Human factors in mental healthcare : A work system analysis of a community-based program for older adults with depression and dementia

Mental healthcare is a critical but largely unexplored application domain for human factors/ergonomics. This paper reports on a work system evaluation of a home-based dementia and depression care program for older adults, the Aging Brain Care program. The Workflow Elements Model was used to guide data collection and analysis of 59 h of observation, supplemented by key informant input. We identified four actors, 37 artifacts across seven types, ten action categories, and ten outcomes including improved health and safety. Five themes emerged regarding barriers and facilitators to care delivery in the program: the centrality of relationship building; the use of adaptive workarounds; performance of duplicate work; travel and scheduling challenges; and communication-related factors. Findings offer new insight into how mental healthcare services are delivered in a community-based program and key work-related factors shaping program outcomes

Applying human factors methods and measures to cognitive rehabilitation for traumatic brain injury

Traumatic brain injury (TBI) is an extensive public health problem. Even a mild TBI (i.e. concussion) can induce long-term cognitive symptoms that can affect one’s ability to perform daily life activities. Cognitive rehabilitation improves outcomes of TBI patients across all severities. Though cognitive rehabilitation strives to deliver evidence-based therapy, few or no cognitive ergonomics or human factors performance evaluation tools have been implemented to quantitatively assess mental workload. Several therapy interventions have tasks that generate data that could benefit from the application of these human factors and ergonomics performance assessment tools. Two cognitive tasks, one commonly used in longitudinal therapy and one assessment common in neuropsychological assessments (Attention Process Training and the Rey-Osterreith Complex Figure Test, respectively), were examined to determine the data generated from those tasks and the current and potential uses of that data. Applicable tools included subjective mental workload measurements, error rate categorization, and data visualization. In addition to formative research, a quasi-experiment was performed to examine the relationship between mental workload and task performance. This research sought to examine the considerations for applying human factors tools to aid the clinician is assessing progress and patient challenges in common cognitive rehabilitation tasks. The intent of this research was to support clinicians in the delivery of evidence-based therapy by generating quantitative individual metrics to assist with tracking outcomes in order to determine the effectiveness of an intervention. This research integrated both examinations of the current therapy practice and first-hand experience with TBI rehabilitation

Information and Coordination for Tracking Traumatic Brain Injury Recovery: A Functional Needs Assessment

Traumatic brain injury (TBI) affects approximately 1.7 million Americans annually, and over 5.3 million persons in the US are living with a TBI-related disability, which costs about $60 billion annually. TBI is a multi-dimensional injury that requires multi-disciplinary care teams to coordinate and deliver care. Due to the unique symptoms and outcomes of each TBI patient, rehabilitation must be highly tailored and individualized. Clinicians want to know if their treatments for a specific patient are effective for that patient. The goal of this research is to determine the data needed for clinical decision support tools that would allow rehabilitation professional teams to track the short-term and long-term recovery of TBI survivors in a timely and effective manner. Specifically, this dissertation’s overarching goals are to: 1) map the processes of TBI rehabilitation with providers at each process stage; 2) define the roles of each provider and their expertise; 3) specify the information needs for each provider and their information flows in the process over time; and 4) consider future technological advances that might benefit care delivery coordination in this process. This functional needs assessment used semi-structured interviews (n = 32) to determine the needs of the professional care providers involved in the rehabilitation process for adult civilian TBI survivors. The findings from this work informed process maps, which were useful in understanding team coordination, and highlighted the information handoffs that occur at various levels of the system (e.g. shift-change level, healthcare system transfer level). Content analysis identified process characteristics, such as differences in TBI care in athletic programs versus purely clinical settings. This analysis also identified and defined over 30 key professional roles, their expertise, and their information needs. Provider role definitions highlighted the criticality of multi-disciplinary teamwork due to the need for different perspectives and consistency of treatment. Thus, the coordination and communication in TBI may need to be even more robust than in some other disease populations. While each professional role in TBI rehabilitation varies in their information needs, there was a general consensus in wanting to know everything about the patient. Certain information types and formats are prioritized differently for each TBI professional. All professionals want timely information, although their time-scales for what is considered timely varied. In general, the earlier the patient is in the care continuum, the more frequent information updates (i.e., multiple updates per hour or day) for providers are desired/necessary. Finally, barriers and facilitators to care were identified. The findings from two use cases informed information architectures for building a system that can house the various data formats of professionals’ information needs and support their sensemaking and coordination with other providers in TBI rehabilitation. Recommendations for improvement and areas for future work include telehealth and telemedicine interventions, automated patient data collection, information system (re)design, resource allocation analysis, and macro-ergonomic handoff research. Just as no one clinical discipline “owns” TBI care, the numerous functional needs identified in this study cannot be addressed by one discipline or field. There are numerous research and development opportunities for persons from multiple disciplines and fields, especially engineering; they are invited to join the “team” in improving the complex system that is TBI rehabilitation