The field of human factors in home health care takes into account provider and recipient capabilities in the design of interactive home care systems of people, devices and technology, and environments to ensure their safety, effectiveness, and ease of delivering care.

Figure 1-1 provides a more detailed characterization of the role of human factors in home health care. From the perspective of the care recipient, the ultimate goal is to ensure the delivery of high-quality care in the home and to avoid preventable adverse events, as shown at the bottom of the figure. A host of factors must come together for this objective to be achieved, Henriksen observed. The factors closest to the recipient that can cause adverse events are the characteristics of the provider and the recipient. (These are labeled as “active errors” in the figure.) Factors more distant from the recipient (labeled “latent conditions”) can also result in deficiencies in care. These factors include the nature of home health care tasks and the characteristics of the physical environment, of medical devices and technologies, and of the social or community environment. Exerting an even broader influence are factors in the external environment, including demographic, economic, and political factors. Thus, recipients and providers “inherit the sins of omission and commission of everybody else who has played a role in the design of the greater sociotechnical system,” said Henriksen.

Human factors research has a long track record of addressing challenging issues in demanding environments, particularly when it is able to address issues in the context of integrated systems. But systems thinking has not come easily to home health care, Henriksen said. Homes are not designed for health care, and considerable variation exists in what constitutes a home. Recipients and providers, whether formal or informal, have considerable variation in knowledge and skills. Many lay providers are themselves care recipients, as the provider workforce ages. Hazards in the home are often unrecognized, and home health care providers have limited experience with medical devices and medical information technologies. Home and community culture and environments are extremely variable. And health care reform often tends to mean doing more with less.

A comprehensive study of the role of human factors in home health care faces a challenging set of goals:

  • Achieve an in-depth understanding of the human factors challenges underlying safe and high-quality home health care.

  • Specify critical gaps in understanding.

  • Develop an integrated framework to guide research across the major components and disciplines relevant to safe delivery of care in the home.

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