Tools for developing a quality management program: human factors and systems engineering tools.

During the past 10 years, there has been growing acceptance and encouragement of partnerships between medical teams and engineers. Using human factors and systems engineering descriptions of process flows and operational sequences, the author's research laboratory has helped highlight opportunities for reducing adverse events and improving performance in health care and other high-consequence environments. This research emphasized studying human behavior that enhances system performance and a range of factors affecting adverse events, rather than a sole emphasis on human error causation. Developing a balanced evaluation requires novel approaches to causal analyses of adverse events and, more importantly, methods of recovery from adverse conditions. Recent work by the author's laboratory in collaboration with the Regenstrief Center for Healthcare Engineering has started to address possible improvements in taxonomies describing health care tasks. One major finding includes enhanced understanding of events and how event dynamics influence provider tasks and constraints. Another element of this research examines team coordination tasks that strongly affect patient care and quality management, but may be undervalued as "indirect patient care" activities.