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:
- Date Issued: 2022-10-14
- 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:
- Date Issued: 2022-10-14
Academic or ‘zoombie’? Characterizing sleep quality, work and lifestyle behaviours among a cohort of South African academic staff during the Covid-19 pandemic
- Authors: Le Grange, Sarah-Ann
- Date: 2022-04-06
- Subjects: Sleep-wake cycle South Africa Eastern Cape , Sleep Physiological aspects , Lifestyles Health aspects South Africa Eastern Cape , COVID-19 Pandemic, 2020- Influence , Work environment Psychological aspects , Work environment Physiological aspects , College teachers Workload South Africa Eastern Cape , Pittsburgh Sleep Quality Index (PSQI)
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/291099 , vital:56818
- Description: Working in academe is characterized by high work demands, long and late working hours and balancing multiple roles. This often leaves academic staff (interchangeably referred to as ‘academics’ and ‘staff’) with limited time to prioritize adequate rest and sleep. While sufficient sleep is important for general well-being and work performance, it may be important for academics given the cognitive and interactive nature of their work. However, limited research has characterized sleep behaviours and sleep quality in academic staff globally and specifically in South Africa (SA). Further, research shows that academics from different academic ranks and genders differ in their work experiences but less is known about whether these factors affect their sleep and lifestyle factors. Over and above the demands of academic work, the current study was conducted during COVID-19, which saw unprecedented change in workloads for academic staff due to online teaching and learning. Additionally, the pandemic has been associated with poorer sleep quality and lifestyle behaviours in the general population, but very few studies have explored this in the context of academics. Thus, this study aimed to characterize the sleep quality, work and lifestyle factors among academics from a university in the Eastern Cape province of SA and determine the effects of gender and academic rank on these measures. Additionally, the study aimed to determine the impact of COVID-19 on sleep and work-related factors of this group. This study adopted a cross-sectional design and made use of an online questionnaire that was distributed to all academics employed at the institution via email. The data collection occurred over an 8-week testing period between August and September of 2020. The questionnaire explored sociodemographic, work and lifestyle characteristics, while the characteristics of sleep and sleep quality were explored with the Pittsburgh Sleep Quality Index (PSQI). Additionally, an open-ended section was included to determine the impact of COVID-19-related changes on sleep and work. The questionnaire responses were analyzed with descriptive and inferential statistics and the open-ended questions were analyzed with thematic analyses. A total of 84 respondents completed the questionnaire. On average, sleep quality was poor (global score of 7.09 ± 3.8), the reported sleep duration was short (6.41 ± 1.06 hrs) and the group was classified as overweight according to median BMI (26.67 [23.8-2 29.45] kg/m2). Over a third (35.71%) of academic staff reported not meeting physical activity guidelines and reported using screens one hour prior to bed every night during the week (76.19%) and the weekend (67.88%). Staff also worked long total weekly work hours (54.25 ± 11). Female academics had a poorer sleep quality (p = 0.035), spent a longer time in bed (p = 0.04), experienced more bad dreams (p = <0.01), had their last serving of alcohol earlier (p = 0.04) and worked less weekday (p = 0.04) and less total weekly (p = 0.02) hours compared to male academics. Professorship-level academics were significantly older than junior- and senior-level academics (p = <0.01) while senior-level academics had a poorer PSQI compared to professorship-level academics (p = 0.03). The thematic analysis showed that home environment, neighbourhood noise, work and mental health were the main emerging factors that disturbed sleep. The thematic analysis showed that, in relation to the impact of COVID19, sleep schedules changed and sleep duration and sleep quality improved or got worse. Respondents reported their work hours increasing, work schedules becoming less routine while working from home, dealing with the challenges of working online and experiencing worry, stress and anxiety due to the pandemic. The study highlights that, in the context of lockdown and having to work and teach online from home, academics reported poor quality sleep and short sleep duration. Further, on average, the sample reported working extensive hours and unhealthy lifestyle behaviours. The sleep health, nature of work and overall lifestyles of academic staff deserves more research attention, given the importance of their work and the impact that inadequate sleep could have on academics’ health and work performance. Sleep quality was worse for females and mid-career academics, suggesting that their sleep quality may be at greater risk than other sub-groups. However, the reasons for these differences need to be explored in future studies. The findings contribute to the narrative that academe involves numerous demands and supports previous research that has suggested that academics’ sleep is insufficient. Furthermore, COVID-19 had an impact on staff’s sleep, with staff reporting changes in their sleep quality and duration. The pandemic impacted work of academics by presenting novel demands related to online teaching, intensifying demands overall and disrupting work routines. However, future research is needed to understand academics’ sleep behaviours, work and lifestyles, especially in South Africa. , Thesis (MSc) -- Faculty of Science, Human Kinetics and Ergonomics, 2022
- Full Text:
- Date Issued: 2022-04-06
- Authors: Le Grange, Sarah-Ann
- Date: 2022-04-06
- Subjects: Sleep-wake cycle South Africa Eastern Cape , Sleep Physiological aspects , Lifestyles Health aspects South Africa Eastern Cape , COVID-19 Pandemic, 2020- Influence , Work environment Psychological aspects , Work environment Physiological aspects , College teachers Workload South Africa Eastern Cape , Pittsburgh Sleep Quality Index (PSQI)
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/291099 , vital:56818
- Description: Working in academe is characterized by high work demands, long and late working hours and balancing multiple roles. This often leaves academic staff (interchangeably referred to as ‘academics’ and ‘staff’) with limited time to prioritize adequate rest and sleep. While sufficient sleep is important for general well-being and work performance, it may be important for academics given the cognitive and interactive nature of their work. However, limited research has characterized sleep behaviours and sleep quality in academic staff globally and specifically in South Africa (SA). Further, research shows that academics from different academic ranks and genders differ in their work experiences but less is known about whether these factors affect their sleep and lifestyle factors. Over and above the demands of academic work, the current study was conducted during COVID-19, which saw unprecedented change in workloads for academic staff due to online teaching and learning. Additionally, the pandemic has been associated with poorer sleep quality and lifestyle behaviours in the general population, but very few studies have explored this in the context of academics. Thus, this study aimed to characterize the sleep quality, work and lifestyle factors among academics from a university in the Eastern Cape province of SA and determine the effects of gender and academic rank on these measures. Additionally, the study aimed to determine the impact of COVID-19 on sleep and work-related factors of this group. This study adopted a cross-sectional design and made use of an online questionnaire that was distributed to all academics employed at the institution via email. The data collection occurred over an 8-week testing period between August and September of 2020. The questionnaire explored sociodemographic, work and lifestyle characteristics, while the characteristics of sleep and sleep quality were explored with the Pittsburgh Sleep Quality Index (PSQI). Additionally, an open-ended section was included to determine the impact of COVID-19-related changes on sleep and work. The questionnaire responses were analyzed with descriptive and inferential statistics and the open-ended questions were analyzed with thematic analyses. A total of 84 respondents completed the questionnaire. On average, sleep quality was poor (global score of 7.09 ± 3.8), the reported sleep duration was short (6.41 ± 1.06 hrs) and the group was classified as overweight according to median BMI (26.67 [23.8-2 29.45] kg/m2). Over a third (35.71%) of academic staff reported not meeting physical activity guidelines and reported using screens one hour prior to bed every night during the week (76.19%) and the weekend (67.88%). Staff also worked long total weekly work hours (54.25 ± 11). Female academics had a poorer sleep quality (p = 0.035), spent a longer time in bed (p = 0.04), experienced more bad dreams (p = <0.01), had their last serving of alcohol earlier (p = 0.04) and worked less weekday (p = 0.04) and less total weekly (p = 0.02) hours compared to male academics. Professorship-level academics were significantly older than junior- and senior-level academics (p = <0.01) while senior-level academics had a poorer PSQI compared to professorship-level academics (p = 0.03). The thematic analysis showed that home environment, neighbourhood noise, work and mental health were the main emerging factors that disturbed sleep. The thematic analysis showed that, in relation to the impact of COVID19, sleep schedules changed and sleep duration and sleep quality improved or got worse. Respondents reported their work hours increasing, work schedules becoming less routine while working from home, dealing with the challenges of working online and experiencing worry, stress and anxiety due to the pandemic. The study highlights that, in the context of lockdown and having to work and teach online from home, academics reported poor quality sleep and short sleep duration. Further, on average, the sample reported working extensive hours and unhealthy lifestyle behaviours. The sleep health, nature of work and overall lifestyles of academic staff deserves more research attention, given the importance of their work and the impact that inadequate sleep could have on academics’ health and work performance. Sleep quality was worse for females and mid-career academics, suggesting that their sleep quality may be at greater risk than other sub-groups. However, the reasons for these differences need to be explored in future studies. The findings contribute to the narrative that academe involves numerous demands and supports previous research that has suggested that academics’ sleep is insufficient. Furthermore, COVID-19 had an impact on staff’s sleep, with staff reporting changes in their sleep quality and duration. The pandemic impacted work of academics by presenting novel demands related to online teaching, intensifying demands overall and disrupting work routines. However, future research is needed to understand academics’ sleep behaviours, work and lifestyles, especially in South Africa. , Thesis (MSc) -- Faculty of Science, Human Kinetics and Ergonomics, 2022
- Full Text:
- Date Issued: 2022-04-06
Potential running related injury contributors in South African long-distance runners
- Authors: Jäger, Chloë Rose Laubscher
- Date: 2022-04-06
- Subjects: Running injuries South Africa , Long-distance running South Africa , Running Physiological aspects , Running shoes , Biomechanics , Chi-square test , Fisher exact test
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/290943 , vital:56801
- Description: Running related injuries (RRIs) are a common problem among long-distance runners, with injury rates ranging from 19.4% to 79.3%. Many studies have been done, investigating possible contributors to RRIs however, very few studies have investigated RRIs in South African long-distance runners, a population which may differ from previously studied populations. The current study aimed to build a descriptive profile of South African long-distance runners, as well as to determine associated factors that may contribute to RRIs. In order to do this, a cross-sectional, retrospective study design was employed using a questionnaire which was mostly electronically distributed. The sample consisted of 378 long-distance runners from each province in South Africa (SA). Using the Chi-square analysis and Fisher exact tests, significant associations were established (p<0.05). The current study found that certain RRI variables were associated with specific aspects of the participants’ personal characteristics and demographics, training characteristics, running experience, footwear, and cross training activities. Footwear and training characteristics produced the largest number of significant RRI associations. The findings of the current study could assist future research on RRIs in South African long-distance runners, by informing researchers of potential areas where more in-depth research is needed. In the long term, researchers may be able to narrow down the main contributors to RRI, possibly decreasing RRI rates in the unique population of South African long-distance runners. , Thesis (MSc) -- Faculty of Science, Human Kinetics and Ergonomics, 2022
- Full Text:
- Date Issued: 2022-04-06
- Authors: Jäger, Chloë Rose Laubscher
- Date: 2022-04-06
- Subjects: Running injuries South Africa , Long-distance running South Africa , Running Physiological aspects , Running shoes , Biomechanics , Chi-square test , Fisher exact test
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/290943 , vital:56801
- Description: Running related injuries (RRIs) are a common problem among long-distance runners, with injury rates ranging from 19.4% to 79.3%. Many studies have been done, investigating possible contributors to RRIs however, very few studies have investigated RRIs in South African long-distance runners, a population which may differ from previously studied populations. The current study aimed to build a descriptive profile of South African long-distance runners, as well as to determine associated factors that may contribute to RRIs. In order to do this, a cross-sectional, retrospective study design was employed using a questionnaire which was mostly electronically distributed. The sample consisted of 378 long-distance runners from each province in South Africa (SA). Using the Chi-square analysis and Fisher exact tests, significant associations were established (p<0.05). The current study found that certain RRI variables were associated with specific aspects of the participants’ personal characteristics and demographics, training characteristics, running experience, footwear, and cross training activities. Footwear and training characteristics produced the largest number of significant RRI associations. The findings of the current study could assist future research on RRIs in South African long-distance runners, by informing researchers of potential areas where more in-depth research is needed. In the long term, researchers may be able to narrow down the main contributors to RRI, possibly decreasing RRI rates in the unique population of South African long-distance runners. , Thesis (MSc) -- Faculty of Science, Human Kinetics and Ergonomics, 2022
- Full Text:
- Date Issued: 2022-04-06
An ergonomics approach to understanding perceived barriers to the provision of high-quality healthcare: a Sarah Baartman District clinics case study
- Authors: Card, Jason
- Date: 2020
- Subjects: Medical care -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/170536 , vital:41933
- Description: Background:The complex nature of healthcare systemsoftenresultsinthe emergence of context-specific barriers that limit the ability for healthcare stakeholders to ensure safe and effective care delivery. In low-to middle-income (LMIC) countries, such as South Africa (SA), limited financial, material and human resources coupled withpoor infrastructure and poor public health determinants, includingpoverty andpoor education, affectthe ability to maintain andimprove on quality care outcomes.Understanding what different stakeholders perceive as barriers, and if these barriers are understood at different levels, is therefore important when attempting to mitigate the risk for unsafe or inefficient care delivery. Human Factors and Ergonomics (HFE) adoptssystems and participatory approaches for the exploration, analysis, and design of socio-technical systems to optimize both human wellbeing and system performance.The barriers to safe and effective healthcare delivery, from an HFE perspective, are not known in the South African context, particularly in parts of the Eastern Cape Province. Elucidatingthesebarriers, even if self-reported,may guidefuture efforts aimed at mitigating risks.The purpose of this study, therefore,wasto explore and highlight the perceived systemic barriers to local and national healthcare delivery, within the Sarah Baartman District in the Eastern Cape Province of South Africa.Methods: Ashort discussion aimed at introducing HFE and components of the Work Systems Model, followed by a survey that captured participant demographics, job characteristics, the perceived national and local systemic barriers, and proposed solutions, was administered withhealthcare stakeholders from 14 primary healthcare facilities and 1 department office within the Sarah Baartman District.Participants (n=120) included management, pharmacy, administration, maintenance, community-and home-based care and nursing staff.Data from the surveys were thematically analysed and categorised according to components of the work system model (Carayon, 2009) and respective workgroup.Results: The findings revealed many overlapping,systemic barriersthat includedshortages of staff, poor management and leadership, a lack of equipmentand basic necessities, poor infrastructure, patient complexity,and high workloads. The results further indicate that the way in which the reported barriers affect worksystem interactionsand performance are unique to different workgroups. Stakeholders iiproposedthat,among others, the absorption of contract workers, the provision of training and adequate human and medical resources and the maintenance of facilities may mitigate the barriers and improve healthcare delivery.Conclusion: The findings highlight a myriad of perceived systemic barriers perceived in the Sarah Baartman district, some of which were fundamental for the effective function of any healthcare system. These barriers may have wide-spread implications for stakeholders at all levels, ultimately affecting the performance, satisfaction and safety and the quality of care. It is especially important to consider these barriers in light of the COVID-19 epidemic, which emerged throughout this study and the major threat it presents to South African healthcare systems. Future research should aim to explore how these barriers interact to contribute to processes and outcomes, as well as explore the perceptions at provincial and national levels in order to better identify areas and strategies for improvement.
- Full Text:
- Date Issued: 2020
- Authors: Card, Jason
- Date: 2020
- Subjects: Medical care -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/170536 , vital:41933
- Description: Background:The complex nature of healthcare systemsoftenresultsinthe emergence of context-specific barriers that limit the ability for healthcare stakeholders to ensure safe and effective care delivery. In low-to middle-income (LMIC) countries, such as South Africa (SA), limited financial, material and human resources coupled withpoor infrastructure and poor public health determinants, includingpoverty andpoor education, affectthe ability to maintain andimprove on quality care outcomes.Understanding what different stakeholders perceive as barriers, and if these barriers are understood at different levels, is therefore important when attempting to mitigate the risk for unsafe or inefficient care delivery. Human Factors and Ergonomics (HFE) adoptssystems and participatory approaches for the exploration, analysis, and design of socio-technical systems to optimize both human wellbeing and system performance.The barriers to safe and effective healthcare delivery, from an HFE perspective, are not known in the South African context, particularly in parts of the Eastern Cape Province. Elucidatingthesebarriers, even if self-reported,may guidefuture efforts aimed at mitigating risks.The purpose of this study, therefore,wasto explore and highlight the perceived systemic barriers to local and national healthcare delivery, within the Sarah Baartman District in the Eastern Cape Province of South Africa.Methods: Ashort discussion aimed at introducing HFE and components of the Work Systems Model, followed by a survey that captured participant demographics, job characteristics, the perceived national and local systemic barriers, and proposed solutions, was administered withhealthcare stakeholders from 14 primary healthcare facilities and 1 department office within the Sarah Baartman District.Participants (n=120) included management, pharmacy, administration, maintenance, community-and home-based care and nursing staff.Data from the surveys were thematically analysed and categorised according to components of the work system model (Carayon, 2009) and respective workgroup.Results: The findings revealed many overlapping,systemic barriersthat includedshortages of staff, poor management and leadership, a lack of equipmentand basic necessities, poor infrastructure, patient complexity,and high workloads. The results further indicate that the way in which the reported barriers affect worksystem interactionsand performance are unique to different workgroups. Stakeholders iiproposedthat,among others, the absorption of contract workers, the provision of training and adequate human and medical resources and the maintenance of facilities may mitigate the barriers and improve healthcare delivery.Conclusion: The findings highlight a myriad of perceived systemic barriers perceived in the Sarah Baartman district, some of which were fundamental for the effective function of any healthcare system. These barriers may have wide-spread implications for stakeholders at all levels, ultimately affecting the performance, satisfaction and safety and the quality of care. It is especially important to consider these barriers in light of the COVID-19 epidemic, which emerged throughout this study and the major threat it presents to South African healthcare systems. Future research should aim to explore how these barriers interact to contribute to processes and outcomes, as well as explore the perceptions at provincial and national levels in order to better identify areas and strategies for improvement.
- Full Text:
- Date Issued: 2020
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