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OBJECTIVE: Design criteria specifications (needs, obstacles, and context-of-use considerations) for continuing safe and efficient patient care activities during downtime were identified by using phenomenological analysis. METHODS: Interview transcripts from medical personnel who had experience with downtime incidents were examined using a phenomenological approach. This process allowed for the identification of design criteria for performing downtime patient care activities. RESULTS: A substantial variation in criteria was found from participants in different roles. The differences suggest opportunities to address downtime that may require attention to individual roles. CONCLUSIONS: Workload distribution and communication are significant issues in patient care during downtime. There may not be an equal work distribution, leading to an increased workload for some personnel during downtime. Phenomenological analysis was completed after participants were interviewed, indicating it is a viable post hoc approach. Some downtime criteria were identified as potential guidelines for the development of better downtime contingency plans.

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INTRODUCTION: Electronic health record (EHR) downtime is any period during which the EHR system is fully or partially unavailable. These periods are operationally disruptive and pose risks to patients. EHR downtime has not sufficiently been studied in the literature, and most hospitals are not adequately prepared. OBJECTIVE: The objective of this study was to assess the operational implications of downtime with a focus on the clinical laboratory, and to derive recommendations for improved downtime contingency planning. METHODS: A hybrid qualitative-quantitative study based on historic performance data and semistructured interviews was performed at two mid-Atlantic hospitals. In the quantitative analysis, paper records from downtime events were analyzed and compared with normal operations. To enrich this quantitative analysis, interviews were conducted with 17 hospital employees, who had experienced several downtime events, including a hospital-wide EHR shutdown. RESULTS: During downtime, laboratory testing results were delayed by an average of 62% compared with normal operation. However, the archival data were incomplete due to inconsistencies in the downtime paper records. The qualitative interview data confirmed that delays in laboratory result reporting are significant, and further uncovered that the delays are often due to improper procedural execution, and incomplete or incorrect documentation. Interviewees provided a variety of perspectives on the operational implications of downtime, and how to best address them. Based on these insights, recommendations for improved downtime contingency planning were derived, which provide a foundation to enhance Safety Assurance Factors for EHR Resilience guides. CONCLUSION: This study documents the extent to which downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their downtime contingency plans need to find more effective methods to collect data during these times.

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Safety management in construction is an integral effort and its success requires inputs from all stakeholders across design and construction phases. Effective risk mitigation relies on the concordance of all stakeholders' risk perceptions. Many researchers have noticed the discordance of risk perceptions among critical stakeholders in safe construction work, however few have provided quantifiable evidence describing them. In an effort to fill this perception gap, this research performs an experiment that investigates stakeholder perceptions of risk in construction. Data analysis confirms the existence of such discordance, and indicates a trend in risk likelihood estimation. With risk perceptions from low to high, the stakeholders are architects, contractors/safety professionals, and engineers. Including prior studies, results also suggest that designers have improved their knowledge in building construction safety, but compared to builders they present more difficultly in reaching a consensus of perception. Findings of this research are intended to be used by risk management and decision makers to reassess stakeholders' varying judgments when considering injury prevention and hazard assessment.

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Theoretical and practical approaches to safety based on sociotechnical systems principles place heavy emphasis on the intersections between social-organisational and technical-work process factors. Within this perspective, work system design emphasises factors such as the joint optimisation of social and technical processes, a focus on reliable human-system performance and safety metrics as design and analysis criteria, the maintenance of a realistic and consistent set of safety objectives and policies, and regular access to the expertise and input of workers. We discuss three current approaches to the analysis and design of complex sociotechnical systems: human-systems integration, macroergonomics and safety climate. Each approach emphasises key sociotechnical systems themes, and each prescribes a more holistic perspective on work systems than do traditional theories and methods. We contrast these perspectives with historical precedents such as system safety and traditional human factors and ergonomics, and describe potential future directions for their application in research and practice. PRACTITIONER SUMMARY: The identification of factors that can reliably distinguish between safe and unsafe work systems is an important concern for ergonomists and other safety professionals. This paper presents a variety of sociotechnical systems perspectives on intersections between social--organisational and technology--work process factors as they impact work system analysis, design and operation.

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Falls remain the leading cause of injuries and fatalities in the small residential roofing industry and analogous investigations are underrepresented in the literature. To address this issue, fall-protection training needs were explored through 29 semi-structured interviews among residential roofing subcontractors with respect to recommendations for the design of fall-protection training. Content analysis using grounded theory was conducted to analyze participants' responses. Results of the analysis revealed six themes related to the design of current fall-protection training: (1) barriers to safety training; (2) problems of formal safety-training programs; (3) recommendations for training implementation; (4) important areas for fall-protection training; (5) training delivery means; and (6) design features of training materials. Results of the study suggest the need for informal jobsite safety training to complement what had been covered in formalized safety training. This work also provides recommendations for the design of a more likely adopted fall-protection training program.

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Multiple types of users (i.e. patients and care providers) have experiences with the same technologies in health care environments and may have different processes for developing trust in those technologies. The objective of this study was to assess how patients and care providers make decisions about the trustworthiness of mutually used medical technology in an obstetric work system. Using a grounded theory methodology, we conducted semi-structured interviews with 25 patients who had recently given birth and 12 obstetric health care providers to examine the decision-making process for developing trust in technologies used in an obstetric work system. We expected the two user groups to have similar criteria for developing trust in the technologies, though we found patients and physicians differed in processes for developing trust. Trust in care providers, the technologies' characteristics and how care providers used technology were all related to trust in medical technology for the patient participant group. Trustworthiness of the system and trust in self were related to trust in medical technology for the physician participant group. Our findings show that users with different perspectives of the system have different criteria for developing trust in medical technologies.

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OBJECTIVE: Our goal was to briefly describe how macroergonomics was developed to fill a void in human factors and ergonomics. BACKGROUND: A study commissioned by the Human Factors Society in 1978 resulted in the formalization of a new subdiscipline of human factors, called organizational design and management, which eventually was coined macroergonomics. METHOD: Differentiators of macroergonomics are presented along with methods adapted from other domains as well as unique methods. RESULTS: Based on laboratory and field studies conducted at multiple universities, government facilities, and industries, work system factors can be manipulated in the laboratory and studied in the field successfully. Also, case studies in academia, industry, and government demonstrate 60% to 90% performance impact and positive qualitative changes such as culture change. CONCLUSION: Macroergonomics offers a perspective as well as methods and tools for more successful human factors and ergonomics design, development, intervention, and implementation. APPLICATION: Human factors engineers or psychologists and ergonomists can use the perspective of macroergonomics to achieve better results or can expand their involvement of macroergonomics through the use of methods and tools.

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Hendrick is attributed with the formalization of organizational design and management (ODAM) in ergonomics [Hendrick, H.W., Kleiner, B.M., 2001. Macroergonomics: An Introduction to Work System Design. Human Factors and Ergonomics Society, Santa Monica, CA.]. Specifically, the method called "Macroergonomic Analysis of Structure" or MAS provides a framework and analysis of these factors and provides the context for an analysis of organizational design and management process through the MacroErgonomic Analysis and Design method (MEAD). Together, MAS and MEAD represent the formalization of staple methods in macroergonomics and can be used to organize existing tools and methods such as those that exist in systems safety and help to differentiate macroergonomics from other approaches. This article illustrates such an integrative role for macroergonomics with respect to systems safety using the example of the construction sector, a domain in which accidents, injuries and fatalities are all too common.

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OBJECTIVE: We examined the willingness and ability of general aviation pilots to execute steep approaches in low-visibility conditions into nontowered airports. BACKGROUND: Executing steep approaches in poor weather is required for a proposed Small Aircraft Transportation System (SATS) that consists of small aircraft flying direct routes to a network of regional airports. METHOD: Across two experiments, 17 pilots rated for Instrument Flight Rules at George Mason University or Virginia Tech flew a Cessna 172R simulator into Blacksburg, Virginia. Pilots were familiarized with the simulator and asked to fly approaches with either a 200- or 400-foot ceiling (at approach angles of 3 degrees, 5 degrees, and 7 degrees in the first experiment, 3 degrees and 6 degrees in the second). Pilots rated subjective workload and the simulator recorded flight parameters for each set of approaches. RESULTS: Approaches with a 5 degree approach angle produced safe landings with minimal deviations from normal descent control configurations and were rated as having a moderate level of workload. Approaches with 6 degree and 7 degree approach angles produced safe landings but high workload ratings. Pilots reduced power to control the speed of descent and flew the aircraft slightly above the glide path to gain time to control the landing. CONCLUSION: Although the 6 degree and 7 degree approaches may not be practical for routine approaches, they may be achievable in the event of an emergency. APPLICATION: Further work using other aircraft flying under a wider variety of conditions is needed before implementing SATS-type flights into airports intended to supplant or complement commercial operations in larger airports.

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OBJECTIVE: This study explored the potential for auditory and haptic spatial cuing approaches to alert drivers to the direction of a crash threat. BACKGROUND: For an automobile equipped with multiple crash avoidance systems, effective cuing of the crash threat direction may help the driver avoid the crash. Because the driver may not be looking in the direction of a visual crash alert, nonvisual crash alerts were explored as an additional means of directing attention to a potential crash situation. METHODS: In this in-traffic study, 32 drivers were asked to verbally report alert direction in the absence of any crash threats. Driver localization accuracy and response time were examined as a function of eight alert locations surrounding the vehicle and four directional alert approaches (auditory, haptic, haptic and auditory, and haptic and nondirectional auditory). The auditory directional alert approach used four speakers and broadband alert sounds, and the haptic directional alert approach used vibrations generated at various locations on the bottom of the driver's seat. RESULTS: Overall, relative to the auditory alert approach, the three approaches that included the haptic seat alert component reduced correct localization response times by 257 ms and increased percentage correct localization from 32% to 84%. CONCLUSION: These results suggest that seat vibration alerts are a promising candidate for alerting drivers to the direction of a crash threat. APPLICATION: These findings should facilitate developing a multimodality integrated crash alert approach for vehicles equipped with multiple crash avoidance systems.

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In the event of a nuclear, biological, or chemical terrorist attack against civilians, both military and civilian emergency response teams must be able to respond and operate efficiently while wearing protective equipment. Chemical protective equipment protects the user by providing a barrier between the individual and hazardous environment. Unfortunately, the same equipment that is designed to support the user can potentially cause heat stress, reduced task efficiency, and reduced range-of-motion. Targeted Acceptable Responses to Generated Events of Tasks (TARGETS), an event-based team performance measurement methodology was used to investigate the effects of Mission Oriented Protective Posture (MOPP) on the behavioral processes underlying team performance during simulated rescue tasks. In addition, this study determined which team processes were related to team performance outcomes. Results of six primary analyses indicated that team process performance was not degraded by MOPP 4 on any rescue task and that the team processes critical for successful task performance are task-dependent. This article discusses the implications of these results with respect to the study design and the limitations of using an event-based team performance measurement methodology.

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Attending to the larger system components such as organizational design and management is not novel for ergonomists. In Europe, there has been a strong tradition to investigate ergonomic problems within a holistic, systems context. "Macroergonomics" builds upon this tradition by providing specific methods and tools that yield large-scale results. It is believed that meaningful and large-scale results are needed in today's competitive and turbulent work environments. Macroergonomics is defined, its history is uncovered and focus is given to a key methodology, macroergonomic analysis and design. Case studies are used to validate the method and illustrate that performance results in the 60-90% range can be expected.

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