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A Human Factors approach to A Human Factors approach to A Human Factors approach to A Human Factors approach to PreventionPreventionPreventionPrevention----inininin----Practice Practice Practice Practice

Al Ross

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ScotlandScotlandScotlandScotland• A national programme to improve the oral health of children

• reduce inequalities in dental health and access to dental services

• …priority groups and older people

• Children and Young People (Scotland) Act 2014

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ScotlandScotlandScotlandScotland

• …National Patient Safety Programme

• …National Health and Social Care Standards

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England and WalesEngland and WalesEngland and WalesEngland and Wales

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Human Factors [offers] an integrated,

evidenced and coherent approach to

patient safety, quality improvement and

clinical excellence.

Human Factors understanding and

techniques can be used to inform quality

improvement in teams and services […]

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Scotland…

• New strategy to embed HF in all health and social care education and training

• Undergraduate; post-graduate; work-based learning

• Competency-based

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Human Factors/Ergonomics

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Derived from the Greek ergon (work) and

nomos (laws) to denote the science of

work, ergonomics is a systems-oriented

discipline which […] promotes a holistic

approach in which considerations of

physical, cognitive, social, organizational,

environmental and other relevant factors

are taken into account

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HF is about design of work

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• Interventions need a work systems analysis

• To be designed in to practice

• Simplify/ standardise

• Some variability is inevitable

• Flexibility

• Adaptation to circumstance

• Decisions make sense in context

• Field rationality

• Solutions are best driven from the ground

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Physical ergonomics Physical ergonomics• Safe, efficient operation;

• what are the stressors on staff that inhibit activity?

• what design solutions might facilitate CS tasks?

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Workflow

Cost

Tools

Cognitive Ergonomics

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Cognitive Ergonomics

• reasoning; what priority decisions do people make?

• techniques; what skills or competencies are involved?

• tools; what are the affordances in documents/ procedures/ IT?

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Organisational (or ‘macro’) Ergonomics

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Organisational Ergonomics• professional aspects; what are

the optimal work arrangements for teams?

• regulatory; how best should we fund, audit and/or inspect CS?

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Fluoride Varnish variable in practice

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Ross AJ, Sherriff A, Kidd J, Gnich W, Anderson JE, Deas L, Macpherson L

(2018) A systems approach using the Functional Resonance Analysis

Method to support fluoride varnish application for children attending

General Dental Practice. Applied Ergonomics 68, pp. 294-303,( doi:

10.1016/j.apergo.2017.12.005) FRAM• The FRAM is a method to develop a

representation or model of the ergonomic system i.e. how something happens or how something works

• A FRAM model represents the functions that are sufficient and necessary for the activity to take place

• And how they are connected…

Data synthesis using FRAM

Routine monitoring

data

Questionnaire studies

(n= 1,090; n= 709)Stratified

practitioner interviews

(n= 36)

Key Informant interviews

(n= 7)

FRAM synthesis

World café workshop

(n= 56)Outcom e: Frequency of

fluoride varnish application at Adj usted

β [95% CI] Adj R2

df F p

S oc ial/ prof essional role and

part of my profess ional Important part of my profess ional role

0.11 [0.07 t o 0.16]

I mportant part of prof essional role of ot her members of team;

I s my responsibility to ensure is Is my respons ibilit y to ensure is provided

0.08 [0.04 t o 0.12]

B eliefs about consequences : A pplying FV is important Applying FV is

important 0.12 [0.07 t o

0.17]

A pplying FV is necessary A pplying FV is pract ical Applying FV is

pract ical 0.06 [0.03 t o

0.09]

I n general applying FV to t he t eeth of my child patients at least t wice yearly:

Has benefits which outweigh the

Will prevent caries Will generally improve the oral healt h of a pati ent

I s not a pri ority for me (rev ) Is not a priorit y f or me (rev)

0.09 [0.05 to 0.12]

undesirable consequences f or the pat ient (rev )

May have undesirable consequences f or the me (rev)

I s s trongly supported by research

s something I recei ve appropriate

compensat ion t o do.

Would increase in my pract ice if it was more f inancially rewarding

46% 8, 640

314.3

Patient

management

activities

CS

In

practice

Claims,

monitoring and

administration

activities

Practice

management

activities

Research,

evidence and

guidance

activities

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We are now developing an

activity toolkit

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Co-designed with practitioners

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Groups of FRAM-linked activities with Human Factors tips

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Human Factors

tips, strategies

and nudges

Human Factors

tips, strategies

and nudges

Examples, tips and views

from practitioners

applying high rates of

varnish

Examples, tips and views

from practitioners

applying high rates of

varnish

Practice Management

section

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Future trialFuture trialFuture trialFuture trial

• Cluster randomized

• FVA outcome

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/glasgowuniversity

@UofGlasgow

@UofGlasgow

UofGlasgowSearch: University of Glasgow

Thank you

alastair.ross@gla.ac.uk