Macroergonomics in Health Care Quality and Patient Safety

The U.S. Institute of Medicine and health care experts have called for new approaches to manage health care quality problems. In this chapter, we focus on macroergonomics, a branch of human factors and ergonomics that is based on the systems approach and considers the organizational and sociotechnical context of work activities and processes. Selected macroergonomic approaches to health care quality and patient safety are described, such as the SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety and the model of health care professional performance. Focused reviews on job stress and burnout, workload, interruptions, patient-centered care, health information technology and medical devices, violations, and care coordination provide examples of macroergonomics contributions to health care quality and patient safety. Health care systems and processes clearly need to be systematically redesigned; examples of macroergonomic approaches, principles, and methods for health care system redesign are described. Further research linking macroergonomics and care processes/patient outcomes is needed. Other needs for macroergonomics research are highlighted, including understanding the link between worker outcomes (e.g., safety and well-being) and patient outcomes (e.g., patient safety) and macroergonomics of patient-centered care and care coordination.