The impact of complications and errors on surgeons

All surgical procedures carry with them the potential for adverse events. Dealing with the sequelae of the complications and errors that arise in the course of normal practice is therefore part and parcel of a surgeon’s working life. The challenges and stresses that this creates are now well recognised although surgical training has, until recently, done little to help surgeons prepare for such events and on-going professional and personal support is limited. This review shows that much of the research examining the impact of adverse events has been concentrated in healthcare systems outside of the UK, often markedly different to our own. With notable exceptions, sample sizes are often small and studies are often qualitative. While the latter provide rich and fascinating data, they may not always be representative, particularly if the focus is on serious errors where there is a risk of litigation. Despite the preponderance of complications, which are an acknowledged risk of surgical procedures, there is no research to date which has examined whether or not there are differences in the impact of complications versus errors on surgeons’ professional and personal lives. A national survey is currently planned to provide detailed information about the impact of adverse events – both complications and errors – which will map the way for better targeted support for surgeons to help them use their experiences to enhance their wellbeing and improve their practice

Making healthcare safer by understanding, designing and buying better IT

When nobody or nothing notices an error, it may turn into patient harm. We show that medical devices ignore many errors, and therefore do not adequately support patient safety. In addition to preventable patient harm, errors may be reported ignoring potential flaws in medical device design, and front line staff may be inappropriately blamed. We present some suggestions to improve reporting and the procurement of hospital equipment

Technology and the future of healthcare

Healthcare changes dramatically because of technological developments, from anesthetics and antibiotics to magnetic resonance imaging scanners and radiotherapy. Future technological innovation is going to keep transforming healthcare, yet while technologies (new drugs and treatments, new devices, new social media support for healthcare, etc) will drive innovation, human factors will remain one of the stable limitations of breakthroughs. No predictions can satisfy everybody; instead, this article explores fragments of the future to see how to think more clearly about how to get where we want to go

Unreliable numbers: error and harm induced by bad design can be reduced by better design

Number entry is a ubiquitous activity and is often performed in safety- and mission-critical procedures, such as healthcare, science, finance, aviation and in many other areas. We show that Monte Carlo methods can quickly and easily compare the reliability of different number entry systems. A surprising finding is that many common, widely used systems are defective, and induce unnecessary human error. We show that Monte Carlo methods enable designers to explore the implications of normal and unexpected operator behaviour, and to design systems to be more resilient to use error. We demonstrate novel designs with improved resilience, implying that the common problems identified and the errors they induce are avoidable

CLINIC-Q MEDICAL AND DENTAL DEVELOPMENT BUSINESS STRATEGY WITH SUSTAINABLE DEVELOPMENT PERSPECTIVE

This research is research related to the formation of strategy development in a clinic. The Discussion is aimed at the theme of the clinical business development strategy. In addition, the discussion will use a sustainable business development perspective. Data collected is sourced from experts with different expertise. Assessing experts were asked to provide a questionnaire assessment related to the internal environment and the external environment of the clinic. Financial statements used are from 2015 to 2017. Assessment results from experts are then adjusted to the IE Matrix to obtain the company's strategy formulation. After obtaining the strategy formulation, the best strategy for the clinic was conducted using the QSPM approach. Results of the study show that the position of the clinic-Q Medical & Dental is in quadrant 1 which means the clinic is recommended for development. In addition, based on the assessment of QSPM, it is found that the company can implement product development, integration and market penetration. On the other hand, clinics are also advised to continue to increase their role in protecting the environment

Safer User Interfaces: A Case Study in Improving Number Entry

Numbers are used in critical applications, including finance, healthcare, aviation, and of course in every aspect of computing. User interfaces for number entry in many devices (calculators, spreadsheets, infusion pumps, mobile phones, etc.) have bugs and design defects that induce unnecessary use errors that compromise their dependability. Focusing on Arabic key interfaces, which use digit keys 0-9-· usually augmented with correction keys, this paper introduces a method for formalising and managing design problems. Since number entry and devices such as calculators have been the subject of extensive user interface research since at least the 1980s, the diverse design defects uncovered imply that user evaluation methodologies are insufficient for critical applications. Likewise, formal methods are not being applied effectively. User interfaces are not trivial and more attention should be paid to their correct design and implementation. The paper includes many recommendations for designing safer number entry user interfaces

On the Privacy, Security and Safety of Blood Pressure and Diabetes Apps

Part 8: Mobile and Cloud Services SecurityInternational audienceMobile health (mHealth) apps are an ideal tool for monitoring and tracking long-term health conditions. In this paper, we examine whether mHealth apps succeed in ensuring the privacy, security, and safety of the health data entrusted to them. We investigate 154 apps from Android app stores using both automatic code and metadata analysis and a manual analysis of functionality and data leakage. Our study focuses on hypertension and diabetes, two common health conditions that require careful tracking of personal health data.We find that many apps do not provide privacy policies or safe communications, are implemented in an insecure fashion, fail basic input validation tests and often have overall low code quality which suggests additional security and safety risks. We conclude with recommendations for App Stores, App developers, and end users

Development and assessment of the reliability and validity of a proposed Medi-Socio AcciMap Taxonomy approach for analysing IT-related incidents in healthcare

The thesis argues that synthesising a domain-specific classification scheme/taxonomy with Branford’s standardised AcciMap approach will improve the reliability and validity of its outcomes. Based on Waterson et al. (2017)’s review of the AcciMap methodology, this argument discussed the need for improving the AcciMap approach rather than simply developing novel accident analysis approaches. One recommended way to achieve this includes combining the AcciMap approach with existing error-based classification schemes as part of the “remixing process”. Recent studies implementing this process include the UPLOADS classification scheme based on the AcciMap methodology for investigating led outdoor activities (Australia). This example supports the need to develop a health-specific AcciMap approach, as Goode et al. (2017) argued for accident analysis, including health IT analysis. The Medi-Socio AcciMap taxonomy approach built on Branford’s standardised AcciMap method was proposed. This novel approach was applied to analysing a significant health-IT related incident (Septra overdose of a patient) as detailed in the Digital Doctor book (Wacther, 2015). Standardised AcciMap and Medi-Socio AcciMap taxonomy approaches were applied to this incident to identify contributing factors, causal relationships (links) and formulate safety recommendations. In assessing the reliability of both AcciMap versions, professionals (Clinical safety/human factors practitioners, NHS) participated in the Septra overdose incident analysis. The validity assessment involved safety experts experienced in using the AcciMap method and applied the two AcciMap approaches to the incident. Qualitative and quantitative measurements were used to analyse and compare findings between professional users (reliability) and expert results (validity) based on causal/contributing factors, causal relationships and safety recommendations. These studies indicated lower reliability and validity scores for the Medi-Socio AcciMap taxonomy than the standardised AcciMap version, particularly relating to contributing factors and safety recommendations. Outcomes on reliability and validity studies, including usability, were discussed. Also, study limitations, research reflections, and recommendations were presented for future research

Improving safety in medical devices and systems

Abstract—We need to improve healthcare technologies — electronic patient records, medical devices — by reducing use error and, in particular, unnoticed errors, since unnoticed errors cannot be managed by clinicians to reduce patient harm. Every system we have examined has multiple opportunities for safer design, suggesting a safety scoring system. Making safety scores visible will enable all stakeholders (regulators, procurers, clinicians, incident investigators, journalists, and of course patients) to be more informed, and hence put pressure on manufacturers to improve design safety. In the longer run, safety scores will need to evolve, both to accommodate manufacturers improving device safety and to accommodate insights from further research in design-induced error. I