The Impact of the Human Factor on Your Life
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Many professions, especially in the delivery of healthcare, experience burnout. The human condition of burnout is the same among occupations, but the stressors differ by field. Physician Burnout has increased from However, clinician burnout affects the individual, the organization, and the entire healthcare system through quality, safety, economic, legal risk as well as affecting availability to provide care and the experience by patients  - . Patient healthcare satisfaction is also highly correlated with physician career satisfaction .
In our society there are accelerations of technological change proceeding on an exponential scale, which outpaces the human ability to adapt . Connectivity has rapidly increased along with increased expectations and accountability. Widespread health professional burnout has been a predictable result. The healthcare administrative framework of The Triple Aim  lower costs, improve quality and improving patient satisfaction has been extensively adopted, but misses human factors in the delivery of care that are now more important than ever.
Two other landmark publications proposed a Quadruple Aim framework for healthcare which includes the Triple Aim objectives but includes a fourth aim described as: 1 Improving the work life of healthcare providers, including clinicians and staff  , and 2 Creating conditions for the healthcare workforce to find joy and meaning in their work, and in doing so improving the experience of providing care . Many industries which support healthcare and administrators who manage healthcare delivery do not have firsthand knowledge of the complexities of delivering care. As a result, the experience and human factors of providing care are often overlooked at high decision-making levels unless incorporated into the healthcare delivery framework, proposed as the fourth aim in The Quadruple Aim framework.
As more evidence of the negative impact of burnout emerges, this fourth aim has been more critical to patient safety, quality and the survival of the healthcare system than has previously been appreciated. Their approach to humans and the systems they interface with includes awareness of human capabilities as well as human limitations . HFE purpose is to optimize system performance while optimizing human well-being.
The day after tomorrow?
Patient safety is one component of system performance. The HFE range includes physical, neurocognitive and organizational macro ergonomics and integrates contributions from biological, psychological and social sciences. Clinicians and administrators in healthcare have acknowledged that the number and complexity of many well-meaning quality and safety efforts in healthcare reform were overwhelming.
These quality and safety efforts in healthcare came from legitimate authorities, but due to lack of interagency collaboration and harmonization, have been felt to be wearing out clinicians and backfiring in attempts to improve patient safety and quality by means of human factors unaccounted for in design. Finding a scientific framework to understand and communicate these dangers and improve the delivery of care experience became a goal of our institution.
This approach is a-political, has immediate validity from application in other industries, and has a uniting effect toward better patient care. It is a limited resource that needs to be replenished . It is fundamentally used when we sift, sort, and classify, as well as using executive functions of the clinician brain required in healthcare delivery.
Human Growth and Development
Executive functions of the brain include focus, attention, self-control of behavior and speech, plan and organize, perspective taking, cognitive flexibility, medical and other decision making, ability to defer gratification, estimating time and working memory. Neural resource gets used when we switch back and forth between different tasks e. Set-shifting switching between tasks and inter-task coordination as required in multitasking are executive function abilities, emerging from neural networks centered around the prefrontal cortex of the brain.
Part of executive function is cognitive flexible memory CFM which allows individuals to draw upon facts and concepts from memory. The anticipated next steps of being emotionally available to the patient and their family for conveying the plan or bad news are also controlled through CFM. When neural resources are low due to acute excessive or chronic stress in burnout states, our brain shifts from behavior relying on executive functions and CFM to habit memory HM , which is primarily controlled through the basal ganglia of the brain.
Hence, this condition is conducive to non-fund of knowledge errors. Burned out individuals have thinner prefrontal cortexes and enlarged amygdalae, which predict diminishment of executive function and poor modulation of emotions respectively  . Individuals with burnout are more prone to attentional lapses and memory impairments . Humans contribute to errors in two forms: Active and latent errors .
Active errors occur at the level of the frontline individual, and their effects are felt nearly immediately. Latent errors tend to be removed from the direct control of the individual and include poor design, installation and maintenance of equipment, management decisions, and organizational functioning. An unintended consequence from many well-meaning efforts to improve quality, reduce costs and improve patient satisfaction, when in the absence of consideration of human factors in the delivery of care, is increasing latent error risk.
In other industries such as the airline industry, latent conditions are actively reduced and managed through industrial engineering and HFE principles to allow the best performance of the pilot. Currently in healthcare, attention to total workload and total expectations on the clinician does not exist. When extraneous cognitive load is too large, total cognitive load exceeds the limits of mental processing capacity, raising risk of error.
Extraneous cognitive load is modifiable factor that can be the target of efforts to improve the experience of providing care and performance. Job-related mandatory requirements that bleed into clinician off time needs to be rethought in a new human factor-based risk vs. Currently healthcare settings do not grasp the down side risk of such extended vigilance. It is through culture and policy change that we can solidify the barrier between work and home. This barrier is required to allow for mental and physical recovery and retain a life outside of medicine, which pays off by better performance when at work in addressing the needs of patients, and contributing to career sustainability.
Two recent meta-analyses analyzed comparisons of individual and organizational interventions to reduce burnout  . The strongest evidence for effectiveness was those organizational interventions to modify resources, working environment and work tasks to decrease stress. Like other healthcare institutions, during the peak years of rapid roll-out of healthcare reform initiatives, faculty and staff at the University of Rochester Medical Center URMC experienced a very high level of occupational stress.
Despite the human struggle to master each new initiative, multiple external authoritative forces required roll-out of each new initiative in a serial fashion but with little recovery time to get back up to speed and functionality. It was noticed by many, how healthcare workers were struggling to keep up with the changes, while attempting to still see patients and avoid errors. The administrative topic focus began with improving patient satisfaction, then to disruptive behavior in clinicians, which led to the topic of reducing clinician burnout.
We also acknowledged that the wellness initiative would likely start off with individual based approaches, but later must also address organizational contributions to burnout. Application of concepts involved in the effects of stress on cognitive processes and decision making quality were helpful in aligning patient safety and quality efforts with staff wellbeing. Multiple Grand Rounds on clinician burnout and reduction occurred in 18 departments and divisions by request.
Eleven wellness seminars were provided by volunteer faculty and staff each year. These seminars became a safe space to open up the topic of occupational stress and the toll that it takes. The process of the institution Faculty Development Office advertising seminars which had stress-validating titles, was a powerfully supportive intervention in and of itself.
Examples of seminar titles:. The medical culture of endurance, isolation and silence is a barrier to get actionable input into improving operations. Oxford Press, New Delhi, India. Bibcode : PNAS.. Summary report national resources inventory. Climate change , The physical science basis.
Human Growth and Development - Body, Children, Factors, and Hormones - infiffiltheart.ga
Fifth Assessment Report. Nisbet, R. Fisher and D. Lowry Methane mitigation in ruminants: from microbe to the farm scale. Livestock Science. Australian Journal of Soil Research. Nutrient Cycling in Agroecosystems. The green, blue and grey water footprint of farm animals and animal products. Profile of the agricultural livestock production industry. Environmental Protection Agency. Office of Compliance. Targeted Grazing: a natural approach to vegetation management and landscape enhancement.
American Sheep Industry. Wildlife Soc. Soil Water Cons. Soil Sci. Retrieved January 24, Science of the Total Environment. Bibcode : ScTEn. Retrieved May 18, Retrieved July 1, Retrieved August 2, The global scope of the livestock issue is huge. A page online report published by the United Nations Food and Agriculture Organization says 26 percent of the earth's terrestrial surface is used for livestock grazing. AIChE Journal. Archived from the original PDF on Life cycle inventory of biodiesel and petroleum diesel in an urban bus.
Bibcode : EnST M; Arou, M. Renewable and Sustainable Energy Reviews. World Oil Conference.
Archived from the original PDF on July 6, Royal Society for the Protection of Birds. Galway, Ireland" PDF. The Derrybrien Development Cooperatve Ltd. Archived from the original PDF on 18 December Retrieved 20 May Remote Sensing. Bibcode : RemS Fair Observer. December 12, Retrieved July 7, Thompson Learning, Inc.
Pacific Grove, California. Chapter 9, pp. Conditions and provisions for developing a national strategy for biodiversity conservation.
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