healthcare

In the recent issue of the journal Psychology and Aging, researchers Andrew Reed, Joseph Mikels, and Kosali Simon examined whether older adults would prefer having fewer options when faced with a decision-making task.  Confirming previous research, they found that across 6 domains (e.g., prescription health plans, hospitals), older adults preferred having fewer options rather than greater.

In their study, 102 older adults (ranging in age from 60-94) and 99 younger adults (ranging in age from 18-24) completed questionnaires asking about their desired number of choices in everyday decisions.

The authors surmised that older adults prefered fewer choices because of their awareness of their reduced decision-making competence (metacognitive recognition of their own limitations).

This kind of research certainly could have human factors and design implications.  However, it might be too simplistic to just suggest that we give older adults fewer options.  More research is necessary

Reed, A. E., Mikels, J. A., & Simon, K. I.  (2008).  Older adults prefer less choice than younger adults.  Psychology and Aging, 23, 671-675.

This brief report reminds me of the easy to read book, The Paradox of Choice, by Barry Schwartz.

The Paradox of Choice

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New York’s 11 public hospitals are at the forefront of a national movement to standardize color coding of hospital wristbands to designate patient conditions, in which purple — the color of amethyst — means “Do Not Resuscitate.” Red, or ruby, indicates allergies, while yellow — call it amber — marks someone at risk for falling.

The goal is to prevent potentially dangerous mistakes, like giving the wrong food to an allergic child, or allowing a patient with balance problems to walk unescorted down a freshly waxed hallway. The drive was spurred, in part, by a notorious 2005 Pennsylvania case in which a patient nearly died because a nurse used a yellow band thinking it meant “restricted extremity” (don’t draw blood from that arm), as it did at another hospital where the nurse sometimes worked, when at this hospital it meant D.N.R.

Hospital Bracelets Face Hurdles as They Fix Hazard - NYTimes.com

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In July, builders broke ground on a new hospital in Rwanda’s Burera district, near the Uganda border. The design relies on simple features to reduce the spread of airborne disease: outdoor walkways instead of enclosed halls, waiting rooms alfresco and large windows staggered at different levels on opposing walls to keep air circulating.

Global Update - Rwanda - Hospital’s Design Keeps Fresh Air in Mind - NYTimes.com

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First thing every morning, Lynn Pitet, of Cody, Wyo., checks her computer to see whether her mother, Helen Trost, has gotten out of bed, taken her medication and whether she is moving around inside her house hundreds of miles away in Minnesota.

High-Tech Devices Keep Elderly Safe From Afar - NYTimes.com

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I was reading a lengthy Q&A with Newt Gingrich in Freakonomics this morning, and came across the following:

Q: You discuss a united American front in your book. What healthcare platforms do you think Americans will unite around?

A: “… This system will have three characteristics, none of which are present in today’s system…. It will make use of information technology. Paper kills. It’s just that simple. With as many as 98,000 Americans dying as a result of medical errors in hospitals every year, ridding the system of paper-based records and quickly adopting health information technology would save lives and save money. We must also move toward e-prescribing to drastically reduce prescription errors.

Newt Gingrich is a powerful man. I am glad he is comfortable with and encouraging of technology. Me too! However, I am terrified of the assumption that information technology systems are inherently better or less error prone than paper systems. “Paper kills” is a nice, tight tag line that people are bound to remember. Is it true?

My earlier post on Paper Protocols saving lives and dollars in Michigan says otherwise. So does research in the context of medical adherence. Linda Liu and Denise Park (2004) identified a paper system as one of the most effective tested when it comes to diabetics remembering to measure their glucose.

It is not the material of the system, it is the design of the system that makes it either intuitive, fail-safe, or error prone. Blindly replacing known paper protocols and records with electronic alternatives is not a guaranteed improvement. This is the kind of thinking that brought us the touchscreen voting system.*

“Oh, it wouldn’t be blind,” one might say. I hope so, but a blanket statement such as “paper kills” doesn’t give me confidence. Paper doesn’t kill, bad design does.

I wouldn’t want to end this post without being clear: We need to stop pitting paper against computers and start solving:

1. Under what circumstances each is better

2. Why each would be better

3. How to best design for each. Paper isn’t going away, folks.

*The linked article mentions reliability and security without mentioning usability. I don’t want to go too far afield, so I will save my post on being unable to vote on the Georgia Flag (thanks to the compression artifacts present in the pictures, making it impossible to tell them apart.)

References:

Liu, L. L., & Park, D. C. (2004). Aging and Medical Adherence: The Use of Automatic Processes to Achieve Effortful Things. Psychology and Aging, 19(2), 318-325.

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If you’re Apple, you want people to see the similarities between their iPod and their iPhone. However, if you are a drug manufacturer, you do not want similarities between adult and pediatric medicine.

Above are bottles of Heparin, manufactured by Baxter Healthcare. Both blood thinners, one of these vials is 1,000 times more concentrated than the other. Confusion between these two bottles killed infants at an Indiana hospital back in 2002. This article provides a good overview of past cases.

I actually remember reading about this back then, and thought “Wow, there’s a good human factors lesson. How awful that children had to die to bring it into the spotlight.”

Unfortunately, this lesson stayed unlearned, as two more children were administered the adult drug this week. Because these were the newborn twins of Dennis and Kimberly Quaid, who have already spoken out on 60 Minutes about medication mistakes, we may see the problem addressed more thoroughly in the drug industry.

On a final note, these cases touch on the human desire to blame other humans rather than the systems they interact with. In the Indiana case, a mother who lost her child was quoted as saying:

“… who blames the nurses, not drug labeling, for her daughter’s death. “I don’t think it was from the label,” she said. “They are both blue, but one is lighter than the other. How could they mistake those?”

Change blindness, automaticity, expectation, fatigue, and time pressure are but a few of the factors that might have caused the error. Sometimes, it isn’t a case of someone not just “being careful.” This is actually a good thing: we can understand and solve human factors problems. We can’t make someone care.

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