Doing More with Less - Human Factors Engineering in Pathology

• Pathologists Leadership Summit

Becca Battisfore:

To proactively drive change, you need the tools to make things happen. At the 2023 Pathologists Leadership Summit, you'll gain unparalleled access to the education and training needed to make a positive impact on pathology. Grow personally and professionally while inspiring the leader within to protect the future of our specialty. You can also be an advocate for pathology during our Hill Day as you, along with your colleagues, will meet with legislative staff. Register today for the Summit at pathologistsleadershipsummit.org

Welcome to the latest edition of the College of American Pathologist’s CAPCast. I’m Becca Battisfore, the CAP’s Content Specialist. In this episode, I’m joined by Dr. Moira Larsen and Dr. Ethan Larsen. We’ll be discussing the Human Factors Engineering course that they will be leading at the Pathologists Leadership Summit on April 17, 2023. Dr. Moira Larsen, can you introduce yourself?

Moira Larsen, MD:

Thank you, Becca. Really glad to be here. My name is Moira Larsen. I am the Physician Executive Director for MedStar Medical Group Pathology. It is a nine acute care hospital system in the mid-Atlantic region. I am a board certified anatomic and clinical pathologist, and I serve as a member of the CAP Practice Management Committee.

Becca Battisfore:

Great. Dr. Ethan Larsen?

Ethan Larsen, PhD:

Yes. Thank you, Becca. Dr. Ethan Larsen. I am a PhD Human Factors Engineer at the Children's Hospital of Philadelphia, attached to the radiology department and the Center for Healthcare Quality and Analytics. I work independently for the radiology department and as part of a seven-engineer team of human factors engineers embedded to the entire hospital serving quality improvement and process improvement work.

Becca Battisfore:

Great. So let's get right into the questions. First, why is process improvement important to the practice of pathology? Dr. Moira?

Moira Larsen, MD:

I'll take that one.

Becca Battisfore:

Yes.

Moira Larsen, MD:

As we're seeing practices evolve with increasing complexity and needs for diagnosis and testing, in both the anatomic and clinical pathology world, there are new technologies and tools that require consistent addition to our practices, refinement, and efficiencies. This process brings better diagnostic accuracy, increased patient safety, but we also need to do the things that will enhance pathologists and laboratory technologists’ workflow and productivity.

Becca Battisfore:

And what is human factors engineering?

Ethan Larsen, PhD:

I can take that one. Human factors engineering is a scientific field dedicated to focusing on understanding how people think, how we perceive the world around us, and how we can fit into the parts of a work system. And so, foundationally, human factors engineers are looking for how do we design systems, work environments, work processes that make it easier for workers to do the right thing, but also be able to engineer barriers to prevent them from doing the wrong thing, taking incorrect or erroneous actions, or shunting error pathways away from resulting in patient harm.

Becca Battisfore:

I see. And so what challenges will this course help participants address when trying to increase efficiency in their lab?

Ethan Larsen, PhD:

So, this course is going to help resolve a favorite quote of mine, which is every system is perfectly designed to get the results it has been designed for. Human factors tries to bring the human element into the work system in a way that traditionally, we don't really always scope. And so, understanding that there are limits to people's attention, to their physical capabilities, in terms of even reach and grasp, all of these aspects feed into error pathways that we can help shunt by designing them out.

Becca Battisfore:

And so how does human factors engineering differ from other process improvement frameworks, like LEAN or Six Sigma, and how is it relevant in quality improvement?

Moira Larsen, MD:

It's really important that we consider moving beyond LEAN and Six Sigma, as Ethan has described. LEAN and Six Sigma are great tools, but they are very defined, very almost rigid, numeric, data-driven systems. Whereas to achieve the greatest benefit and the most quality improvement, we do have to make considerations regarding the human worker and make them be part of the improvement effort, recognizing that we have inherent limitations that our machines don't. So, our systems have to acknowledge our limitations, and we have to set up processes that take that into account.

Becca Battisfore:

And Ethan, back to you. What are the risks if one does not consider human factors when trying to increase efficiency?

Ethan Larsen, PhD:

So, not taking into account the human element in human factors, especially if you're trying to find more efficiency, you run the risk of, if you follow exclusively a LEAN or Six Sigma, a data-driven approach, of losing sight of those human limitations. Of course, I can push someone to perform a task five times in a minute, but that is not sustainable, potentially, over the span of an entire work shift. And so when your outcomes of your traditionally data-driven exploration suggest that's the solution, is push everyone to perform that operation more times per minute, you'll end up with outcomes on the other end that will lead to errors, lead to employee departures, and you need to take that into account. And that proactive human factors approach will help you avoid those problems before they manifest in the outcome. So, your risks are really that you could, in the pursuit of data-driven perfection, reduce your workflow, reduce your workforce, and increase errors.

Becca Battisfore:

Right, which is something we really want to avoid in a lab. Okay. Moving on to some more questions. What are some of the benefits a laboratory could realize by bringing human factors engineering into their process improvement activities in the lab?

Moira Larsen, MD:

Well, as we've already discussed, Becca, human factors engineering gives insight into behavioral risks. And some of those behavioral risks can contribute to days missed from work and can inform redesigns. If I could give an example, we have made ample use of the undergraduate, senior industrial, and systems engineering design teams program from Virginia Polytechnic Institute, Virginia Tech. They have a program where you provide a problem, and they give you a group of students who spend a school year working on solutions. At one point, we engaged a team to look at the specimen receiving the accessioning department at one of our hospitals, where we were having an unacceptable number of specimen mishandlings, specimens rolling off tables and into trash cans, in order to ask them to help us redesign that workflow for efficiency. Well, they came and did that, but in the course of that process, they pointed out to us that we had an ergonomic problem, where we had a pneumatic tube system delivering specimens to the lab, but the carriers for the tube system were stored at foot level and the carrier system operated at waist height. So, our staff was constantly bending over, picking up carriers, bending over, putting them back down. While the carriers weren't heavy, that repetitive motion was causing some musculoskeletal issues for our staff and days missed from work. And they provided us the explanation as to why that was happening and the opportunity to fix it, in the course of looking at other processes.

Becca Battisfore:

Wow. What a fascinating example. And so, speaking specifically about the course, what can participants expect?

Ethan Larsen, PhD:

So, our plan is, in addition to introducing the core elements of human factors engineering, its theory and science, and some basic tools that participants can take back to their home institutions, we actually intend to make this a participatory exercise and want to engage the participants in using human factors processes in the moment. We will facilitate, of course, but getting them to articulate what are the problems you're facing right now? Now let's talk through how do you take that human factors lens in the moment to pull it apart, think about the pieces of the system, how they want to interact, and build something that might actually have impact on the other end.

Becca Battisfore:

Thank you both for joining the podcast to talk about this exciting new course. But as we wrap up, do either of you have any final thoughts?

Moira Larsen, MD:

I just want to say that back in the day, when the current Dr. Larsen was a master's candidate, he needed a project for a course and we needed some help with design in one of our laboratories, because there were a lot of distractions and challenges in our blood bank. And he and his team designed a solution. And as laboratorians who'd been in the business for years, we looked at his solution and his team's solution and we said, "Oh, no, no, no, that'll never work in our lab." A year later, when all of our attempts at solutions had failed, we said, "Let's pull that plan out again." We looked at it, we instituted it, and it worked. And I have been a convert to considering human factors since. It is a very powerful way of looking at issues, problems, solutions, quality, process improvement, and I do think that everyone can benefit from it. So, I am very excited that the CAP is giving us the opportunity to share this.

Ethan Larsen, PhD:

Likewise, I am incredibly eager to bring this knowledge to the CAP as someone who has trained most of my educational career to be a human factors engineer in a hospital in this capacity. It is wonderful to see organizations starting to recognize the value of what a human factors engineer can bring to their departments and to their institutions.

Becca Battisfore:

Great. Yeah, and this course sounds like a great opportunity to really spread the word. Thank you for joining us on this CAPcast. For more information on this course and to register for the leadership summit, visit pathologistsleadershipsummit.org.

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