Applying human factors and ergonomics to a healthcare clinic record-keeping process using a community-based participatory research approach in Makhanda
- Authors: Kingwill, Kirsten Rosemary
- Date: 2025-04-02
- Subjects: Human engineering , Clinics Records and correspondence , Community-engaged research , Community-based research , Records management
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/479152 , vital:78265
- Description: Background: Healthcare record-keeping is an important process. However, several challenges associated with taking, storing and maintaining accurate records have been identified as a barrier to the quality and safety of care globally and locally in primary healthcare clinics in Makhanda, Eastern Cape, South Africa. In this context, local healthcare providers argue that this stems from the hybrid nature of the system (paper and electronic) and the impact of several systemic challenges. Poor records can result in negative outcomes for patients, healthcare workers and the greater public healthcare system. For example, if patient files are not adequately completed, poor patient care and medico-legal litigation costs may emerge. Furthermore, given that HFE promotes the participation of stakeholders in identifying and resolving workplace challenges, this study adopted a participatory research approach, more specifically a Community-Based Participatory Research (CBPR) approach. This research project, therefore, aimed to explore the barriers and facilitators to record-keeping in a primary healthcare clinic in Makhanda, the adequacy of patient file completeness and reasons as to why files may or may not have been adequately completed, following a CBPR approach. Methods: Following a period of pre-data collection embedding in the clinic to become familiar with the system and the staff and to form a relationship with a community collaborator from the clinic, this study was completed in two broad phases. During Phase 1, observations, informal discussions and semi-structured interviews were conducted with 11 clinic staff members to understand the clinic and record-keeping systems through the work system components and barriers of both systems. Phase 1 data was analysed through thematic analysis and presented by work system components, selected SEIPS 101 tools and a Hierarchical Task Analysis to detail the tasks involved in the record-keeping process. During Phase 2, a comparative assessment of a sample of patient files (n=55) was conducted against a local standard checklist, detailing what was to be completed in patient files. This was done to assess the completeness of different file sections which were analysed through a frequency count. This was followed by three interviews with clinicians, which explored their perceptions on why sections of the records may have been better completed than others. The interviews were then thematically analysed. Results: Administrative staff shortages, a lack of file storage space, limited access to technology such as computers, lost files, and the amount of information to complete in files were identified as the major challenges associated with the record-keeping system and influencing the completion of patient files. Through the analysis of patient files, it was found that some patient file sections were completed more adequately than others. For example, administrative details were the most well-completed section, and the Anti-Retroviral Therapy (ART) initiation section was the most poorly completed. The findings also revealed reasons as to why these sections may or may not have been adequately completed. These included the need for the duplication of information, particularly for antenatal care clinicians. Time pressure for clinicians to see and complete patient records and work ethic and accountability were additional emergent themes. Lastly, clinicians argued that having a lack of access to, a shortage of or broken medical and record-keeping equipment that inhibited clinicians from obtaining and recording patient information, were additional reasons for poorly taken records. Conclusions: As the findings revealed, the primary healthcare clinic and its hybrid record-keeping system and process were influenced by a variety of clinic and record-keeping challenges that interacted and ultimately influenced the record-keeping process and completeness of patient files. The system constraints are important considerations as understanding how the clinic functions under them is a starting point for future system improvement. Furthermore, barriers impacting the record-keeping system influence several key steps in the record-keeping process, including the completion of details within patient files. Here it was found that some sections and information details were more adequately completed than others, which impacted the continuity, quality and safety of patient care. Additionally, the discrepancies found between the standard checklist and patient files were highlighted as a point of concern for the Department of Health (DoH) as clinics were being assessed based on a checklist that did not match the patient files, incorrectly representing the completeness of files to the DoH. Throughout the research project, the application and implementation of HFE and CBPR have been shown to be important in the local healthcare record-keeping system in that real-world challenges were identified through the perspective of community members facing the challenges. Therefore, HFE researchers should adopt a CBPR approach and apply these complementary domains in other complex systems and varying contexts to comprehensively understand the barriers, facilitators and opportunities for human-system interaction improvements. , Thesis (MSc) -- Faculty of Science, Human Kinetics and Ergonomics, 2025
- Full Text:
- Authors: Kingwill, Kirsten Rosemary
- Date: 2025-04-02
- Subjects: Human engineering , Clinics Records and correspondence , Community-engaged research , Community-based research , Records management
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/479152 , vital:78265
- Description: Background: Healthcare record-keeping is an important process. However, several challenges associated with taking, storing and maintaining accurate records have been identified as a barrier to the quality and safety of care globally and locally in primary healthcare clinics in Makhanda, Eastern Cape, South Africa. In this context, local healthcare providers argue that this stems from the hybrid nature of the system (paper and electronic) and the impact of several systemic challenges. Poor records can result in negative outcomes for patients, healthcare workers and the greater public healthcare system. For example, if patient files are not adequately completed, poor patient care and medico-legal litigation costs may emerge. Furthermore, given that HFE promotes the participation of stakeholders in identifying and resolving workplace challenges, this study adopted a participatory research approach, more specifically a Community-Based Participatory Research (CBPR) approach. This research project, therefore, aimed to explore the barriers and facilitators to record-keeping in a primary healthcare clinic in Makhanda, the adequacy of patient file completeness and reasons as to why files may or may not have been adequately completed, following a CBPR approach. Methods: Following a period of pre-data collection embedding in the clinic to become familiar with the system and the staff and to form a relationship with a community collaborator from the clinic, this study was completed in two broad phases. During Phase 1, observations, informal discussions and semi-structured interviews were conducted with 11 clinic staff members to understand the clinic and record-keeping systems through the work system components and barriers of both systems. Phase 1 data was analysed through thematic analysis and presented by work system components, selected SEIPS 101 tools and a Hierarchical Task Analysis to detail the tasks involved in the record-keeping process. During Phase 2, a comparative assessment of a sample of patient files (n=55) was conducted against a local standard checklist, detailing what was to be completed in patient files. This was done to assess the completeness of different file sections which were analysed through a frequency count. This was followed by three interviews with clinicians, which explored their perceptions on why sections of the records may have been better completed than others. The interviews were then thematically analysed. Results: Administrative staff shortages, a lack of file storage space, limited access to technology such as computers, lost files, and the amount of information to complete in files were identified as the major challenges associated with the record-keeping system and influencing the completion of patient files. Through the analysis of patient files, it was found that some patient file sections were completed more adequately than others. For example, administrative details were the most well-completed section, and the Anti-Retroviral Therapy (ART) initiation section was the most poorly completed. The findings also revealed reasons as to why these sections may or may not have been adequately completed. These included the need for the duplication of information, particularly for antenatal care clinicians. Time pressure for clinicians to see and complete patient records and work ethic and accountability were additional emergent themes. Lastly, clinicians argued that having a lack of access to, a shortage of or broken medical and record-keeping equipment that inhibited clinicians from obtaining and recording patient information, were additional reasons for poorly taken records. Conclusions: As the findings revealed, the primary healthcare clinic and its hybrid record-keeping system and process were influenced by a variety of clinic and record-keeping challenges that interacted and ultimately influenced the record-keeping process and completeness of patient files. The system constraints are important considerations as understanding how the clinic functions under them is a starting point for future system improvement. Furthermore, barriers impacting the record-keeping system influence several key steps in the record-keeping process, including the completion of details within patient files. Here it was found that some sections and information details were more adequately completed than others, which impacted the continuity, quality and safety of patient care. Additionally, the discrepancies found between the standard checklist and patient files were highlighted as a point of concern for the Department of Health (DoH) as clinics were being assessed based on a checklist that did not match the patient files, incorrectly representing the completeness of files to the DoH. Throughout the research project, the application and implementation of HFE and CBPR have been shown to be important in the local healthcare record-keeping system in that real-world challenges were identified through the perspective of community members facing the challenges. Therefore, HFE researchers should adopt a CBPR approach and apply these complementary domains in other complex systems and varying contexts to comprehensively understand the barriers, facilitators and opportunities for human-system interaction improvements. , Thesis (MSc) -- Faculty of Science, Human Kinetics and Ergonomics, 2025
- Full Text:
Applying human factors and ergonomics system analysis methods to the V5-NRS Cessna 441 Conquest II aviation accident
- Authors: Fischer, Jordan Daena
- Date: 2023-10-13
- Subjects: Ergonomics , Human engineering , Accident investigation , Aircraft accidents Investigation , AcciMap Approach , System theory , Study of complex systems
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/424245 , vital:72136
- Description: Intro: Accidents are complex in nature with multiple contributing factors. The way in which accidents are investigated is important and using system-based analysis tools assists in understanding and mapping these contributing factors to learn from them. There has been an increase in the number of accidents that have occurred within the general aviation industry in South Africa and while accident investigations have been undertaken, these have not included the application of system-based analysis tools. This led to a collaboration between Rhodes University and the Accident and Incident Investigations Division (AIID) of the South African Civil Aviation Authority where it was agreed that two systems-based analysis tools will be applied to a previously investigated accident that occurred in 2015. Aims: The first aim of this thesis was to identify if, through the implementation of these systems-based tools, the systemic contributory factors could be determined using the existing report by the AIID. The second aim of this thesis was to identify if, using the two systems-based tools, the actors and levels involved in the accident could be identified and the third aim was to identify if the implementation of these tools generates the same or different recommendations to that of the AIID. Methods: The two systems-based analysis tools applied were AcciMap and Causal Analysis using Systems Theory (CAST). These tools were applied to the V5-NRS Cessna 441 Conquest II accident report which captured the details of how the aircraft flew into the Tygerberg mountain on its descent into the Cape Town International Airport in August 2015. Results: Through the application of these two systems-based analysis tools the major contributing factors elucidated throughout this analysis were: visual and lighting conditions, pilot experience, training, lack of terrain warning equipment, fatigue, inadequate oversight, and inadequate risk management. In line with these findings, the analysis revealed various actors across various levels (the crew; South African Air Traffic Control, the SACAA, WestAir (the operator) and the Namibian Civil Aviation Authority Through the elucidation of these factors at various levels, 14 to 15 different recommendations were generated which was more than the one recommendation that was generated by the AIID. Discussion: Even when applied to an existing report, both the CAST and Accimap tools were able to bring to light the systemic contributing factors to this accident and importantly, highlight the role that various actors and levels within the system had in this unfortunate event. Consistent with previous literature, most of the contributing factors were found at the lowest level (the crew in this case) and fewer, but key factors were identified at higher levels (management and regulator level). Importantly, the application of the systems tools facilitated a systematic and systemic analysis of this accident, which allowed for the generation of recommendations at all levels, not just at the operator level. Conclusion: This study demonstrates the benefits and importance behind implementing a systems-based analysis method to an accident as these tools generate more useful recommendations which allows for important lessons to be learned following accidents, with the intention of re-designing systems to prevent them from happening again. , Thesis (MSc) -- Faculty of Science, Human Kinetics and Ergonomics, 2023
- Full Text:
- Authors: Fischer, Jordan Daena
- Date: 2023-10-13
- Subjects: Ergonomics , Human engineering , Accident investigation , Aircraft accidents Investigation , AcciMap Approach , System theory , Study of complex systems
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/424245 , vital:72136
- Description: Intro: Accidents are complex in nature with multiple contributing factors. The way in which accidents are investigated is important and using system-based analysis tools assists in understanding and mapping these contributing factors to learn from them. There has been an increase in the number of accidents that have occurred within the general aviation industry in South Africa and while accident investigations have been undertaken, these have not included the application of system-based analysis tools. This led to a collaboration between Rhodes University and the Accident and Incident Investigations Division (AIID) of the South African Civil Aviation Authority where it was agreed that two systems-based analysis tools will be applied to a previously investigated accident that occurred in 2015. Aims: The first aim of this thesis was to identify if, through the implementation of these systems-based tools, the systemic contributory factors could be determined using the existing report by the AIID. The second aim of this thesis was to identify if, using the two systems-based tools, the actors and levels involved in the accident could be identified and the third aim was to identify if the implementation of these tools generates the same or different recommendations to that of the AIID. Methods: The two systems-based analysis tools applied were AcciMap and Causal Analysis using Systems Theory (CAST). These tools were applied to the V5-NRS Cessna 441 Conquest II accident report which captured the details of how the aircraft flew into the Tygerberg mountain on its descent into the Cape Town International Airport in August 2015. Results: Through the application of these two systems-based analysis tools the major contributing factors elucidated throughout this analysis were: visual and lighting conditions, pilot experience, training, lack of terrain warning equipment, fatigue, inadequate oversight, and inadequate risk management. In line with these findings, the analysis revealed various actors across various levels (the crew; South African Air Traffic Control, the SACAA, WestAir (the operator) and the Namibian Civil Aviation Authority Through the elucidation of these factors at various levels, 14 to 15 different recommendations were generated which was more than the one recommendation that was generated by the AIID. Discussion: Even when applied to an existing report, both the CAST and Accimap tools were able to bring to light the systemic contributing factors to this accident and importantly, highlight the role that various actors and levels within the system had in this unfortunate event. Consistent with previous literature, most of the contributing factors were found at the lowest level (the crew in this case) and fewer, but key factors were identified at higher levels (management and regulator level). Importantly, the application of the systems tools facilitated a systematic and systemic analysis of this accident, which allowed for the generation of recommendations at all levels, not just at the operator level. Conclusion: This study demonstrates the benefits and importance behind implementing a systems-based analysis method to an accident as these tools generate more useful recommendations which allows for important lessons to be learned following accidents, with the intention of re-designing systems to prevent them from happening again. , Thesis (MSc) -- Faculty of Science, Human Kinetics and Ergonomics, 2023
- Full Text:
Drifting towards death: a South African patient safety incident through an HFE Systems lens
- Authors: Agar, Sarah Leigh
- Date: 2022-10-14
- Subjects: Patients Safety measures , Medical errors Prevention , Human engineering , Medical care South Africa
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/362716 , vital:65356
- Description: Patient Safety Incidents (PSI) are a frequent occurrence within the South African public healthcare system wherein a patient is unnecessarily maimed, harmed, killed, or put through significant trauma, emotional or physical. These incidents have a significant impact on the performance of the system and the well-being of individuals involved. Often PSI are the result of multiple system failings that provide the necessary preconditions for the PSI to occur. Thus, to provide appropriate patient safety recommendations to address and aid in the prevention of future PSI it is necessary to apply a systems approach to PSI analysis. A systems approach supports a ‘bigger picture’ view of an incident which includes looking beyond the immediate causes of a PSI and taking the different levels of the healthcare system into consideration during incident analysis. Human Factors and Ergonomics (HFE) is at its core a systems discipline and has been successfully applied to multiple fields including healthcare. HFE offers multiple incident analysis tools grounded in systems theory. The Life Esidimeni incident, a PSI that resulted in the death of 144 MHCU, is the biggest PSI in recent South African history and is therefore an important potential case study for the application of HFE systems tools within the South African healthcare context (an area that is lacking in existing literature). The objectives of this research were to (i) Systematically uncover the causal factors that led to the outcome of the of the Life Esidimeni incident; (ii) Identify critical faults, and gaps within the healthcare system that led to the Life Esidimeni PSI; and (iii) Provide proactive recommendations for future prevention of PSI. To fulfil these objectives a descriptive case study research method design was adopted using a qualitative systems-based tool, AcciMap. The application of AcciMap to Life Esidimeni enabled both the sharp end and blunt end causal factors that contributed to the outcome of the incident to be identified. Importantly this provided insight into the critical faults and gaps of the South African public healthcare system. The results of the AcciMap indicated that there were four main broad systemic faults in the system. These broad areas were categorized as key themes, which include: (i) competency, (ii) safeguards, (iii) time pressures, and (iv) vertical integration. From these key themes recommendations aimed at addressing the critical faults and gaps in the system and preventing future PSI were made. , Thesis (MSc) -- Faculty of Science, Human Kinetics and Ergonomics, 2022
- Full Text:
- Authors: Agar, Sarah Leigh
- Date: 2022-10-14
- Subjects: Patients Safety measures , Medical errors Prevention , Human engineering , Medical care South Africa
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/362716 , vital:65356
- Description: Patient Safety Incidents (PSI) are a frequent occurrence within the South African public healthcare system wherein a patient is unnecessarily maimed, harmed, killed, or put through significant trauma, emotional or physical. These incidents have a significant impact on the performance of the system and the well-being of individuals involved. Often PSI are the result of multiple system failings that provide the necessary preconditions for the PSI to occur. Thus, to provide appropriate patient safety recommendations to address and aid in the prevention of future PSI it is necessary to apply a systems approach to PSI analysis. A systems approach supports a ‘bigger picture’ view of an incident which includes looking beyond the immediate causes of a PSI and taking the different levels of the healthcare system into consideration during incident analysis. Human Factors and Ergonomics (HFE) is at its core a systems discipline and has been successfully applied to multiple fields including healthcare. HFE offers multiple incident analysis tools grounded in systems theory. The Life Esidimeni incident, a PSI that resulted in the death of 144 MHCU, is the biggest PSI in recent South African history and is therefore an important potential case study for the application of HFE systems tools within the South African healthcare context (an area that is lacking in existing literature). The objectives of this research were to (i) Systematically uncover the causal factors that led to the outcome of the of the Life Esidimeni incident; (ii) Identify critical faults, and gaps within the healthcare system that led to the Life Esidimeni PSI; and (iii) Provide proactive recommendations for future prevention of PSI. To fulfil these objectives a descriptive case study research method design was adopted using a qualitative systems-based tool, AcciMap. The application of AcciMap to Life Esidimeni enabled both the sharp end and blunt end causal factors that contributed to the outcome of the incident to be identified. Importantly this provided insight into the critical faults and gaps of the South African public healthcare system. The results of the AcciMap indicated that there were four main broad systemic faults in the system. These broad areas were categorized as key themes, which include: (i) competency, (ii) safeguards, (iii) time pressures, and (iv) vertical integration. From these key themes recommendations aimed at addressing the critical faults and gaps in the system and preventing future PSI were made. , Thesis (MSc) -- Faculty of Science, Human Kinetics and Ergonomics, 2022
- Full Text:
- «
- ‹
- 1
- ›
- »