Publikationen

The aim is to demonstrate the benefit of the medico-ergonomic approach for the redesign of clinical work systems. Based on the six layer model, a concept for an ‘integrated therapy safety management’ is drafted. This concept could serve as a basis to improve resilience. Methods The concept is developed through a concept-based approach. The state of the art of safety and complexity research in human factors and ergonomics forms the basis. The findings are synthesized to a concept for ‘integrated therapy safety management’. The concept is applied by way of example for the ‘medication process’ to demonstrate its practical implementation. Results The ‘integrated therapy safety management’ is drafted in accordance with the six layer model. This model supports a detailed description of specific work tasks, the corresponding responsibilities and related workflows at different layers by using the concept of ‘bridge managers’. ‘Bridge managers’ anticipate potential errors and monitor the controlled system continuously. If disruptions or disturbances occur, they respond with corrective actions which ensure that no harm results and they initiate preventive measures for future procedures. The concept demonstrates that in a complex work system, the human factor is the key element and final authority to cope with the residual complexity. The expertise of the ‘bridge managers’ and the recursive hierarchical structure results in highly adaptive clinical work systems and increases their resilience. Conclusions The medico-ergonomic approach is a highly promising way of coping with two complexities. It offers a systematic framework for comprehensive analyses of clinical work systems and promotes interdisciplinary collaboration.

Over the past, the continuous increase of medical knowledge in combination with a high number of medical and technological innovations has lead to an enormous quality improvement in healthcare. But this development also requires a professional staff specialization resulting in an increased fragmentation and division of the entire patient treatment processes to individual specialists and/or departments. Therefore the improvement potential associated with the introduction of modern Information and Communication Technology (ICT) supporting the cooperation of all involved medical actors seems to be obvious. However, in reality the majority of such ICT-Tools does not meet those high expectations. A major reason for this is often an insufficient functionality directly resulting from an inadequate user integration into the development process. In this context a systematic analysis approach has been developed for the identification of optimization potential for ICT-Tools supporting collaborative work processes in healthcare based on a participatory analysis of the underlying medical treatment processes and a cooperative functionality definition. In a first investigative study this system ergonomic analysis approach was tested for the identification of the existing optimization potential for a web-based patient record to be introduced into the pre-, in- and post-hospital treatment processes of an emergency abdominal surgery. Together with the involved medical users a total number of 11 functionality requirements have been identified being essential for a systematic improvement of the underlying communication and coordination processes, whereas an improvement of the shared knowledge was rather less important for the later users. However, a broader optimization of web-based patient records in general will only be possible when also the treatment processes of different patient groups are taken into account.