. easy) with the technique of priming to induce their immediate financial worries. Then we measure cognitive function using Raven’s Progressive Matrices and uncover their decision-making priorities with a budget allocation task. 301 participants finished the study and 264 were included in the main analysis. The results show that both immediate financial worries and cumulative poverty have negative effects on participants’ cognitive performance. Responses to scarcity could lead to attentional focus on limited resources, thereby neglecting long-term health consequences, particularly for the lower income group. Based on the findings, we suggest a number of human factors design considerations that are critical to successful healthcare design.

Older adults who present to the emergency department (ED) sometimes have a negative patient experience. Collaboration between care partners, patients and ED staff is one way to improve the patient experience in the ED, but patient, care partner, and ED clinician perspectives on collaborative work have yet to be studied. The objective of our exploratory study is to compare patient, care partner and clinician perspectives on collaborative work that occurs in the ED. Using data collected from patients, care partners, and ED clinicians during the design of an ED patient journey map, we identified four instances where patients, care partners, and clinicians expressed their perspectives regarding collaborative work. We found that patients, care partners and ED clinicians often had differing perspectives about collaborative work in the ED. For instance, during the intake process, patients report being “checked” by ED clinicians, whereas ED clinicians view this as being “seen”. Patients, care partners, and ED clinicians also shared similar perspectives, such as the importance of an ED care team. Older adult patients, care partners and ED clinicians have some similar and some different perspectives of patient-clinician collaboration in the ED that may affect how they interact with each other and the resulting patient experience.

People with a physically demanding job have an unhealthy disbalance in occupational and leisure-time physical activity (PA). We aimed to understand which contextual factors influence this disbalance, and explore opportunities for lifestyle interventions that could restore this disbalance. We applied a contextmapping study with six production workers from a Dutch coating department. Participants filled in a sensitizing booklet with PA-related activities, and were interviewed afterwards. Participants reported reasons for (not) being active in leisure-time using an experience sampling method. Our results indicate that main reasons for being inactive during leisure time were their believes that occupational PA is enough for a healthy lifestyle, and the need to rest after work. Results show that lifestyle interventions should tackle workers inadequate risk perception and over-exhaustion to empower them to shift their PA behavior in a healthier direction. This indicates the need for a holistic approach targeting both home and working environments.

Human Factors and Ergonomics (HFE) has been recognised as a critical strategy for improving the quality and safety of healthcare systems and increasing the wellbeing of the different stakeholders. Despite efforts to integrate HFE training into healthcare worldwide, there is an unequal situation in different parts of the world. This is the case in Latin American countries, where the dissemination and implementation of HFE in healthcare systems have been slow despite the urgency to do it. This paper presents the case of a Latin American Network of Ergonomics and Human Factors in Healthcare (RELAESA) in its journey to address the need to develop and deliver HFE training for the healthcare community. The case presents five key milestones and their learnings, from creating the network in 2019 to the ongoing collaboration to adapt the Learning Pathway for a Latin American context. The lessons learned show that significant progress has been made in creating awareness of HFE among healthcare practitioners that are committed to undertaking training. However, it also recognised the urgency of increasing the capacity and capability of HFE specialists in the region. It also evidenced that existing educational/training content generated outside Latin America and translated into Spanish requires a more in-depth adaptation that is culturally aware of the conditions and limitations of the public health systems. Future work includes partnering with existing training organisations to translate, culturally adapt and provide access to existing guidance (HF in Health and Social Care White Paper) and formal training (Healthcare Learning Pathway).

Research about operating room (OR)-to-intensive care unit (ICU) handoffs reports barriers and facilitators to the team-based process, but less is known about role-specific challenges and strategies. Based on a secondary analysis of eight interviews with frontline clinicians from two health systems, we identify seven dimensions of role-specific barriers and facilitators to a team-based OR-to-ICU handoff, also referred to as the team huddle in the patient’s ICU room. The seven dimensions are related to three factors: (1) preparing for the patient’s arrival to the ICU, (2) providing information at the team huddle, and (3) participating in the co-located, synchronous team huddle. The role-specific barriers and facilitators describe challenges related to the timing of the team huddle in the patient’s room, which is dependent on the end of the patient’s surgery and therefore cannot be scheduled. Another challenge is that busy clinicians with competing priorities are physically separated across the OR and ICU. Thus, the sending roles from the OR are required to travel with the patient to the ICU while receiving roles prepare for the patient’s arrival. Identifying role-specific barriers and facilitators to a team-based process can inform the design, or redesign. When implemented, the handoff process can positively impact care quality by ensuring important information is shared among team members.

Ward Rounds (WR) are an essential organisational process at the interface between patients, their families/carers and the clinicians who provide their care. WRs are also complex socio-technical systems (STS) involving interactions between people and technology commonly occurring in environments not fit for purpose. This study was undertaken as part of a longitudinal improvement project in relation to WRs taking an STS approach. A STS analysis (STSA) called the Cube was undertaken to understand current ‘AS IS’ WR practice from a Human Factors and Safety Science perspective. Key findings are broken into the domains of the Cube and include the following: Time constraints on all disciplines make it difficult for shared sense-making; Goals are not always shared in relation to the purpose of WRs; there is variation in practice in relation to pre-rounds, board rounds and handover; Safari WRs make relationship-building, collaboration and trust between disciplines difficult; there is a lack of defined outcome metrics for ‘success’ in relation to WRs. This initial STSA has helped us to identify areas which we need to improve. Reforming care for patients who require unscheduled care in acute hospitals is a healthcare priority. Given the resources required by WRs and the pivotal role they play, improving WRs will significantly contribute to this reform.

The research was carried out in the Emergency Room of a private hospital in the city of São Paulo, Brazil. This addressed the activity of mobilizing and removing patients from inside the car, when they arrive at the service. The nursing team presented complaints regarding the lack of standardization and institutional guidelines for practice, which support safety and injury prevention for patients and professionals. The study then sought to carry out an evaluation of the nursing work activity in the vehicular extrication of the patient to identify conditions of the activity, barriers, facilitators and variability. The methodology was an exploratory study with the application of a questionnaire to approach and analyze the characteristics of the population and the vision of the nursing professionals, in complementarity with a structured guided observation of the simulation of the activity by 4 different work teams. As a result, a description of the activities was obtained concerning to: the principle of scene safety, classification of severity according to the patient's assessment, the postures and positioning of the professional's body and the use of equipment. The reflection on this theme points to the need for the development of institutional training and care flows, mentioned as being of importance by the professionals participating in the activity. As a conclusion, it was possible, through concrete data, to dialogue in order to seek new options for modes of operation, as well as to promote future comparisons with other reference centers in the world.

This research and design project is part of the Green ICU initiative and focused on reducing the environmental impact of gloves at the Intensive Care Unit (ICU) of the Erasmus Medical Center (EMC). At the ICU of the EMC around 108 gloves are used per patient per day; to protect the user (healthcare staff) from infections. The high frequency of use and the resource-intensive production define disposable nitrile gloves as one of the ‘hotspots’ contributing to the environmental impact created by the ICU. This research and design project addressed the problem from three different perspectives: user-centred, product-centred and supply-centred. The extensive research resulted in three design directions on how to reduce the environmental impact of gloves. Subsequently, all insights from the research were brought together into five design building blocks. These design building blocks provided guidance for the design phase of the project. The project resulted in a redesign of the current glove dispensers. The final design is named ‘GloVe’, a vertical dispense system. By incorporating the five building blocks, the design can provide benefits for multiple stakeholders within the healthcare system. It reduces the environmental impact of gloves in the ICU by dispensing one glove at a time. Furthermore, the gloves are dispensed at the cuff, which comes in little contact with the patient. The vertical movement is pleasant to the user. The use of colour for different sizes makes it clear to the care assistant which box should go in which holder. Also, nurses will see at a glance, which size gloves they are dispensing. The small V-shaped opening makes the undesirable behaviour, of placing gloves back, almost impossible.

This research project, part of the Green Intensive Care Unit (ICU) initiative at the Erasmus University Medical Center (EMC), is focused on reducing the environmental impact of syringes at the ICU by designing solutions based on circular economy principles. Based on a Material Flow Analysis of the EMC ICU, syringes and their packaging have been identified as one of the main environmental impact hotspots. Therefore, this project aimed to redesign the syringes, their packaging, and their use, according to circular design strategies suitable for medical products to decrease their environmental impact, while remaining convenient and safe in use for the healthcare staff and patients. Research was executed to understand the context from multiple perspectives. The outcomes demonstrated that decreasing the impact of syringes is not only related to the design of the syringe itself. Manufacturing, preparation, use and disposal, all contribute to the environmental impact of the syringe. Various possible interventions were derived to reduce its impact:

The final design is an optimised filling process for prefilled sterilised syringes (PFSs), based on circular strategies such as reduce, reuse, rethink and repurpose. Interventions include: eliminating a redundant sterilisation phase, reducing residual medication and changing from steam to gamma sterilisation. This resulted in decreasing the amount of waste, material, energy and water consumption, while offering similar convenience and safety for the staff and patients of the ICU.

This project aims to reduce the environmental impact of the Intensive Care Unit (ICU) of the Erasmus Medical Center (EMC). Systemic design research was executed to map the current waste flow created by the ICU. Literature review, interviews and observations were performed to gather information about the healthcare protocols, hospital procurement process, intubation practices and used devices and consumables. This resulted in a set of challenges which were used to ideate from different perspectives to improve the sustainability of the ICU. A set of opportunities to introduce circularity within the ICU were defined. These opportunities ranged from waste separation to the reduction of the disposal of unused products. The selected circular opportunity was intubation, needed when patients cannot breathe by themselves. For this, a video laryngoscope, which is composed of various plastics, a video camera, and a led light, is used for only a few minutes and disposed of (and incinerated) directly afterwards. The aim of the second part of this research project was: Can we design a circular intubation procedure as a catalyzer for systemic change towards circular ICUs? One of the proposed circular strategies for the video laryngoscope is the reprocessing of intubation devices used at the ICU itself. A transition model toward reprocessing using UV-C radiation technique was further developed. Compared to current reprocessing procedures, UV-C disinfection consumes no water and less electricity and offers the possibility of decentralized reprocessing within the ICU department itself. This project aims to provoke conversations between the hospital, manufacturers and other stakeholders about how the healthcare sector could start reprocessing valuable medical devices towards a circular ICU.

In recent years the preoperative phase of a patient undergoing colorectal cancer surgery is increasingly studied, due to the increasing evidence of “better in, better out” prehabilitation programs, as a means to improve patient outcomes in recovery after surgery. Multimodal programs seem to be of additional benefit to these patient outcomes. Questions remain however which interventions are best suited for improving patient outcomes and to what extent these are tailored to personal capabilities and personal preferences. This systematic literature review analysed, after a thorough search through four different databases, six studies of which four randomized clinical trials. Results showed that most patients benefited from participating in a multimodal prehabilitation program, increasing their functional capacities before and after surgery. Yet frail elderly seemed to benefit less from a prehabilitation program while inactive patients showed greater improvements compared to the more active patients. Furthermore, adherence was higher in the prehabilitation program compared to rehabilitation and personalization of the program appeared to improve adherence. It seems to be of importance to identify which colorectal cancer patients benefit most from a prehabilitation program and how personalization can further increase the benefits of prehabilitation.

Early mobilisation after abdominal surgery is necessary to avoid complications and increase recovery. However, due to a variety of factors, failure of early mobilisation is seen in clinical practice. The aim of this study is to investigate the perspectives of nurses and patients of the Haaglanden Medical Center (HMC) how to increase mobilisation frequency after colorectal surgery in the oncological surgery ward. This explorative study employed qualitative data collection and analysis by means of semi-structured interviews with patients and nurses. Patients were included when they had a colorectal resection, were older than 18 years and spoke Dutch. The interviews were audiotaped and verbatum transcribed. A thematic content analysis was performed. It was concluded that mobilisation can be increased when it is incorporated in daily care activities and family support during visiting hours. Appropriate information about mobilisation and physical activity is needed for nurses, patients and family and the hospital environment should stimulate mobilisation.

Auto-injector pens (AIPs) can improve a patient’s quality of life. However, some human factors problems in AIP design can prompt the occurrence of use errors with sometimes dramatic consequences. AIP manufacturers are required to identify characteristics of the user interface that might lead to use errors. This identification can be time-consuming and fastidious. Here, we report on the initial steps in the design of a checklist for identifying AIP use errors (CAPU). The checklist is intended to help professionals in charge of the design and risk management of disposable AIPs to determine the likelihood of use errors more easily. A review of the literature (57 publications) enabled us to identify 341 semantic units that were representative of use errors. These errors were grouped into 50 categories and covered all the steps in AIP use (i.e. from storage to injection and disposal). Initial feedback on CAPU from human factors engineers enabled us to clarify the list’s content and the way in which the use errors were listed. CAPU is intended to simplify certain tasks for risk management professionals working on AIPs. It is not intended to replace the involvement of human factors experts in AIP design, evaluation and risk management. The next steps in the project consist in developing a software version of the checklist and extending the volume and type of data underpinning it. Lastly, the checklist’s usefulness and psychometric qualities should be evaluated with risk management professionals working on AIPs.

Diagnostic laboratories have faced unprecedented challenges during the COVID-19 pandemic, being under immense pressure to maintain workplace safety while remaining operational and providing the best quality of diagnostic testing. In this study, we analyzed the work system (WS) elements impacting the burnout of three health care professionals (HCPs) working in a COVID-19 testing laboratory. Data collection took place between July and August of 2021 and used surveys to capture the participants’ burnout and job and organizational characteristics. We performed correlation analyses to identify the job and organizational characteristics associated with higher burnout scores and used the Systems Engineering for Patient Safety (SEIPS) framework to analyze the WS elements influencing the burnout of these HCPs. The variables highly correlated with burnout were: physical environment, social support from supervisor, social support from family/friends, control, skill underutilization, role conflict, role ambiguity, intragroup and intergroup conflict, and responsibility for people. Sixty percent of them (role conflict, role ambiguity, intragroup and intergroup conflict, social support from supervisor, and responsibility for people) were part of the organization element of the WS model, likely as a direct consequence of the abrupt and rapidly evolving status of the COVID-19 pandemic, which saw diagnostic laboratories redesigning their workflow, policies, and procedures to introduce adequate guidelines against virus diffusion. Future research will expand the sample size and timeframe of data collection to holistically explore WS design requirements (i.e., systems-based interventions) to prevent burnout of laboratory workers, a very important, and often overlooked, group of HCPs during the COVID-19 pandemic.

Online health consultation (OHC) platforms have been extensively used since the outbreak of COVID-19, that the number of active users has been increasing dramatically in China. OHC interfaces require a more immersive environment to support the entire medical consultation journey. This study intends to explore the design features of existing OHC platforms, and how they relate to patient experience and patient OHC journey. A literature review of design features, patient experience, and patient OHC journey was conducted to generate a framework to guide the study. Then, semi-structured interviews with 10 participants were carried out. The notions of “Design Features” were interpreted differently by individuals. For example, ‘graphic design’ was viewed as colour, font, icon, etc. Design Features have varying degrees of influence on “Patient Experience” and “Patient OHC Journey”. This study explores what comprises Design Features of OHC platforms. The associations between Design Features and Patient Experience found in this study are different from the associations that have been found in other contexts, like e-commerce. The design on telemedicine platforms especially OHC should be studied as an independent topic to inform the design of a better patient experience throughout the OHC journey.

Design is expanding its influence on shaping future healthcare. Ideally, designers apply human-centered design and human factors that introduce theory, principles, and methods to design to optimize people’s healthcare experiences in both digital and non-digital environments. To discuss and implement experience design in healthcare, consensus about experience design in healthcare is needed. Objectives: Therefore, the purpose of this study is to investigate designers’ views on experience design in health, and to uncover their understanding about three experience design concepts, i.e., user experience (UX), patient experience (PEx), and digital patient experience (dPEx). We conducted online semi-structured interviews study with convenience samples who met the eligibility. We used ATLAS.ti for an in-depth data coding following thematic analysis. 24 international designers of digital health solutions, either in industry or in academia took part in the interviews. We found the similarities and differences mentioned between healthcare design and non-healthcare design relate to (1) design principles, (2) user attributes, and (3) design contexts. Furthermore, the differences between UX, PEx, and dPEx can be mapped on five dimensions: people, contexts, purposes, means, and usage scenarios. These insights can help designers and human factors specialists build a common design language for experience design in healthcare. Our study can also assist designers and human factors specialists with experience design in digital health by pointing out the areas where design thinking generally is appropriate and the places where particular expertise in healthcare design is needed.

Medication and equipment must be located and retrieved quickly during resuscitation to ensure good patient outcomes; code carts are often used to store commonly used items and may be standardized to support faster retrieval. An augmented reality (AR) application to teach clinicians about the contents and organization of a standardized pediatric code cart was developed for mobile devices to improve the speed and accuracy of retrieval of items from the code cart. In this study, we explore the use, usability, and satisfaction of users of that application. We conducted surveys (n = 56) with physicians, physicians in training, nurses and nurse educators who used the application. The surveys collected self-reported use, usability with the System Usability Scale (SUS) and satisfaction. We compared results from different clinical roles. The application had acceptable usability (average SUS score = 75.9) and average satisfaction of 74.9 on a scale from 0 to 100 reported after an average of nearly 3 h of application use, with no significant differences between clinical roles. While the application was acceptable, improving the interface design, features and function of the application could enhance the experience of users. Future work could include participants from other health care systems to gain a more generalizable understanding of user experience and compare the experience of users of the AR application with their experiences with other training methods.

Training of healthcare professionals in nursing homes (NH) is fundamental to improve quality and safety. This project (funding by 2 resolutions) is carried out at a sample of 7 NHs of Tuscany Region (Italy), for evaluate a participatory approach to reduce preventable incidents and implement good practices, through behavioral and systems change. The inclusion criteria were defined to represent the different areas of the Region. The method for training sessions is based on what emerged in the literature, according to the principles of andragogy and management of human factors. It is based on interactive class, that follow action research method, with bottom-up approach to multidisciplinary groups. Each session lead by a nurse and a psychologist takes 8 h. Participants’ experience of a good or a bad day of practice is elicited to let the tacit knowledge on strengths and weaknesses emerge, to help the group envision a joint commitment to improve on the more relevant themes for patient safety. Evaluation included participant reactions, learning and change in practice. Staff who attended responded very well. In the majority they appreciated training but above all the intention to change and improve their job. Follow-up (up to 2 months) was carried out in all NHs through field observations and a second meeting. In some cases, we were able to observe changes in care and organizational practices, in other no changes emerged. In all NHs we have found the need for supported in working practices, the request to continue to be followed over time.