Embedding human factors & ergonomics in healthcare with building design at the centre of the system
Background: Risk factors for patient slips, trips and falls (STF) have been identified and reported since the 1950s and are mostly unchanged in the 2010s. The prevailing clinical view has been that STF events indicate underlying frailty or illness and so many of the interventions over the last 60 years have focussed on assessing and treating physiological factors (dizziness, illness, vision/hearing, medicines) rather than designing interventions to reduce risk factors at the time of the STF. Purpose: To use a theoretical model for HFE (DIAL-F) and a comparison with occupational STF risk management to discuss patient STF interventions. Methods: Three case studies are used to discuss how HFE has been, or could be, applied to STF risk management as (1) a design-based (building) approach to embed safety into the built environment; (2) a staff (and organisation)-based approach; and (3) a patient behaviour-based approach to explore and understand patient perspectives of STF events. Results: The results from the case studies suggest that there will be benefits from taking a as HFE approach similar to other industries, i.e. a sustainable design intervention for the person who experiences the STF event - the patient. The DIAL-F model supports a change in bedside interventions from a passive model of providing care and treatment (analogous to a production line with inanimate components) to an active model representing independent functional activities with changed physical, cognitive and behavioural capabilities. The challenge is to design inclusive interventions to benefit a range of patients that do not introduce barriers or problems for staff and other system stakeholders. For example poor balance linked to rising from a chair might be assisted by building and technology design solutions, or not using an out of reach assistive device could be addressed by providing accessible equipment and timely assistance. Conclusions/implications: As over 70% reported patient STF are un-witnessed and research indicates there are benefits from retaining mobility associated with continence, cognitive function and pressure care there is an argument to design STF interventions to support patient mobility and autonomy. Rather than continuing to fight this seemingly intractable problem with complex packages of care, we suggest it is time to look proactively at this problem with an HFE approach to facility design and other interventions that include the perspective of all the stakeholders.