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
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- 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
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The application of human factors and ergonomics (HFE) to community-sport organisations in resource scarce contexts: a case study of grassroots football in Makana, Eastern Cape
- Authors: Bennett, Ryan
- Date: 2021
- Subjects: Makana Local Football Association (South Africa) , Human engineering , Soccer teams -- South Africa -- Makhanda -- Management , Soccer -- Management -- South Africa
- Language: English
- Type: text , Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10962/172412 , vital:42198 , 10.21504/10962/172412
- Description: Background: Modern Human Factors and Ergonomics (HFE) focuses on the optimisation of complex socio-technical systems and has been challenged to contribute to broader societal issues. An example is within grassroots football organisations in resource-scarce areas such as Makana, South Africa. Through embedded participatory approaches, the research problem was co-constructed: To investigate the socio-technical system of the Makana Local Football Association (LFA). Method: A useful complex system modelling tool is that of Cognitive Work Analysis (CWA), with its 5 phases used to identify constraints and affordances. Three perspectives were adopted for the application of an adapted (to suit participant characteristics) CWA to the Makana LFA: 1) how work is prescribed by the governing body SAFA, 2) how subject matter experts (SME) disclose its current functioning, and 3) how SMEs imagine it could function. Five SMEs attended 12 three-hour workshops to complete the latter two perspectives. Results: The composite work domain analysis between work as prescribed and work as disclosed identified significant mismatches between how policymakers envision the system and how SMEs report its functioning. Key differences in perspectives included the fundamental purpose of the Makana LFA, while only four of 22 functions operate within the Makana LFA. Participants also identified key affordances for the LFA such as reorientation as a community sports organisation. Discussion: Comparison between perspectives indicated four mismatches. 1) SAFA views the LFA as the foundation of the talent identification and development infrastructure of South African football. SMEs view it as a community centred organisation. 2) A lack of human capacity is evident at the community level of Makana football. 3) Funding and assets are absent at this grassroots level. 4) The LFA relies on other stakeholders, but these relationships are not formalised. Policymakers, therefore, have a lack of knowledge of the contextual challenges faced by LFA administrators. It is recommended that SAFA view the LFA as a community sport organisation, focusing on improving human capacity, increasing funding, and formalising stakeholder networks. Furthermore, conceptual models from CWA provide explicit socio-technical system redesign recommendations. Conclusion: Large mismatches between the organising body SAFA and the actual functioning of the LFA significantly hinder the effective management and running of football at a grassroots level in resource-scarce contexts in South Africa. The perspectives approach to CWA was useful in elucidating the constraints and affordances of the Makana LFA socio-technical system and informing redesign opportunities. Systems HFE methodology is therefore well placed to contribute to broader societal issues within resources scarce contexts such as football in Makana. Furthermore, the philosophical underpinnings of systems based HFE were successful in the development of sustainable participatory research within the South African grassroots football context.
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- Authors: Bennett, Ryan
- Date: 2021
- Subjects: Makana Local Football Association (South Africa) , Human engineering , Soccer teams -- South Africa -- Makhanda -- Management , Soccer -- Management -- South Africa
- Language: English
- Type: text , Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10962/172412 , vital:42198 , 10.21504/10962/172412
- Description: Background: Modern Human Factors and Ergonomics (HFE) focuses on the optimisation of complex socio-technical systems and has been challenged to contribute to broader societal issues. An example is within grassroots football organisations in resource-scarce areas such as Makana, South Africa. Through embedded participatory approaches, the research problem was co-constructed: To investigate the socio-technical system of the Makana Local Football Association (LFA). Method: A useful complex system modelling tool is that of Cognitive Work Analysis (CWA), with its 5 phases used to identify constraints and affordances. Three perspectives were adopted for the application of an adapted (to suit participant characteristics) CWA to the Makana LFA: 1) how work is prescribed by the governing body SAFA, 2) how subject matter experts (SME) disclose its current functioning, and 3) how SMEs imagine it could function. Five SMEs attended 12 three-hour workshops to complete the latter two perspectives. Results: The composite work domain analysis between work as prescribed and work as disclosed identified significant mismatches between how policymakers envision the system and how SMEs report its functioning. Key differences in perspectives included the fundamental purpose of the Makana LFA, while only four of 22 functions operate within the Makana LFA. Participants also identified key affordances for the LFA such as reorientation as a community sports organisation. Discussion: Comparison between perspectives indicated four mismatches. 1) SAFA views the LFA as the foundation of the talent identification and development infrastructure of South African football. SMEs view it as a community centred organisation. 2) A lack of human capacity is evident at the community level of Makana football. 3) Funding and assets are absent at this grassroots level. 4) The LFA relies on other stakeholders, but these relationships are not formalised. Policymakers, therefore, have a lack of knowledge of the contextual challenges faced by LFA administrators. It is recommended that SAFA view the LFA as a community sport organisation, focusing on improving human capacity, increasing funding, and formalising stakeholder networks. Furthermore, conceptual models from CWA provide explicit socio-technical system redesign recommendations. Conclusion: Large mismatches between the organising body SAFA and the actual functioning of the LFA significantly hinder the effective management and running of football at a grassroots level in resource-scarce contexts in South Africa. The perspectives approach to CWA was useful in elucidating the constraints and affordances of the Makana LFA socio-technical system and informing redesign opportunities. Systems HFE methodology is therefore well placed to contribute to broader societal issues within resources scarce contexts such as football in Makana. Furthermore, the philosophical underpinnings of systems based HFE were successful in the development of sustainable participatory research within the South African grassroots football context.
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Effectiveness of different interventions to reduce occupational sitting among office administrators at Rhodes University
- Authors: Malesa, Thato
- Date: 2020
- Subjects: Standing position , Sedentary behavior , Work environment , Employee health promotion , Office furniture -- Design , Industrial hygiene , Employees -- Health risk assessment , Human engineering , Compliance
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/166403 , vital:41360
- Description: Background: Sitting for prolonged periods is common in the working environment. Office workers are exposed to long periods of sitting time at work. Research has reported associations between prolonged sitting and negative health implications. As such studies have proposed different interventions aimed at reducing sitting times in the workplace. The aim of the current study was to evaluate the effectiveness of two different interventions, physical intervention (sit-stand worktables) and personal intervention (instruction to stretch) on compliance and reducing occupational sitting behaviour. The study also aimed to investigate the effectiveness of interventions in improving or impairing mood. Methods: The study took the form of a fieldbased study atRhodes University, Makhanda, South Africa. Fifteen full–time office workers in different divisions participated in the study. Participants were randomly allocated to either the physical or personal intervention group. In both intervention groups, partic ipants were prompted to stand for five minutes every hour during the workday to either work in a standing position or perform stretches. Over the course of the experiment, desk occupancy, sitting/standing time and mood effect were recorded in both intervention groups Both intervention groups were monitored for a period of three months (58 days). Results: The study found that the physical intervention group was an effective approach to reduce prolonged sitting in the workplace in comparison to the personal intervention group. Over the course of the experiment, there was sustain usage of interventions in both groups, however, in the physical intervention group desk usage decreased overtime. The findings of the study also show that some participants were more compliant with the study procedures than others. It was also found that mood improved upon introducing interventions in the workplace. However, with the outcomes of the results, the study acknowledges that several factors emerged which are likely to impact compliance, which future studies may investigate. Conclusion: Although sit-stand worktables are expensive, it seems like introducing them was successful in reducing sitting time and changing sitting behaviour in comparison to an intervention that instruct s individuals to stand up and stretch.
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- Authors: Malesa, Thato
- Date: 2020
- Subjects: Standing position , Sedentary behavior , Work environment , Employee health promotion , Office furniture -- Design , Industrial hygiene , Employees -- Health risk assessment , Human engineering , Compliance
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/166403 , vital:41360
- Description: Background: Sitting for prolonged periods is common in the working environment. Office workers are exposed to long periods of sitting time at work. Research has reported associations between prolonged sitting and negative health implications. As such studies have proposed different interventions aimed at reducing sitting times in the workplace. The aim of the current study was to evaluate the effectiveness of two different interventions, physical intervention (sit-stand worktables) and personal intervention (instruction to stretch) on compliance and reducing occupational sitting behaviour. The study also aimed to investigate the effectiveness of interventions in improving or impairing mood. Methods: The study took the form of a fieldbased study atRhodes University, Makhanda, South Africa. Fifteen full–time office workers in different divisions participated in the study. Participants were randomly allocated to either the physical or personal intervention group. In both intervention groups, partic ipants were prompted to stand for five minutes every hour during the workday to either work in a standing position or perform stretches. Over the course of the experiment, desk occupancy, sitting/standing time and mood effect were recorded in both intervention groups Both intervention groups were monitored for a period of three months (58 days). Results: The study found that the physical intervention group was an effective approach to reduce prolonged sitting in the workplace in comparison to the personal intervention group. Over the course of the experiment, there was sustain usage of interventions in both groups, however, in the physical intervention group desk usage decreased overtime. The findings of the study also show that some participants were more compliant with the study procedures than others. It was also found that mood improved upon introducing interventions in the workplace. However, with the outcomes of the results, the study acknowledges that several factors emerged which are likely to impact compliance, which future studies may investigate. Conclusion: Although sit-stand worktables are expensive, it seems like introducing them was successful in reducing sitting time and changing sitting behaviour in comparison to an intervention that instruct s individuals to stand up and stretch.
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The effects of intermittent task parameters on muscle fatigue development during submaximal dynamic exertions
- Authors: King, Josephine Claire
- Date: 2018
- Subjects: Muscles -- Physiology , Muscles -- Wounds and injuries , Fatigue , Human engineering , Occupational diseases
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/63855 , vital:28498
- Description: The negative effects of localised muscle fatigue on accidents, injuries and poor work performance are well known, as is the realisation that modifying task characteristics can minimise fatigue development. A large amount of literature has investigated the effects of task-dependent factors on localised muscle fatigue, most studies have focussed on prolonged or intermittent static (isometric) exertions. Few studies have investigated muscle fatigue development during more complex tasks, namely those which resemble common work activities and which tend to be intermittent and dynamic in nature. More specifically, the interactions between the main intermittent parameters - duty cycle, force level, and cycle time - during dynamic exertions are poorly understood. The purpose of this study was to investigate the effects of cycle time and combinations of duty cycles and force levels on the development of muscle fatigue during submaximal dynamic exertions while the overall mean muscle load was kept constant. A two-factorial repeated-measures experiment was developed for this study. Nine experimental conditions, each lasting 16 minutes, aimed at inducing muscle fatigue in the middle deltoid muscle via intermittent dynamic shoulder abduction and adduction motions at three cycle times (30, 60, and 120 seconds) and three combinations of duty cycles and force levels. The percentage of muscle activation during one cycle (i.e. the duty cycle) varied depending on the exertion intensity (force level) so that the overall mean muscle load remained consistent throughout all experimental conditions, namely at 20% of maximum force exertion. As a result, the three duty cycle/force level combinations were: 0.8/25% of maximum voluntary force (MVF), 0.5/40%MVF, and 0.4/50%MVF. Muscle fatigue development was inferred by changes in peak torque, total work, average power, local Ratings of Perceived Exertion (RPE), and surface electromyographical (EMG) activity (time domain and frequency domain).Two-factorial analyses of variance with Tukey post-hoc tests were used to identify significant condition effects at p<0.05. All dependent measures showed that muscle fatigue was induced by the 16-minute fatigue protocol. Peak torque, total work, average power, and EMG percentage of maximum showed that cycle time and the duty cycle/force level combination had no effect on the development of muscle fatigue, whereas the measures evaluated during the 16-minute fatigue protocol did. The cycle time of 120 seconds induced the greatest change in six of the eight variables, while the duty cycle/force level combination (0.8/25%) also resulted in the greatest effect in six of the measures. Fatigue was also found to be dependent on the interaction of cycle time and duty cycle/force level combination. The conclusion draws from this study is that shorter cycles and activities with short activation periods, and proportionally longer rest breaks result in the lowest fatigue developments.
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- Authors: King, Josephine Claire
- Date: 2018
- Subjects: Muscles -- Physiology , Muscles -- Wounds and injuries , Fatigue , Human engineering , Occupational diseases
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/63855 , vital:28498
- Description: The negative effects of localised muscle fatigue on accidents, injuries and poor work performance are well known, as is the realisation that modifying task characteristics can minimise fatigue development. A large amount of literature has investigated the effects of task-dependent factors on localised muscle fatigue, most studies have focussed on prolonged or intermittent static (isometric) exertions. Few studies have investigated muscle fatigue development during more complex tasks, namely those which resemble common work activities and which tend to be intermittent and dynamic in nature. More specifically, the interactions between the main intermittent parameters - duty cycle, force level, and cycle time - during dynamic exertions are poorly understood. The purpose of this study was to investigate the effects of cycle time and combinations of duty cycles and force levels on the development of muscle fatigue during submaximal dynamic exertions while the overall mean muscle load was kept constant. A two-factorial repeated-measures experiment was developed for this study. Nine experimental conditions, each lasting 16 minutes, aimed at inducing muscle fatigue in the middle deltoid muscle via intermittent dynamic shoulder abduction and adduction motions at three cycle times (30, 60, and 120 seconds) and three combinations of duty cycles and force levels. The percentage of muscle activation during one cycle (i.e. the duty cycle) varied depending on the exertion intensity (force level) so that the overall mean muscle load remained consistent throughout all experimental conditions, namely at 20% of maximum force exertion. As a result, the three duty cycle/force level combinations were: 0.8/25% of maximum voluntary force (MVF), 0.5/40%MVF, and 0.4/50%MVF. Muscle fatigue development was inferred by changes in peak torque, total work, average power, local Ratings of Perceived Exertion (RPE), and surface electromyographical (EMG) activity (time domain and frequency domain).Two-factorial analyses of variance with Tukey post-hoc tests were used to identify significant condition effects at p<0.05. All dependent measures showed that muscle fatigue was induced by the 16-minute fatigue protocol. Peak torque, total work, average power, and EMG percentage of maximum showed that cycle time and the duty cycle/force level combination had no effect on the development of muscle fatigue, whereas the measures evaluated during the 16-minute fatigue protocol did. The cycle time of 120 seconds induced the greatest change in six of the eight variables, while the duty cycle/force level combination (0.8/25%) also resulted in the greatest effect in six of the measures. Fatigue was also found to be dependent on the interaction of cycle time and duty cycle/force level combination. The conclusion draws from this study is that shorter cycles and activities with short activation periods, and proportionally longer rest breaks result in the lowest fatigue developments.
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