Participatory user-centered design approach to tool/checklist development

1. Participatory user-centered design approach to tool/checklist development Mahiyar Nasarwanji PhD, Ayse P. Gurses PhD, AnpingXie, PhD Armstrong Institute for Patient Quality and Safety

2. Goals • Use a participatory approach to • Improve (handoff) communication • Consider information needs of all players • Develop a shared standardized form • Develop your own tool/checklist

3. Toolkit • New material • User centered design approach to tool / Today checklist development • Assessment of Care Transitions (ACT)  • Reinforcement • Teamwork across unit tool  • Barrier identification and mitigation tool  • Currently implemented • Transitions of care survey  • Part of HSPOS  • Relational Coordination 

4. Systems Engineering Initiative for Patient Safety (SEIPS) Model Carayon, P., Hundt, A.S., Karsh, B.-T., Gurses, A.P., Alvarado, C.J., Smith, M. and Brennan, P.F. “Work System Design for Patient Safety: The SEIPS Model”, Quality & Safety in Health Care, 15 (Suppl. 1): i50-i58, 2006.

5. Participatory Ergonomics (PE) Key characteristics

6. Participatory Ergonomics Wilson, 1995; Haines et al., 2002 • Dimensions • Permanence: Temporary, ongoing • Involvement: Representative, direct • Level of influence: Unit, department, hospital • Decision-making: Consensus, consultation, delegation • Mix of participants: providers, management, (patients/families) • Requirement to participate: Voluntary, compulsory • Role of human factors and ergonomics specialist • Initiates process • Trains participants • Available as consultant / guide

7. Good Checklist Design Winters BD, Gurses AP, Lehmann H, Sexton JB, Rampersad CJ, Pronovost PJ. (2009) Clinical review: checklists - translating evidence into practice. Crit Care. 13(6):210 Degani& Wiener, 1993; Evans & Dodge, 2010; Hales et al., 2008; Herring et al., 2011; Winters et al., 2010; World Alliance for Patient Safety, 2008 • Should include all stakeholders and experts • Content of checklist • Number of items • Categories and sequence of items • Format of checklist • Readability, use of color, length, jargon • Checklist should fit workflow • Clear roles of people involved, including leader

8. Good Checklist Implementation Evans & Dodge, 2010; Hales et al., 2008;Lingard et al., 2005; Lingard et al., 2008; Mahajan, 2011; Thomassen et al., 2011; Vats et al., 2010; Winters et al., 2010 • Pilot test to assess usability • Get feedback to revise • Appropriate training before implementation • Local champions and rapport building • Continuous evaluation and improvement

9. Challenges with Checklist Lingard et al., 2005; Lingard et al., 2008; Mahajan, 2011; Thomassen et al., 2011; Vats et al., 2010 The checklist may disrupt workflow Clinicians used to working independently Skepticism from clinicians Lack of familiarity with checklists Checklist may be filled out incompletely or dismissively The checklist may divert attention away from the patient

10. Participatory user centered design approach to tool / checklist development

11. Identify needs • Define overall goals • What is the goal of the tool / checklist? • Is the tool / checklist really needed? • Implementation support • What is needed to support the successful implementation of the tool? • Identify all players their roles and responsibilities • Develop the teams

12. Identify Requirements • Define the context or situation of use • When? Where? How? Who? What? Why? • Consider how the tool / checklist will influence work • Proactively identify potential negative consequences • Benchmark

13. Successful transfer of information • Provider information • Patient information • Plan of care • Discussion and questions • Dedicated time • Sufficient length • Clear leadership • Good communication • Team involvement • Avoid interruptions • Discussion and questions • With the aid of checklists, tools and technology • Close to work area • Large enough space • Free from distractions • Access to required information and technology • Key personnel / players • Active involvement of senior physicians Adapted from: AMA Clinical Handover Guide - Safe Handover: Safe Patients: https://ama.com.au/ama-clinical-handover-guide-safe-handover-safe-patients

14. Identify Requirements • Define the context or situation of use • When? Where? How? Who? What? Why? • Consider how the tool / checklist will influence work • Proactively identify potential negative consequences • Benchmark

15. Need Analysis Define needs of all users Prioritize needs List all constraints of use and hazards Refine and summarize needs

16. Design • Layout and format the tool • Can model based on pre-existing formats • Use human factors principles to • Cluster related information together • Highlight key pieces of information • Order information using common or standard conventions (head to toe assessment) • Use appropriate terms that are universally understood, clear and not easily mistaken • Develop a prototype of the tool / checklist

17. Pre-existing formats to help organize information Joint Commission (2007). Improving hand-off communication

18. Follow up care needs and recommendations Nasarwanji et al 2013 Working paper

19. Design • Layout and format the tool • Can model based on pre-existing formats • Use human factors principles to • Cluster related information together • Highlight key pieces of information • Order information using common or standard conventions (head to toe assessment) • Use appropriate terms that are universally understood, clear and not easily mistaken • Develop a prototype of the tool / checklist

20. Iterative testing • Pilot test the tool • Use the tool as part of simulated training • Evaluate effectiveness • Evaluate Use • Summarize results of the test • Re-design, refine and improve the toolbased on input from the pilot testing • Re-evaluate the usability of the tool iteratively

21. Finalize tool After iterative usability testing and refinement finalize the tool Implement the tool in a real world setting Collect feedback from users on tool Continual improvement and refinement of the tool based on input from users

22. Participatory user centered design approach to tool / checklist development

23. Lessons learned • Participatory ergonomics • Good checklist deign • User centered design approach to tool / checklist development • Improves handoff communication • Considers the information needs of all players • A shared standardized form

24. Your handoff checklist … Let us see your handoff tool / checklist Tell us how you designed your checklist

25. Thank you! Mahiyar Nasarwanji, Ph.D. mnasarw1@jhmi.edu AyseGurses, Ph.D. agurses1@jhmi.edu AnpingXie, PhD axie1@jhmi.edu