Volume 53, Number 2
Public Policy Matters
The Role of Human Factors in Home Health Care
By Daryle Gardner-Bonneau
In 2000, the Institute of Medicine (IOM) of the National Academies released its report, To Err Is Human: Building a Safer Health System, which had a huge impact on the public and specifically on the human factors/ergonomics community. That report highlighted the many serious errors that occur daily in hospitals across the nation and led to many HF/E efforts designed to reduce the error rate in hospitals, or at least to reduce the consequences of errors.
In the years following the IOM report, various attempts were made to consider medical errors outside the hospital setting, but no concerted effort was made to look more broadly at the human factors issues in home health care. The IOM report itself had focused clearly on the safety aspect of medical care in institutions; it had much less to say about three other major goals of human factors/ergonomics - effectiveness, efficiency, and user satisfaction.
Increasingly, health care is occurring outside formal institutions. Patients are being discharged from hospitals sooner, and sicker, than in the past. Because of the never-ending march of technology, more health care and health information can be delivered remotely, through telemedicine and other technology, and more complex medical equipment is being placed in homes. Further, patients and their families are taking more responsibility for their health care, and information seeking about health care management by lay caregivers and patients has skyrocketed.
The nation's demographics are also changing; older adults constitute an ever-greater proportion of the population and make the greatest use of health care resources. Middle-aged people are caring for aging parents; friends and neighbors often care for older adults who are living alone, trying to maintain their independence. Children and adults with chronic conditions and disabilities are receiving care at home. There are significant and widening disparities in health care access attributed to the "digital divide" and socioeconomic and cultural factors. We seem to have left relatively unexplored the human factors issues associated with these sweeping changes.
Between 2004 and 2007, I made several presentations stressing the gaps in our knowledge about, and management of, these issues. One of these was at the invitation of the Committee on Human-Systems Integration (COHSI) of the Division of Behavioral and Social Sciences and Education of the National Research Council. Soon after, COHSI convened a planning meeting of interested parties, including HFES member Kerm Henriksen, human factors advisor for patient safety at the Agency for Healthcare Research and Quality (AHRQ). Attendees agreed that a study should be conducted to address these issues. AHRQ responded with funding for a first phase of the work, and the Committee on the Role of Human Factors in Home Healthcare was established.
The committee, which met for the first time in March 2009, is chaired by David Wegman and comprises a broad spectrum of experts, including health care professionals, policy experts, and human factors specialists. I currently serve on the committee, along with HFES members Sara Czaja and Robert Schumacher. As is typical in these initial meetings, we began by discussing the committee's charge and reaching a common understanding of the fundamental terminology being used to describe it. In this case, the home is being considered as any health care setting outside formal health care institutions. So, in addition to patients receiving care in the home, a patient using a CPAP machine in a hotel room would be considered, for example, as would a person using a portable oxygen delivery system at work.
Similarly, health care has been broadly defined in the charge to include any behaviors involved in managing health and well-being across the life span; therefore, prevention and health maintenance activities are considered along with activities involved in the diagnosis and treatment of acute and chronic conditions and those involved in end-of-life care. The charge also defines caregivers broadly, so the committee is exploring the human factors issues faced by both formal caregivers (e.g., home health nurses, physical therapists working in home care settings) and caregivers with little or no formal training (e.g., many patients, family caregivers, and friends, neighbors, and others in the community at large).
Finally, human factors is being considered in its broadest sense, as specified in the committee's charge, to include not only the human-technology interfaces but also the organizational, social, and cultural human factors that affect the effectiveness, efficiency, and user satisfaction with which human beings manage their health.
Much of the first months of the committee's work involved preparations for a workshop to gather information and data about the human factors issues in home health care. Workshop topic areas were determined: (a) recipients of care and formal and informal caregivers; (b) health care tasks, medical devices, and information technology; and (c) environmental considerations - the immediate health care setting and the social, organizational, cultural, and policy and regulatory environments in which care takes place. Experts in these topics were invited to develop papers and to give presentations at the workshop in early October 2009. HFES members who gave presentations at the workshop were Neil Charness, Colin Drury, and Molly Follette Story. The formal report of this workshop will be released to the public in a few months, but the workshop presentations are available here.
The committee has now received funding for a second phase of work, which is intended to produce a consensus report about the role of HF/E in home health care. As with all reports published by the National Academies, the draft of this report will undergo extensive internal and external review and editing prior to its release to the public. The target date for consensus report publication is sometime in 2011.
We live in an age when people are taking more control of their health - not only because they must but because they desire to do so - and maintaining one's health and well-being is a life-long activity, with various human factors challenges along the way. Access to information and technology is becoming an "anyone, any time, anywhere" proposition. This applies to health care as well as most other aspects of our lives. The Committee on the Role of Human Factors in Home Healthcare hopes to illuminate these challenges and to make human-factors-related recommendations that will lead to productive activities designed with the goal of improving the management of people's health - by all people, throughout their lives, and in any setting.
Institute of Medicine (2001). To err is human: Building a safer health system. Washington, DC: National Academy Press.
Gardner-Bonneau, D. J. (2007, August). Human factors issues in home health care. Presentation to the Committee on Human-Systems Integration, Division of Behavioral and Social Sciences and Education, The National Academies, Woods Hole, MA.
Daryle Gardner-Bonneau, PhD (firstname.lastname@example.org), is the principal of Bonneau and Associates, 2264 Quincy Ave., Portage, MI 49024-4806, and an HFES Fellow. For the past 15 years her work has focused on the design of health care and telecommunications products, systems, and services to meet the needs of older adults and people with disabilities. She is active in technical standards work and was recently named to the National Research Council's Committee on the Role of Human Factors in Home Healthcare.
Read more health care articles in this issue of the Bulletin:
NIH Issues Information Request for New Health Care Funding
Submissions Welcomed for Special Issue on Health Care
Back to the Table of Contents for the February 2010 HFES Bulletin
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Archive of past HFES Bulletin issues (in .pdf format)