Applying Human Factors Methods to Explore ‘Work as Imagined’ and ‘Work as Done’ in the Emergency Departments Response to Chemical, Biological, Radiological, and Nuclear Events
The Emergency Department (ED) is a complex, hectic, and high-pressured environment. Chemical, Biological, Radiological, and Nuclear (CBRN) events are multi-faceted emergencies and present numerous challenges to ED staff (first receivers) with large scale trauma, consequently requiring a combination of complex responses.
Human Factors and Ergonomics (HF/E) methods such as Hierarchical Task Analysis (HTA) have been used in healthcare research. However, HF/E methods and theory have not been combined to understand how the ED responds to CBRN events.
This study aimed to compare Work as Imagined (WAI) and Work as Done (WAD) in the ED CBRN response in a UK based hospital. WAI was established by carrying out document analyses on a CBRN plan and WAD by exploring first receivers response to CBRN scenario cards. The responses were converted to HTAs and compared.
The WAI HTAs showed 4–8 phases of general organizational responsibilities during a CBRN event. WAD HTAs placed emphasis on diagnosing and treating presenting conditions. A comparison of WAI and WAD HTAs highlighted common actions and tasks. This study has identified three key differences between WAI and WAD in the ED CBRN response: (1) documentation of the CBRN event (2) treating the patient and (3) diagnosing the presenting complaint.
Findings from this study provide an evidence base which can be used to inform future clinical policy and practice in providing safe and high quality care during CBRN events in the ED.
KeywordsHuman Factors and Ergonomics CBRN events Emergency Department
The authors would like to thank Professor Tim Coates, Aaron Vogel, Elizabeth Cadman- Moore, Lisa Mclelland, and the first receivers for their enthusiasm and support throughout this study.
- 2.NHS England. https://www.england.nhs.uk/ourwork/eprr/
- 9.IEA (2017) International Ergonomics Assocation. http://www.iea.cc/whats/
- 10.National Quality Board. https://www.england.nhs.uk/wp-content/uploads/2013/11/NQB-13-04-02.pdf
- 12.Chuang S, Hollnagel E (2017) Challenges in implementing resilient healthcare. In: Braithwaite J, Wears RL, Hollnagel E (eds) Resilient healthcare: Reconciling Work-as-Imaged and Work-as-Done. Ashgate, Surrey, pp 72–84Google Scholar
- 13.Saurin TA, Rosso CB, Lacey C (2017) Towards a resilient healthcare. In: Braithwaite J, Wears RL, Hollnagel E (eds) Resilient healthcare: Reconciling Work-as-Imaged and Work-as-Done. Ashgate, Surrey, pp 30–42Google Scholar
- 19.Creswell JW, Plano-Clark VL (2011) Designing and conducting mixed methods research. Sage, LondonGoogle Scholar
- 20.Palinkas LA, Horwitz SM, Green CA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K (2015) Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Heal Ment Heal Serv Res 42:533–544. https://doi.org/10.1007/s10488-013-0528-yCrossRefGoogle Scholar
- 21.Legislation UK. https://www.legislation.gov.uk/ukpga/1998/29/contents
- 22.Larson TC, Orr MF, Auf der Heide E, Wu J, Mukhopadhyay S, Kevin-Horton D (2016) Threat of secondary chemical contamination of emergency departments and personnel: an uncommon but recurrent problem. Disaster Med Public Health Prep 10:199–202. https://doi.org/10.1017/dmp.2015.127CrossRefGoogle Scholar
- 24.North Atlantic Treaty Organisation. https://www.nato.int/ https://www.nato.int/nato_static_fl2014/assets/pdf/pdf_2016_08/20160802_140801-cep-first-responders-CBRN-eng.pdf