Work system design for patient safety: the SEIPS model
Open accessAbstract
Models and methods of work system design need to be developed and implemented to advance research in and design for patient safety. In this paper we describe how the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety, which provides a framework for understanding the structures, processes and outcomes in health care and their relationships, can be used toward these ends. An application of the SEIPS model in one particular care setting (outpatient surgery) is presented and other practical and research applications of the model are described.
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- Findingown data§ Assessing work systems, processes, and outcomes of outpatient surgery
Tasks, tools, and organization coincide with an issue repeatedly reported by staff concerning the process of obtaining clinical information on patients in a timely fashion.
“Tasks, tools, and organization coincide with an issue repeatedly reported by staff concerning the process of obtaining clinical information on patients in a timely fashion.”
Quote in the paperNot a substantial claim - Findingown data§ Assessing work systems, processes, and outcomes of outpatient surgery
Quality and safety issues identified were related to insufficient and potentially inaccurate information then collected because of the last minute nature of these clinical assessments.
“Likewise, quality and safety issues identified were related to insufficient and potentially inaccurate information then collected because of the last minute nature of these clinical assessments.”
Quote in the paperSubstantial claim - Findingreasoning§ Assessing work systems, processes, and outcomes of outpatient surgery
Staff responses to the questionnaire were also associated with various processes (including care processes) and outcomes.
“Staff responses to the questionnaire were also associated with various processes (including care processes) and outcomes.”
Quote in the paperNot a substantial claim - Findingcitation§ Assessing work systems, processes, and outcomes of outpatient surgery
Staff responses to the questionnaire can be associated with numerous aspects of the work system.
“Staff responses to the questionnaire can be associated with numerous aspects of the work system.29”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [29] 29. Carayon P, Gurses AP, Hundt AS, et al. Performance obstacles and facilitators of healthcare providers. In: Korunka C, Hoffmann P, eds. Change and quality in human service work. Munich: Hampp Publishers, 2005:257-76.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationcitation§ Introduction
The SEIPS model nests itself in Donabedian's quality model.
“and nesting itself in a model familiar to many health care professionals-namely, Donabedian's quality model.11 12”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 11 12
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning§ Donabedian's model
Components of the work system (such as the organization or the environment) and their interdependencies may be overlooked or underemphasized in Donabedian's model.
“As a result, components of the work system (such as the organization or the environment) and their interdependencies may be overlooked or underemphasized.”
Quote in the paperSubstantial claim - Premisecitation§ SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETY
The interactions between the work system components produce outcomes of performance, safety and health, and quality of working life.
“The interactions between the various components ''produce'' different outcomes: performance, safety and health, and quality of working life.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5][6][7]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Donabedian's model
Donabedian's model explicitly links the structure and processes of care to subsequent patient outcomes.
“Donabedian's model explicitly links the structure and processes of care to subsequent patient outcomes.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning§ SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETY
Assessing patient safety and designing systems that produce safe patient care can be accomplished by using the SEIPS model that integrates Donabedian's SPO framework and the work system model.
“Assessing patient safety and designing systems that produce safe patient care can be accomplished by using the SEIPS model that integrates Donabedian's structure-processoutcome (SPO) framework and the work system model (fig 1).”
Quote in the paperSubstantial claim - Interpretationreasoning§ Donabedian's model
The SEIPS model builds on Donabedian's idea by showing how work system design (structure) is linked to patient safety (outcome) through care processes.
“The SEIPS model builds on this idea by showing how work system design (structure) is linked to patient safety (outcome) through care processes.”
Quote in the paperSubstantial claim - Interpretationreasoning§ SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETY
The structure of an organization (or work system) affects how safely care is provided (the process).
“The structure of an organization (or, more generally, the work system) affects how safely care is provided (the process); and the means of caring for and managing the patient (the process) affects how safe the patient is (outcome).”
Quote in the paperSubstantial claim - Interpretationreasoning§ Introduction
The SEIPS model explains how the design of the work system can impact employee and organizational outcomes.
“The SEIPS model explains how the design of the work system can impact not only the safety of patients but also employee and organizational outcomes.”
Quote in the paperSubstantial claim - Interpretationcitation§ Donabedian's model
Donabedian's model is limited in its recognition of the interactions and interdependencies among system components.
“Donabedian's model has proved valuable in examining the clinical processes and outcomes of care, but it is limited in its recognition of the interactions and interdependencies among system components.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETY
The five components of the work system (person, tasks, tools and technologies, physical environment, organizational conditions) interact with each other and influence each other.
“The five components of the work system (person, tasks, tools and technologies, physical environment, organizational conditions) interact with each other and influence each other.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5][6][7]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning§ Introduction
The SEIPS model explains how the design of the work system can impact the safety of patients.
“The SEIPS model explains how the design of the work system can impact not only the safety of patients but also employee and organizational outcomes.”
Quote in the paperSubstantial claim - Interpretationcitation§ Donabedian's model
Donabedian's model has proved valuable in examining the clinical processes and outcomes of care.
“Donabedian's model has proved valuable in examining the clinical processes and outcomes of care, but it is limited in its recognition of the interactions and interdependencies among system components.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning§ SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETY
The process of caring for and managing the patient affects how safe the patient is (outcome).
“The structure of an organization (or, more generally, the work system) affects how safely care is provided (the process); and the means of caring for and managing the patient (the process) affects how safe the patient is (outcome).”
Quote in the paperSubstantial claim - Interpretationreasoning§ Donabedian's model
In contrast to the SPO model, the SEIPS model emphasizes the structure.
“In contrast to the SPO model, the SEIPS model emphasizes the structure.”
Quote in the paperNot a substantial claim - Interpretationreasoning§ Balanced work system
A narrow focus on the physician work system creates a problem for the nurse work system.
“This example shows the need to focus on the entire work system relevant to the particular care process (PICC line insertion): a narrow focus on the physician work system creates a problem for the nurse work system.”
Quote in the paperSubstantial claim - Interpretationcitation§ Impact of work system and processes on outcomes
Work system factors are likely to simultaneously contribute to negative employee/organizational outcomes and negative patient outcomes such as medical errors.
“In addition, work system factors are likely to simultaneously contribute to negative employee/organizational outcomes and negative patient outcomes such as medical errors.35”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [35] 35. Keijsers GJ, Schaufeli WB, LeBlanc PM, et al. Performance and burnout in intensive care units. Work & Stress 1995;9:513-27. source
- Interpretationreasoning§ SEIPS model and the professional model
Quality improvement efforts that incorporate system redesign may be more successful in changing physician behavior because they preserve physician professionalism.
“Quality improvement efforts that incorporate system redesign may therefore be more successful in changing physician behavior because they preserve physician professionalism.”
Quote in the paperSubstantial claim - Premisecitation§ SEIPS model and the professional model
System redesign has been employed in anesthesiology to develop devices such as a system of gas connectors that do not allow a gas hose or cylinder to attach to the wrong site.
“For example, system redesign has been employed in anesthesiology to develop devices such as a system of gas connectors that do not allow a gas hose or cylinder to attach to the wrong site.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] 28. Gaba DM. Anaesthesiology as a model for patient safety in health care. BMJ 2000;320:785-8.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning§ USING THE SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETY: DESIGN AND RESEARCH APPLICATIONS
The SEIPS model can be used both proactively and reactively to improve patient safety by focusing on the design of work systems.
“Because of its emphasis on a systems approach, the SEIPS model can be used both proactively and reactively to improve patient safety by focusing on the design of work systems.”
Quote in the paperSubstantial claim - Premisecitation§ SEIPS model and the professional model
This type of technological advance, in addition to an emphasis on a ''culture of safety'', has helped to decrease deaths due to anesthesia.
“This type of technological advance, in addition to an emphasis on a ''culture of safety'', has helped to decrease deaths due to anesthesia.28”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] 28. Gaba DM. Anaesthesiology as a model for patient safety in health care. BMJ 2000;320:785-8.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning§ Balanced work system
Although the skills and knowledge of an individual healthcare provider are important, they are not sufficient by themselves to ensure high quality care and patient safety.
“The SEIPS model is useful for understanding that, although the skills and knowledge of an individual healthcare provider are important, it is not sufficient by itself to ensure high quality care and patient safety.”
Quote in the paperSubstantial claim - Interpretationreasoning§ SEIPS model and the professional model
A professionally motivated sense of autonomy and responsibility may explain physician resistance to organizational strategies to change their behavior.
“This professionally motivated sense of autonomy and responsibility may, in part, explain physician resistance to organizational strategies to change their behavior.”
Quote in the paperSubstantial claim - Interpretationreasoning§ Balanced work system
The same individual healthcare provider practicing in two different work systems may demonstrate different performance.
“The same individual healthcare provider practicing in two different work systems may demonstrate different performance.”
Quote in the paperSubstantial claim - Premisecitation§ Impact of work system and processes on outcomes
Healthcare workers experience many negative consequences of poor system design such as job dissatisfaction, burnout, intentions to quit, reduced mental health, and injuries.
“Healthcare workers experience many negative consequences of poor system design such as job dissatisfaction, burnout, intentions to quit, reduced mental health, and injuries. 6thers have also emphasized the important relationship between patient outcomes and employee/organizational outcomes.15 33”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [6] 6. Smith MJ, Carayon-Sainfort P. A balance theory of job design for stress reduction. Int J Ind Ergon 1989;4:67-79. source
- Premisecitation§ SEIPS model and the professional model
Performance obstacles such as inadequate supplies in isolation rooms may prevent ICU nurses from safely delivering care to critical patients.
“For instance, performance obstacles such as inadequate supplies in isolation rooms may prevent ICU nurses from safely delivering care to critical patients.29”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [29] 29. Carayon P, Gurses AP, Hundt AS, et al. Performance obstacles and facilitators of healthcare providers. In: Korunka C, Hoffmann P, eds. Change and quality in human service work. Munich: Hampp Publishers, 2005:257-76.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationnone given§ Impact of work system and processes on outcomes
The experience of musculoskeletal pain or discomfort may affect the nurse's psychological and physical resources necessary to perform her job safely.
“The experience of musculoskeletal pain or discomfort may affect the nurse's psychological and physical resources necessary to perform her job safely.”
Quote in the paperNot a substantial claim - Interpretationreasoning§ Donabedian's model
Practitioners tend to associate the SPO model with traditionally punitive efforts and reporting.
“As a result, practitioners tend to associate the SPO model with traditionally punitive efforts and reporting-for example, the credentialing process of medical staff requires reporting performance measures, generally originating from quality assessment activities.”
Quote in the paperNot a substantial claim - Interpretationcitation§ Impact of work system and processes on outcomes
A healthcare HWO would also provide high quality safe patient care.
“A healthcare HWO would also provide high quality safe patient care.15”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] 15. Sainfort F, Karsh B, Booske BC, et al. Applying quality improvement principles to achieve healthy work organizations. J Qual Improve 2001;27:469-83. source
- Interpretationreasoning§ The patient in the SEIPS model
The SEIPS model can be applied directly to the patient.
“Secondly, the SEIPS model can be applied directly to the patient.”
Quote in the paperNot a substantial claim - Interpretationreasoning§ SEIPS model and the professional model
The SEIPS model, which maintains a sense of job control and participation in the process of organizational change, may improve physician acceptance of, and adherence to, new systems.
“The SEIPS model, which maintains a sense of job control and participation in the process of organizational change, may improve physician acceptance of, and adherence to, new systems.”
Quote in the paperNot a substantial claim - Interpretationcitation§ SEIPS model and the professional model
Processes are very much influenced by work system design.
“It is also important to understand that processes are very much influenced by work system design.30”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [30] 30. Carayon P, Schultz K, Hundt AS. Righting wrong site surgery. Jt Comm J Quality Saf 2004;30:405-10. source
- Interpretationcitation§ Impact of work system and processes on outcomes
Poor employee/organizational outcomes, such as back injuries experienced by nurses, are likely to be related to poor patient outcomes.
“Poor employee/organizational outcomes, such as back injuries experienced by nurses, are likely to be related to poor patient outcomes.34”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34] 34. Nelson A, Baptiste A. Evidence-based practices for safe patient handling and movement. Online Journal of Issues in Nursing 2004;9. source
- Interpretationreasoning§ Impact of work system and processes on outcomes
Poor processes and outcomes can be triggers for system redesign.
“Poor processes and outcomes can be triggers for system redesign: the need would then arise to identify negative work system elements that affect processes and the quality and safety of care, as well as employee and organizational outcomes.”
Quote in the paperSubstantial claim - Interpretationreasoning§ The patient in the SEIPS model
Using the SEIPS model with the patient at the centre can help identify deficiencies in the healthcare system that impair the patient's capacity to receive high quality safe care.
“Using the SEIPS model with the patient at the centre of the work system model can help to identify deficiencies in the healthcare system that can impair the patient's capacity to receive high quality safe care, and therefore contribute to the design of systems and processes for delivering patient centred care.”
Quote in the paperSubstantial claim - Premisecitation§ Balanced work system
The SEIPS model uses the concept of ''balance'' proposed by Carayon and Smith.
“The SEIPS model uses the concept of ''balance'' proposed by Carayon and Smith.5 6”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 5 6
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationnone given§ CONCLUSION
The SEIPS model does not tell if a change in one factor in the work system leads to any specific employee, organizational or patient outcome.
“It does not tell if a change in one factor in the work system leads to any specific employee, organizational or patient outcome.”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 66
- May combine two claims. 20
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ Assessing work systems, processes, and outcomes of outpatient surgeryStaff emphasized coordination issues related to patient information.
“They also emphasized coordination issues related to patient information.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
Findingreasoning§ N Environment: patient door open; noisy and distracting interactions between staff in hallway.It was easier to understand comments on the staff questionnaire concerning the work space.
“Likewise, it was easier to understand comments on the staff questionnaire concerning the work space.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ Assessing work systems, processes, and outcomes of outpatient surgeryStaff commented about the low quality of communication with patients regarding preoperative preparation (for example, understanding of instructions) and postoperative recovery (for example, inconsistencies in providers' instructions).
“They commented about the low quality of communication with patients regarding preoperative preparation (for example, understanding of instructions) and postoperative recovery (for example, inconsistencies in providers' instructions).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ Assessing work systems, processes, and outcomes of outpatient surgeryUnavailability of patient related information sometimes can lead to cancellations of surgeries on the day they are scheduled.
“For instance, unavailability of patient related information sometimes can lead to cancellations of surgeries on the day they are scheduled.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingreasoning§ N Environment: patient door open; noisy and distracting interactions between staff in hallway.A review of the floor plans helped the research team further understand the reasons for these concerns.
“A review of the floor plans helped the research team further understand the reasons for these concerns.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ Assessing work systems, processes, and outcomes of outpatient surgeryStaff offered suggestions to remedy this problem through redesign of forms and changes in policy and job design.
“Staff offered suggestions to remedy this problem through redesign of forms and changes in policy and job design.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ Assessing work systems, processes, and outcomes of outpatient surgeryStaff conveyed the inherent inefficiencies of tracking down information that should have been previously provided.
“Here staff conveyed the inherent inefficiencies of tracking down information that should have been previously provided.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown data§ N Environment: patient door open; noisy and distracting interactions between staff in hallway.Concern was expressed by staff regarding the lack of privacy for patients and high noise levels.
“For instance, concern was expressed by staff regarding the lack of privacy for patients and high noise levels.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown data§ NThe assessment of position descriptions gave us greater insight concerning the expectations for the various positions as well as how each centre was organized according to the various tasks.
“This gave us greater insight concerning the expectations for the various positions as well as how each centre was organized according to the various tasks.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingreasoning§ N Environment: patient door open; noisy and distracting interactions between staff in hallway.The plans provided an understanding of the work flow and offered a greater appreciation for the confidentiality issues identified during the patient shadowing.
“In this case the plans provided an understanding of the work flow and offered a greater appreciation for the confidentiality issues identified during the patient shadowing.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationreasoning§ SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETYThe work system model applied to patient safety complements and expands Donabedian's framework.
“We suggest that the work system model applied to patient safety complements and expands Donabedian's framework.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationreasoning§ SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETYChanges to any aspect of the work system will, depending on how the change or improvement is designed and implemented, either negatively or positively affect the work and clinical processes and the consequent patient, employee, and organizational outcomes.
“Changes to any aspect of the work system will, depending on how the change or improvement is designed and implemented, either negatively or positively affect the work and clinical processes and the consequent patient, employee, and organizational outcomes.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETYThe discipline of human factors emphasizes interactions between people and their environment that contribute to performance, safety and health, quality of working life, and the goods or services produced.
“The discipline of human factors emphasizes interactions between people and their environment that contribute to performance, safety and health, and quality of working life, and the goods or services produced.13 14”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 13 14
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Donabedian's modelIn Donabedian's model, the structure includes the organizational structure, material resources, and human resources.
“In Donabedian's model, the structure includes the organizational structure (work system model component = organization); the material resources (work system model components = environment, technology/tools); and the human resources (work system model components = care provider, tasks).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Interpretationreasoning§ SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETYThe work system in which care is provided affects both the work and clinical processes, which in turn influence the patient, employee, and organizational outcomes of care.
“Overall, the work system in which care is provided affects both the work and clinical processes, which in turn influence the patient, employee, and organizational outcomes of care.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Interpretationnone given§ SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETYThe SEIPS model does not highlight any single element of the work system.
“our SEIPS model does not highlight any single element of the work system.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETYAccording to the work system model, a person performs a range of tasks using various tools and technologies.
“According to the work system model, a person (the person could be a care provider, another employee of a healthcare institution such as a biomedical engineer, a unit clerk, or the patient) performs a range of tasks using various tools and technologies.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5][6][7]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Donabedian's modelDonabedian concludes that direct relationships may exist between structure, process and outcome.
“Donabedian 20 concludes that direct relationships may exist between structure, process and outcome.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] 20. Donabedian A. The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press, 1980.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationcitation§ Donabedian's modelMost of the focus of the SPO model centres on the providers and their relationship with the processes and outcome(s).
“This reflects the fact that most of the focus of the SPO model centres on the providers and their relationship with the processes and outcome(s)-that is, quality is assessed by the way in which care is provided by an individual or care team as well as the outcome of the care.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ Donabedian's modelDonabedian's two other means of assessing quality include evaluating the process(es) of care and evaluating the outcome(s) of care.
“Donabedian's two other means of assessing quality include evaluating the process(es) of care (how provider tasks and clinical processes are both organized and performed) and evaluating the outcome(s) of care (assessing the clinical results and impacts of and patient satisfaction with the care provided).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
Interpretationreasoning§ Donabedian's modelAspects of the structure may be of lesser consequence in Donabedian's model.
“The implication is, therefore, that aspects of the structure may be of lesser consequence.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Donabedian's modelAccording to Donabedian's model, poor quality results by not following what is defined as the appropriate or correct means of performing a task (poor process).
“According to Donabedian's model, poor quality, in turn, results by not following what is defined as the appropriate or correct means of performing a task (poor process).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Donabedian's modelIn Donabedian's model, there is a clear statement that we must begin with the performance of physicians and other health care providers.
“In Donabedian's model, however, there is a clear statement that ''we must begin … with the performance of physicians and other health care providers''.19”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETYThe performance of tasks occurs within a certain physical environment and under specific organizational conditions.
“The performance of these tasks occurs within a certain physical environment and under specific organizational conditions.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5][6][7]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
Interpretationnone given§ The individual in the work system modelA healthcare work system often includes both healthcare providers and the patient being cared for.
“It is important to recognize that a healthcare work system often includes both healthcare providers and the patient being cared for.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone given§ Impact of work system and processes on outcomesThe fact that the SEIPS model explains how the design of a system can impact patients, employees, and the organization has its roots in the theory of healthy work organizations (HWOs).
“The fact that the SEIPS model explains how the design of a system can impact patients, employees, and the organization has its roots in the theory of healthy work organizations (HWOs).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone given§ Donabedian's modelThe work system model allows linkage of the various elements of the structure in the SPO model-that is, the organizational structure and material and human resources.
“The work system model also allows linkage of the various elements of the structure in the SPO model-that is, the organizational structure and material and human resources.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ Donabedian's modelThe SEIPS model proposes the work system model as an expansion of the structure by addressing elements such as the physical environment, organizational culture and climate, error reporting and analysis, and work design.
“It proposes the work system model as an expansion of the structure by addressing elements of the work system model such as the physical environment, organizational culture and climate, error reporting and analysis, and work design that are so much a part of the current patient safety focus.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Interpretationnone given§ Impact of work system and processes on outcomesThe SEIPS model specifies feedback loops from processes to work system and from outcomes to work system.
“The SEIPS model specifies feedback loops from processes to work system and from outcomes to work system.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ The individual in the work system modelAny healthcare work system can involve multiple individuals such as healthcare providers and patients.
“Any healthcare work system can therefore involve multiple individuals such as healthcare providers and patients.”
Quote in the paperSubstantial claimMay combine two claims.
Premisecitation§ SEIPS model and the professional modelPhysician professionalism also fosters a ''culture of blame'' when things go wrong because, if physicians are responsible for the entire medical process, then they are also exclusively to blame for poor quality care.
“However, it has been noted that physician professionalism also fosters a ''culture of blame'' when things go wrong because, if physicians are responsible for the entire medical process, then they are also exclusively to blame for poor quality care.26”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [26] 26. Leape LL. Error in medicine. JAMA 1994;272:1851-7.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ SEIPS model and the professional modelProfessionals such as physicians, nurses, pharmacists, and other licensed healthcare providers are bound by ethical mandates to serve in their clients' best interests.
“Professionals such as physicians, nurses, pharmacists, and other licensed healthcare providers are bound by ethical mandates to serve in their clients' best interests.25”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [25] 25. ABIM Foundation. ACP-ASIM Foundation, European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med 2002;136:243-6. source
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationreasoning§ SEIPS model and the professional modelA care process may involve various locations, therefore different physical environments.
“For instance, a care process can be considered as a series of steps or tasks performed by an individual or a team of individuals using various technologies and tools; the care process may involve various locations, therefore different physical environments.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationcitation§ SEIPS model and the professional modelA system redesign approach to changing physician behavior may be more effective and better accepted by physicians than traditional organizational efforts to improve quality using incentives.
“A system redesign approach to changing physician behavior may not only be a more effective approach, but may be better accepted by physicians than traditional organizational efforts to improve quality using incentives.27”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] 27. Flynn EA, Barker KN, Pepper GA, et al. Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities. Am J Health- System Pharm 2002;59:436-46. source
Probably not a substantial claim: may not pass S2 (checkable).
Interpretationreasoning§ Impact of work system and processes on outcomesThe need arises to identify negative work system elements that affect processes and the quality and safety of care, as well as employee and organizational outcomes.
“Poor processes and outcomes can be triggers for system redesign: the need would then arise to identify negative work system elements that affect processes and the quality and safety of care, as well as employee and organizational outcomes.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Interpretationnone given§ The patient in the SEIPS modelThe patient is involved in patient care processes and is the recipient of good or bad outcomes of the care process.
“The patient is also involved in patient care processes and is the ''recipient'' of good or bad outcomes of the care process.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Premisecitation§ Impact of work system and processes on outcomesHWOs are organizations that have both good organizational outcomes and a healthy and safe workforce.
“HWOs are organizations that have both good organizational outcomes and a healthy and safe workforce.31 32”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 31 32
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationreasoning§ The patient in the SEIPS modelFrom the viewpoint of the provider, the patient is an input into the SEIPS model.
“From this viewpoint, the patient is an ''input'' into the SEIPS model.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationreasoning§ Balanced work systemSome negative elements in a work system that are hard to change may be overcome by focusing on some other positive elements.
“Some negative elements in a work system that are hard to change may be overcome by focusing on some other positive elements.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Premisecitation§ Donabedian's modelPatient safety activities place greater emphasis on the system in which practitioners work and less on individual performance.
“Conversely, patient safety activities place greater emphasis on the system in which practitioners work and less on individual performance.21”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [21] 21. Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. JAMA 1995;274:35-43. source
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationreasoning§ Balanced work systemThe PICC line intervention may not decrease the nurse's workload but add to the workload as more and more patients require PICC line insertion rather than central venous catheter insertions.
“However, the PICC line intervention may not decrease the nurse's workload but add to the workload as more and more patients require PICC line insertion rather than central venous catheter insertions.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ Impact of work system and processes on outcomesOur model emphasizes the linkages between patient outcomes and employee/organizational outcomes.
“Our model emphasizes the linkages between patient outcomes and employee/organizational outcomes.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationnone given§ The individual in the work system modelIn the SEIPS model the individual is at the centre of the work system.
“In the SEIPS model the individual is at the centre of the work system.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationreasoning§ SEIPS model and the professional modelThese system redesigns support rather than conflict with the physician's role as a professional.
“These system redesigns support rather than conflict with the physician's role as a professional.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Interpretationcitation§ Donabedian's modelOutcomes (both patient and employee/organizational) are related and are associated with structure aspects of the SPO model.
“The implication is that outcomes (both patient and employee/organizational, as proposed by the SEIPS model) are related and that they also are associated with structure aspects of the SPO model.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ Impact of work system and processes on outcomesThese feedback loops represent pathways to design or redesign the work system.
“These feedback loops represent pathways to design or redesign the work system.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone given§ SEIPS model and the professional modelThe care process is affected by multiple organizational characteristics such as the need for coordination and collaboration among the healthcare providers involved in the process.
“The care process is also affected by multiple organizational characteristics such as the need for coordination and collaboration among the healthcare providers involved in the process.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ SEIPS model and the professional modelDonabedian's model focuses on care process(es)-that is, how care is provided, delivered and managed.
“Donabedian's model focuses on care process(es)-that is, how care is provided, delivered and managed.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
Premisecitation§ Donabedian's modelAccording to Donabedian's model, a bad outcome is associated with the poor performance of an individual (or a group of individuals).
“Likewise, a bad outcome is associated with the poor performance of an individual (or a group of individuals).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] 19. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).
Interpretationnone given§ SEIPS model and the professional modelA care process can be considered as a series of steps or tasks performed by an individual or a team of individuals using various technologies and tools.
“For instance, a care process can be considered as a series of steps or tasks performed by an individual or a team of individuals using various technologies and tools; the care process may involve various locations, therefore different physical environments.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone given§ The patient in the SEIPS modelIf the individual in the work system is a healthcare provider, tasks performed by the individual often involve the patient.
“Firstly, if the individual in the work system is a healthcare provider, tasks performed by the individual often involve the patient-for example, surgical tasks.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ The patient in the SEIPS modelUsing the SEIPS model with the patient at the centre can contribute to the design of systems and processes for delivering patient centred care.
“Using the SEIPS model with the patient at the centre of the work system model can help to identify deficiencies in the healthcare system that can impair the patient's capacity to receive high quality safe care, and therefore contribute to the design of systems and processes for delivering patient centred care.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationcitation§ SEIPS model and the professional modelInvolvement of physicians in the system redesign process is critical to both the success of the system and to physician acceptance of the new system.
“Involvement of physicians in the system redesign process is critical to both the success of the system and to physician acceptance of the new system.26”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [26] 26. Leape LL. Error in medicine. JAMA 1994;272:1851-7.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationreasoning§ SEIPS model and the professional modelThe SEIPS model expands the concept of process to include not only care processes but also other processes that support the care process such as maintenance, housekeeping and supply chain management.
“The SEIPS model expands the concept of process to include not only care processes but also other processes that support the care process such as maintenance, housekeeping and supply chain management.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Impact of work system and processes on outcomesOthers have emphasized the important relationship between patient outcomes and employee/organizational outcomes.
“6thers have also emphasized the important relationship between patient outcomes and employee/organizational outcomes.15 33”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 15 33
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim. May combine two claims.
Interpretationreasoning§ USING THE SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETY: DESIGN AND RESEARCH APPLICATIONSThe SEIPS model can be used proactively to guide system design and hazard analysis, or reactively to guide patient or employee injury investigations.
“It can be used proactively to guide system design and hazard analysis, or reactively to guide patient or employee injury investigations.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based). May combine two claims.
Interpretationnone given§ Additional informationThe design of work systems affects patient safety as well as employee and organizational outcomes.
“The design of work systems affects patient safety as well as employee and organizational outcomes.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Interpretationnone given§ CONCLUSIONThe SEIPS model is descriptive, not prescriptive.
“It is descriptive, not prescriptive.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ CONCLUSIONIt is a limitation of the SEIPS model that it does not provide specific guidance as to the critical elements.
“This can be considered as a limitation of the model because it does not provide specific guidance as to the critical elements; but it can also be a strength because the model is generic and adaptable to the particular context or situation.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based). May combine two claims.
Interpretationnone given§ Additional informationThe individual is at the centre of the work system and can be a healthcare provider, a healthcare team, or the patient.
“The individual is at the centre of the work system and can be a healthcare provider, a healthcare team, or the patient.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ CONCLUSIONThe SEIPS model provides a framework on how to think about the different aspects of a work system, their interactions, and possible outcomes.
“However, it provides a framework on how to think about the different aspects of a work system, their interactions, and possible outcomes.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Premisecitation§ Additional informationThe professional model assumes that providers have the ultimate authority to define and carry out the core tasks of providing medical care.
“The professional model assumes that providers have the ultimate authority to define and carry out the core tasks of providing medical care.42”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [42] 42. Freidson E. Profession of medicine: a study of the sociology of applied knowledge. New York: Harper & Row, 1970.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.
Interpretationreasoning§ Additional informationRecognizing potential resistance and obtaining strong support from key opinion leaders is essential to effective implementation of the SEIPS model.
“Recognizing potential resistance and obtaining strong support from key opinion leaders 43 is essential to effective implementation of the SEIPS model.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [43] 43. Flynn KE, Smith MA, Davis MK. From physician to consumer: the effectiveness of strategies to manage health care utilization. Med Care Res Rev 2002;59:455-81. source
Classified as probably not a substantial claim.
Interpretationreasoning§ USING THE SEIPS MODEL OF WORK SYSTEM AND PATIENT SAFETY: DESIGN AND RESEARCH APPLICATIONSThe SEIPS model can guide patient safety researchers toward developing research questions and understanding what variables to measure for a particular study.
“It can also guide patient safety researchers toward developing research questions and understanding what variables to measure for a particular study.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ Additional informationProviders may resist system efforts to manage the process of medical care as infringing on their autonomy and degrading their professional status.
“Because the professional status of providers is linked so strongly to their autonomy, they may resist system efforts to manage the process of medical care as infringing on their autonomy and degrading their professional status.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Interpretationreasoning§ CONCLUSIONIt is a strength of the SEIPS model that it is generic and adaptable to the particular context or situation.
“This can be considered as a limitation of the model because it does not provide specific guidance as to the critical elements; but it can also be a strength because the model is generic and adaptable to the particular context or situation.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).
Interpretationnone given§ Additional informationThe SEIPS model can be applied in many different ways to patient safety challenges.
“We have shown that the SEIPS model can be applied in many different ways to patient safety challenges.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based).
Interpretationnone given§ CONCLUSIONResistance to a systems approach may limit effective implementation of the SEIPS model in practice.
“It is critical to understand how resistance to a systems approach may limit effective implementation of the SEIPS model in practice.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based). May combine two claims.
Interpretationnone given§ Additional informationThe design of work systems influences processes which, in turn, affect outcomes.
“The design of work systems influences processes which, in turn, affect outcomes.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
Interpretationnone given§ CONCLUSIONThe SEIPS model is useful for providing a view of the whole system instead of focusing on only one aspect of the work system and treating that aspect in isolation.
“The SEIPS model is useful for providing a view of the whole system instead of focusing on only one aspect of the work system and treating that aspect in isolation.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone given§ Additional informationPatient outcomes and employee/organizational outcomes influence each other.
“They also influence each other.”
Quote in the paperNot a substantial claim
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Detecting and preventing EHR-related safety concerns is challenging because concerns are often multifaceted, involving unsafe technological features, user behaviors, organizational characteristics, and rules and regulations.
“Detecting and preventing EHR-related safety concerns is challenging because concerns are often multifaceted, involving not only potentially unsafe technological features of the EHR but also EHR user behaviors, organizational characteristics, and rules and regulations that guide EHR-related activities.”
From An analysis of electronic health record-related patient safety concerns (2014) · cites this paper as [27]
Conceptual frameworks or models have been developed to incorporate the breadth of technical and non-technical factors into the analysis of EHR safety and effectiveness.
“In addition, conceptual frameworks or models have been developed to incorporate the breadth of technical and non-technical factors into the analysis of EHR safety and effectiveness.21 25 27 32 33”
From An analysis of electronic health record-related patient safety concerns (2014) · cites this paper as [27]
Another systematic review found a similarly negative result for EHR use and outpatient care quality.
“Another systematic review of the effect of EHR use on the quality of outpatient care came to a similarly negative conclusion.29”
From EHR Safety: The Way Forward to Safe and Effective Systems (2008) · cites this paper as [29]
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Holden, R. J., Carayon, P., Gurses, A. P., Hoonakker, P., Hundt, A. S., Ozok, A. A., & Rivera-Rodriguez, A. J. (2013) · Ergonomics · doi:10.1080/00140139.2013.838643 · Cited by 1,221 · see citing works
“In the US, a prevalent healthcare human factors model of person-centered sociotechnical systems is the framework introduced by Carayon and colleagues in the University of Wisconsin’s Systems Engineering Initiative for Patient Safety (SEIPS) (Carayon et al., 2006; Carayon et al., 2013).”
BackgroundSelf-citationSittig, D. F., & Singh, H. (2010) · Quality and Safety in Health Care · doi:10.1136/qshc.2010.042085 · Cited by 897 · see citing works
“Third, Carayon's Systems Engineering Initiative for Patient Safety model”
Human factors systems approach to healthcare quality and patient safety
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“…et al., 2005a; Hoonakker et al., 2010; Hoonakker et al., 2011), observation methodology (Carayon et al., 2005d; Carayon et al., 2007b), interviews (Carayon et al., 2006a; Gurses and Carayon, 2009), and proactive risk assessment of healthcare processes (Carayon et al., 2011e; Hundt et al., 2013;…”
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“In the different visual representations of the SEIPS model (Carayon et al., 2006; Carayon et al., 2014b; Holden et al., 2013), the work system and the process are displayed separately.”
InfluentialSelf-citationMeasuring workload of ICU nurses with a questionnaire survey: the NASA Task Load Index (TLX)
Hoonakker, P., Carayon, P., Gürses, A. P., Brown, R., Khunlertkit, A., McGuire, K., & Walker, J. M. (2011) · IIE Transactions on Healthcare Systems Engineering · doi:10.1080/19488300.2011.609524 · Cited by 387 · see citing works
“There are several frameworks that can be used to determine possible causes of nurses’ workload, for example, the work-system model (Carayon et al., 2006; Carayon, 2009).”
Self-citationHealth information technology: fallacies and sober realities
Karsh, B.-T., Weinger, M. B., Abbott, P. A., & Wears, R. L. (2010) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2010.005637 · Cited by 365 · see citing works
“Because information presentation profoundly affects user behavior and decision-making, it is critical that information displays be thoughtfully designed and rigorously tested to ensure they yield the best possible performance outcomes. These evaluations must consider the full complexity of the context in which the sys…”
BackgroundSelf-citationInterruptions and distractions in healthcare: review and reappraisal
Rivera-Rodriguez, A. J., & Karsh, B.-T. (2010) · BMJ Quality & Safety · doi:10.1136/qshc.2009.033282 · Cited by 363 · see citing works
“provide a good start by conceptualising interruptions as a system of events and agents and providing a useful set of interruption attributes. However, we feel that a complex sociotechnical systems approach”
BackgroundSelf-citationOr, C. K., Karsh, B., Severtson, D. J., Burke, L. J., Brown, R., & Brennan, P. F. (2010) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2010.007336 · Cited by 310 · see citing works
“Applying usability principles is necessary but not sufficient to achieve useful CHIT; cognitive analyses and user involvement provide the ‘what’ to design; usability principles and principles of data representation for problem solving”
Self-citationGan, W. H., Lim, J. W., & Koh, D. S. Q. (2020) · Safety and Health at Work · doi:10.1016/j.shaw.2020.03.001 · Cited by 298 · see citing works
“The Systems Engineering Initiative for Patient Safety (SEIPS) is a human factors e based model used in health care to understand the impact of a work system and processes on outcomes [10].”
Kilsdonk, E., Peute, L., & Jaspers, M. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.12.001 · Cited by 284 · see citing works
Musuuza, J., Sutherland, B. L., Kurter, S., Balasubramanian, P., Bartels, C. M., & Brennan, M. B. (2020) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2019.08.244 · Cited by 274 · see citing works
Vincent, C., & Amalberti, R. (2016) · doi:10.1007/978-3-319-25559-0 · Cited by 278 · see citing works
Sørensen, J. L., Østergaard, D., LeBlanc, V. R., Ottesen, B., Konge, L., Dieckmann, P., & van der Vleuten, C. P. M. (2017) · BMC Medical Education · doi:10.1186/s12909-016-0838-3 · Cited by 272 · see citing works
“equipment, guidelines and the physical clinical environment [33].”
BackgroundInterventions to increase patient portal use in vulnerable populations: a systematic review
Grossman, L. V., Masterson Creber, R. M., Benda, N. C., Wright, D., Vawdrey, D. K., & Ancker, J. S. (2019) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocz023 · Cited by 251 · see citing works
Human factors and ergonomics as a patient safety practice
Carayon, P., Xie, A., & Kianfar, S. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2013-001812 · Cited by 272 · see citing works
Self-citationAusserhofer, D., Schubert, M., Desmedt, M., Blegen, M. A., Geest, S. D., & Schwendimann, R. (2012) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2012.04.007 · Cited by 238 · see citing works
“1) describes how organizational features are related to patient outcomes and builds on the System Engineering Initiative for Patient Safety model (Carayon et al., 2006) and the Rationing of nursing care in Switzerland model (Schubert et al.”
BackgroundIn Situ Simulation in Continuing Education for the Health Care Professions: A Systematic Review
Rosen, M. A., Hunt, E. A., Pronovost, P. J., Federowicz, M. A., & Weaver, S. J. (2012) · Journal of Continuing Education in the Health Professions · doi:10.1002/chp.21152 · Cited by 233 · see citing works
SEIPS 101 and seven simple SEIPS tools
Holden, R. J., & Carayon, P. (2021) · BMJ Quality & Safety · doi:10.1136/bmjqs-2020-012538 · Cited by 216 · see citing works
Self-citationAn analysis of electronic health record-related patient safety concerns
Meeks, D. W., Smith, M. W., Taylor, L., Sittig, D. F., Scott, J. M., & Singh, H. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2013-002578 · Cited by 207 · see citing works
Self-citationSingh, H., Thomas, E. J., Mani, S., Sittig, D., Arora, H., Espadas, D., Khan, M. M., & Petersen, L. A. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.263 · Cited by 212 · see citing works
“The impact of several factors such as time pressures, organizational characteristics, factors related to the task of processing alerts, technological factors, and HCP factors should be considered in the design of interventions to improve timely follow-up.(29,30) Future studies should address process-of-care issues lea…”
BackgroundQualitative HCI Research: Going Behind the Scenes
BLANDFORD, A. E., Furniss, D. J., & Makri, S. (2016) · Synthesis lectures on human-centered informatics · doi:10.2200/s00706ed1v01y201602hci034 · Cited by 89 · see citing works
Time to accelerate integration of human factors and ergonomics in patient safety: Table 1
Gürses, A. P., Ozok, A. A., & Pronovost, P. J. (2011) · BMJ Quality & Safety · doi:10.1136/bmjqs-2011-000421 · Cited by 203 · see citing works
“using HFE principles and methods, then healthcare processes will improve, resulting in the improvement of healthcare professionals’ performance and outcomes.(7) A straightforward example is the interaction between healthcare providers and medical devices.”
MethodSelf-citationValdez, R. S., Holden, R. J., Novak, L. L., & Veinot, T. C. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2014-002826 · Cited by 194 · see citing works
Framework for Patient Safety Research and Improvement
Pronovost, P. J., Goeschel, C. A., Marsteller, J. A., Sexton, J. B., Pham, J. C., & Berenholtz, S. M. (2009) · Circulation · doi:10.1161/circulationaha.107.729848 · Cited by 190 · see citing works
Health Care 4.0: A vision for smart and connected health care
Li, J., & Carayon, P. (2021) · IISE Transactions on Healthcare Systems Engineering · doi:10.1080/24725579.2021.1884627 · Cited by 190 · see citing works
“The integration illustrated in Figure 7 can benefit from an overall conceptual framework, such as the SEIPS (Systems Engineering Initiative for Patient Safety) model (Carayon et al., 2006, 2014).”
MethodSelf-citationThe Balance Theory and the Work System Model … Twenty Years Later
Carayon, P. (2009) · International Journal of Human-Computer Interaction · doi:10.1080/10447310902864928 · Cited by 188 · see citing works
“The Systems Engineering Initiative for Patient Safety model of work system and patient safety ( Carayon, Hundt, et al, 2006 ) integrates the work system model into the well-known Structure–Process–Outcome model of quality of care by Donabedian (1978 ).”
MethodSelf-citationSafety Culture, Patient Safety, and Quality of Care Outcomes: A Literature Review
Lee, S. E., Scott, L. D., Dahinten, V. S., Vincent, C., Lopez, K. D., & Park, C. G. (2017) · Western Journal of Nursing Research · doi:10.1177/0193945917747416 · Cited by 186 · see citing works
Gürses, A. P., Carayon, P., & Wall, M. M. (2008) · Health Services Research · doi:10.1111/j.1475-6773.2008.00934.x · Cited by 180 · see citing works
Self-citationWhat Exactly Is Patient Safety?
Emanuel, L. L., Berwick, D., Conway, J., Combes, J., Hatlie, M. J., Leape, L. L., REASON, J. T., Schyve, P. M., Vincent, C. A., & Walton, M. (2009) · Journal of Medical Regulation · doi:10.30770/2572-1852-95.1.13 · Cited by 190 · see citing works
A systematic review of safety violations in industry
Alper, S. J., & Karsh, B. (2009) · Accident Analysis & Prevention · doi:10.1016/j.aap.2009.03.013 · Cited by 179 · see citing works
Self-citationNASA-TLX Assessment of Surgeon Workload Variation Across Specialties
Lowndes, B. R., Forsyth, K. L., Blocker, R. C., Dean, P. G., Truty, M. J., Heller, S. F., Blackmon, S. H., Hallbeck, M. S., & Nelson, H. (2018) · Annals of Surgery · doi:10.1097/sla.0000000000003058 · Cited by 177 · see citing works
Continuous glucose monitors and automated insulin dosing systems in the hospital consensus guideline
Galindo, R. J., Umpierrez, G. E., Rushakoff, R. J., Basu, A., Lohnes, S., Nichols, J. H., Spanakis, E. K., Espinoza, J., Palermo, N. E., Awadjie, D. G., et al. (2020) · Journal of Diabetes Science and Technology · doi:10.1177/1932296820954163 · Cited by 170 · see citing works
Status of patient safety culture in Arab countries: a systematic review
Elmontsri, M., Almashrafi, A., Banarsee, R., & Majeed, A. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-013487 · Cited by 168 · see citing works
“Systems that minimise the likelihood of errors while maximising the likelihood of intercepting these errors need to be established.(63) An efficient operating mechanism that is dependent on the collaboration of the subparts to achieve an outcome is what describes the system approach to patient safety.”
BackgroundDigital Twins for Managing Health Care Systems: Rapid Literature Review
Elkefi, S., & Asan, O. (2022) · Journal of Medical Internet Research · doi:10.2196/37641 · Cited by 169 · see citing works
Holden, R. J. (2010) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2009.12.003 · Cited by 162 · see citing works
“…environment of work stations and walls (i.e., connectivity), to organizational factors such as provision of technical support and other resources, to the content and timing of tasks, to technological capability and usability, to cognitive and motivational personal factors, and more [49,50].”
BackgroundHuman factors in patient safety as an innovation
Carayon, P. (2010) · Applied Ergonomics · doi:10.1016/j.apergo.2009.12.011 · Cited by 162 · see citing works
“They also need to understand the underlying relationships between work system factors and other HFE variables and patient safety outcomes (Carayon et al., 2007a, 2006) [recommendation R4].”
BackgroundSelf-citationSingh, H., Thomas, E. J., Sittig, D. F., Wilson, L., Espadas, D., Khan, M. M., & Petersen, L. A. (2010) · The American Journal of Medicine · doi:10.1016/j.amjmed.2009.07.027 · Cited by 160 · see citing works
Gürses, A. P., Seidl, K. L., Vaidya, V. U., Bochicchio, G. V., Harris, A. D., Hebden, J. N., & Xiao, Y. (2008) · BMJ Quality & Safety · doi:10.1136/qshc.2006.021709 · Cited by 154 · see citing works
Self-citationBritish Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy
Sidhu, R., Turnbull, D., Haboubi, H., Leeds, J., Healey, C., Hebbar, S., Collins, P., Jones, W., Peerally, M., Brogden, S., et al. (2023) · Gut · doi:10.1136/gutjnl-2023-330396 · Cited by 167 · see citing works
Nursing Workload and Patient Safety—A Human Factors Engineering Perspective
Carayon, P., & Gürses, A. P. (2008) · Cited by 162 · see citing works
Self-citationCrossing levels in systems ergonomics: A framework to support ‘mesoergonomic’ inquiry
Karsh, B., Waterson, P. E., & Holden, R. J. (2013) · Applied Ergonomics · doi:10.1016/j.apergo.2013.04.021 · Cited by 150 · see citing works
“Each broader level of the system provides context for the systems nestedwithin it, and that context includes policies and procedures, norms, technologies, physical environments and people specific to that level (Carayon et al., 2006; Holden and Karsh, 2009; Karsh et al., 2006).”
BackgroundInfluentialSelf-citationPatient safety - the role of human factors and systems engineering.
Carayon, P., & Wood, K. E. (2010) · PubMed · Cited by 147 · see citing works
Self-citationA critical review of the systems approach within patient safety research
Waterson, P. E. (2009) · Ergonomics · doi:10.1080/00140130903042782 · Cited by 149 · see citing works
Gurses, A. P., Marsteller, J. A., Ozok, A. A., Xiao, Y., Owens, S., & Pronovost, P. J. (2010) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181e69e02 · Cited by 145 · see citing works
“, workload, task ambiguity, responsibility ambiguity, method ambiguity) Cabana et al (11), PRECEDE (74), SEIPS (37), Systems ambiguity (28)”
BackgroundMethodInfluentialSelf-citationXie, A.-P., & Carayon, P. (2014) · Ergonomics · doi:10.1080/00140139.2014.959070 · Cited by 132 · see citing works
“These projects, although important, do not consider complex sociotechnical system characteristics that need to be addressed to improve overall system outcomes from the viewpoint of patients, employees and organisations (Carayon et al. 2006; 2014; Hendrick 1980; Hendrick and Kleiner 2001).”
BackgroundMethodInfluentialSelf-citationPEARLS for Systems Integration
Dubé, M. M., Reid, J. R., Kaba, A., Cheng, A., Eppich, W., Grant, V. J., & Stone, K. P. (2019) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0000000000000381 · Cited by 136 · see citing works
Holden, R. J. (2010) · Cognition Technology & Work · doi:10.1007/s10111-010-0141-8 · Cited by 134 · see citing works
“eted, dynamically interacting work system (Carayon et al. 2006; Karsh et al. 2006b).”
BackgroundTucker, A. L., Singer, S. J., Hayes, J. E., & Falwell, A. (2008) · Health Services Research · doi:10.1111/j.1475-6773.2008.00868.x · Cited by 129 · see citing works
“Poor facility design can compromise patient confidentiality and create safety risks through limited patient visibility (Carayon et al. 2006).”
BackgroundSociotechnical systems analysis in health care: a research agenda
Carayon, P., Bass, E. J., Bellandi, T., Gürses, A. P., Hallbeck, M. S., & Mollo, V. (2011) · IIE Transactions on Healthcare Systems Engineering · doi:10.1080/19488300.2011.619158 · Cited by 132 · see citing works
“The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety (Carayon et al., 2006) is one example of this STSA approach aimed at understanding the complex system interactions that can produce hazards and patient safety risks.”
BackgroundMethodInfluentialSelf-citationSafety, efficiency and learning curves in robotic surgery: a human factors analysis
Catchpole, K., Perkins, C. E., Bresee, C. J., et al. (2015) · Surgical Endoscopy · doi:10.1007/s00464-015-4671-2 · Cited by 125 · see citing works
Nurse Health, Work Environment, Presenteeism and Patient Safety
Rainbow, J. G., Drake, D. A., & Steege, L. M. (2020) · Western Journal of Nursing Research · doi:10.1177/0193945919863409 · Cited by 123 · see citing works
“The model is also influenced by human factors models, particularly the Systems Engineering Initiative for Patient Safety (SEIPS) model, that suggest there are multiple individual and organizational structures that are a part of processes and outcomes in health care settings (Carayon et al., 2006).”
MethodFrom Tasks To Processes: The Case For Changing Health Information Technology To Improve Health Care
Walker, J. M., & Carayon, P. (2009) · Health Affairs · doi:10.1377/hlthaff.28.2.467 · Cited by 122 · see citing works
Self-citationState of science: human factors and ergonomics in healthcare
Hignett, S. M., Carayon, P., Buckle, P., & Catchpole, K. C. (2013) · Ergonomics · doi:10.1080/00140139.2013.822932 · Cited by 123 · see citing works
“Conceptual model for ergonomics in the healthcare industry (Carayon et al. 2006).”
BackgroundMethodInfluentialSelf-citationSteege, L. M. B., & Rainbow, J. G. (2016) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2016.11.014 · Cited by 120 · see citing works
A systematic review of mixed methods research on human factors and ergonomics in health care
Carayon, P., Kianfar, S., Li, Y., Xie, A., Alyousef, B., & Wooldridge, A. R. (2015) · Applied Ergonomics · doi:10.1016/j.apergo.2015.06.001 · Cited by 121 · see citing works
Self-citationExploring performance obstacles of intensive care nurses
Gürses, A. P., & Carayon, P. (2008) · Applied Ergonomics · doi:10.1016/j.apergo.2008.09.003 · Cited by 121 · see citing works
“For such an initiative, we recommend use of a participatory ergonomics approach (Wilson and Haines, 1997) with active involvement of ICU nurses in prioritizing, developing, implementing, and evaluating interventions that will improve their work system as well as the quality and safety of patient care (Carayon et al.,…”
BackgroundMethodInfluentialSelf-citationCooper, W. O., Guillamondegui, O. D., Hines, O. J., et al. (2017) · JAMA Surgery · doi:10.1001/jamasurg.2016.5703 · Cited by 121 · see citing works
ICU nurses' acceptance of electronic health records
Carayon, P., Cartmill, R. S., Blosky, M. A., Brown, R., Hackenberg, M., Hoonakker, P., Hundt, A. S., Norfolk, E. R., Wetterneck, T. B., & Walker, J. M. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2010-000018 · Cited by 118 · see citing works
Self-citationChui, M. A., Mott, D. A., & Maxwell, L. (2012) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2011.06.001 · Cited by 118 · see citing works
A review of models relevant to road safety
Hughes, B., Newstead, S., Anund, A., Shu, C. C., & Falkmer, T. (2014) · Accident Analysis & Prevention · doi:10.1016/j.aap.2014.06.003 · Cited by 117 · see citing works
Gürses, A. P., Kim, G., Martinez, E. A., Marsteller, J. A., Bauer, L. C., Lubomski, L. H., Pronovost, P. J., & Thompson, D. (2012) · BMJ Quality & Safety · doi:10.1136/bmjqs-2011-000625 · Cited by 115 · see citing works
“The top level followed the SEIPS model and included care provider, tasks, tools/technologies, organisation, physical environment and processes.(21) The second and third level categories were generated based on the data.”
MethodSelf-citationSørensen, J. L., van der Vleuten, C. P. M., Rosthøj, S., Østergaard, D., LeBlanc, V. R., Johansen, M., Ekelund, K., Starkopf, L., Lindschou, J., Gluud, C. N., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008344 · Cited by 117 · see citing works
EHR Safety: The Way Forward to Safe and Effective Systems
Walker, J. M., Carayon, P., Leveson, N., Paulus, R. A., Tooker, J., Chin, H., Bothe, A., & Stewart, W. F. (2008) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m2618 · Cited by 113 · see citing works
Self-citationDeLucia, P. R., Ott, T. E., & Palmieri, P. A. (2009) · Reviews of Human Factors and Ergonomics · doi:10.1518/155723409x448008 · Cited by 120 · see citing works
Global food safety as a complex adaptive system: Key concepts and future prospects
Nayak, R., & Waterson, P. E. (2019) · Trends in Food Science & Technology · doi:10.1016/j.tifs.2019.07.040 · Cited by 112 · see citing works
Realizing Improved Patient Care through Human-centered Operating Room Design
Palmer, G., Abernathy, J. H., Swinton, G., Allison, D., Greenstein, J. S., Shappell, S. A., Juang, K. A., & Reeves, S. T. (2013) · Anesthesiology · doi:10.1097/aln.0b013e31829f68cf · Cited by 107 · see citing works
Carayon, P., Wooldridge, A. R., Hose, B., Salwei, M. E., & Benneyan, J. C. (2018) · Health Affairs · doi:10.1377/hlthaff.2018.0723 · Cited by 111 · see citing works
Self-citationResearch Trends in Artificial Intelligence Applications in Human Factors Health Care: Mapping Review
Asan, O., & Choudhury, A. (2021) · JMIR Human Factors · doi:10.2196/28236 · Cited by 114 · see citing works
“This framework also helps to assess and understand the complex interaction between elements of the work system, and shows the impact of any technology-based intervention on the overall system [83].”
BackgroundMethodInfluentialFactors contributing to an increase in duplicate medication order errors after CPOE implementation
Wetterneck, T. B., Walker, J. M., Blosky, M. A., Cartmill, R. S., Hoonakker, P., Johnson, M., Norfolk, E. R., & Carayon, P. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000255 · Cited by 108 · see citing works
Self-citationUnertl, K. M., Novak, L. L., Johnson, K. B., & Lorenzi, N. M. (2010) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2010.004333 · Cited by 107 · see citing works
The Impact of Electronic Health Records on Diagnosis
Graber, M. L., Byrne, C., & Johnston, D. (2017) · Diagnosis · doi:10.1515/dx-2017-0012 · Cited by 108 · see citing works
“Ensuring that the EHR performs optimally in clinical settings requires not just optimizing the software but also consideration of all the sociotechnical factors that determine performance in using health IT applications [4, 100, 101].”
BackgroundChua, W. L., See, M. T. A., Legido‐Quigley, H., Jones, D. A., Tee, A. K. H., & Liaw, S. Y. (2017) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzx149 · Cited by 107 · see citing works
“themes, which were then categorized into the five interacting components of the work systems of the SEIPS model: the person[s] using various tools and technologies to perform tasks in an environment under certain organizational conditions [73].”
BackgroundMethodInfluentialGuise, V., Anderson, J., & Wiig, S. (2014) · BMC Health Services Research · doi:10.1186/s12913-014-0588-z · Cited by 102 · see citing works
Schneider, A., Wehler, M., & Weigl, M. (2019) · BMC Emergency Medicine · doi:10.1186/s12873-018-0218-x · Cited by 108 · see citing works
Salwei, M. E., & Carayon, P. (2022) · Journal of Cognitive Engineering and Decision Making · doi:10.1177/15553434221097357 · Cited by 112 · see citing works
“Early in the development of AI technologies, designers need to consider how feedback loops will be integrated in the work system to support the monitoring of the technology in real use and to help identify problems as they arise (Carayon et al., 2006, 2014).”
BackgroundSelf-citationVincent, C., Li, Y., & BLANDFORD, A. E. (2013) · Applied Ergonomics · doi:10.1016/j.apergo.2013.05.009 · Cited by 101 · see citing works
Carayon, P., Wetterneck, T. B., Cartmill, R. S., Blosky, M. A., Brown, R., Kim, R., Kukreja, S., Johnson, M., Paris, B. L., Wood, K. E., et al. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2013-001828 · Cited by 102 · see citing works
Self-citationDigital health technology enhances resilient behaviour: evidence from the ward
Rubbio, I., Bruccoleri, M., Pietrosi, A., & Ragonese, B. (2018) · International Journal of Operations & Production Management · doi:10.1108/ijopm-02-2018-0057 · Cited by 104 · see citing works
Olson, A., Rencic, J., Cosby, K., Rusz, D., Papa, F., Croskerry, P., Zierler, B., Harkless, G., Giuliano, M. A., Schoenbaum, S., et al. (2019) · Diagnosis · doi:10.1515/dx-2018-0107 · Cited by 101 · see citing works
“Second, the practice environment and health care system both have a dramatic impact on individual and team performance, and ultimately on the diagnostic process itself [12, 13].”
BackgroundKoppel, R., & Kreda, D. (2009) · JAMA · doi:10.1001/jama.2009.398 · Cited by 99 · see citing works
Lessons Learned From Implementing CDC’s STEADI Falls Prevention Algorithm in Primary Care
Casey, C. M., Parker, E., Winkler, G., Liu, X., Lambert, G. H., & Eckstrom, E. (2016) · The Gerontologist · doi:10.1093/geront/gnw074 · Cited by 102 · see citing works
“…facilitate practice change, including the plan-do-study-act (PDSA) framework, the Systems Engineering Initiative for Patient Safety (SEIPS) model (Carayon et al., 2006; Perry, Bell, Shaw, Fitzpatrick, & Sampson, 2014), and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and…”
Olakotan, O. O., & Mohd Yusof, M. (2021) · Health Informatics Journal · doi:10.1177/14604582211007536 · Cited by 101 · see citing works
Workload and Patient Safety Among Critical Care Nurses
Carayon, P., & Alvarado, C. J. (2007) · Critical Care Nursing Clinics of North America · doi:10.1016/j.ccell.2007.02.001 · Cited by 100 · see citing works
Self-citationKeebler, J. R., Lazzara, E. H., Patzer, B. S., Palmer, E. M., Plummer, J. P., Smith, D. C., Lew, V., Fouquet, S., Chan, Y. R., & Riss, R. (2016) · Human Factors: The Journal of the Human Factors and Ergonomics Society · doi:10.1177/0018720816672309 · Cited by 97 · see citing works
“…and development of the field. theoretical Basis: the Systems Engineering in Patient Safety (SEIPS) Model We elected to adopt the SEIPS model (Carayon et al., 2006) to organize our four overarching categories of variables that are suitable for understanding the effects of protocols in…”
BackgroundMethodInfluentialMeeks, D. W., Takian, A., Sittig, D. F., Singh, H., & Barber, N. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2013-001762 · Cited by 91 · see citing works
Campbell, A. R., Layne, D. M., Scott, E. S., & Wei, H. (2020) · Journal of Nursing Management · doi:10.1111/jonm.13083 · Cited by 101 · see citing works
Holden, R. J. (2011) · Journal of Patient Safety · doi:10.1097/pts.0b013e3182388cfa · Cited by 95 · see citing works
SEIPS-based process modeling in primary care
Wooldridge, A. R., Carayon, P., Hundt, A. S., & Hoonakker, P. (2016) · Applied Ergonomics · doi:10.1016/j.apergo.2016.11.010 · Cited by 95 · see citing works
“…for Process Modeling The SEIPS model integrates human factors and healthcare models to propose a systems engineering model to understand the care process by representing all work system elements; this model provides a representation of the complexities of health care (Carayon et al., 2006).”
BackgroundMethodInfluentialSelf-citationTo err is human: use of simulation to enhance training and patient safety in anaesthesia
Higham, H., & Baxendale, B. (2017) · British Journal of Anaesthesia · doi:10.1093/bja/aex302 · Cited by 96 · see citing works
A scoping review of interventions for older adults transitioning from hospital to home
Liebzeit, D., Rutkowski, R. A., Arbaje, A. I., Fields, B., & Werner, N. E. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17323 · Cited by 98 · see citing works
Safety Hazards During Intrahospital Transport: A Prospective Observational Study
Bergman, L., Pettersson, M. E., Chaboyer, W. P., et al. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002653 · Cited by 95 · see citing works
“The System Engineering Initiative for Patient Safety (SEIPS) model (26, 27), a framework for proactively improving patient safety by focusing on the design of the work system, was used to guide data analysis.”
MethodOzok, A. A., & Wei, J. C. (2010) · Electronic Commerce Research · doi:10.1007/s10660-010-9048-y · Cited by 94 · see citing works
Waterson, P. E. (2013) · Applied Ergonomics · doi:10.1016/j.apergo.2013.07.004 · Cited by 96 · see citing works
“Much of the case study data reported here for example, could have been interpreted through a large range of alternative theoretical ‘lenses’ (e.g., alternative sociotechnical models e Carayon et al., 2006; Sittig and Singh, 2010; HIT technology acceptance models e Holden and h et al., 2010).”
BackgroundImproving cardiac surgical care: A work systems approach
Wiegmann, D. A., Eggman, A. A., ElBardissi, A. W., et al. (2010) · Applied Ergonomics · doi:10.1016/j.apergo.2009.12.008 · Cited by 93 · see citing works
“Specifically, the Systems Engineering Initiative to Patient Safety (SEIPS) model (Carayon et al., 2006) indicates that in addition to surgical skill (person factors), performance and outcomes are also impacted by such factors as teamwork and communication, the physical working environment,…”
BackgroundPatterson, B. W., Pulia, M. S., Ravi, S., Hoonakker, P., Hundt, A. S., Wiegmann, D. A., Wirkus, E. J., Johnson, S. M., & Carayon, P. (2019) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2018.10.034 · Cited by 100 · see citing works
“Given the complexity of the sociotechnical systems (such as the ED) in which they are implemented, 13,14 however, clinical decision support technologies have the potential for negative consequences.”
BackgroundSelf-citationHealth care provider social network analysis: A systematic review
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Patient Adherence to Dysphagia Recommendations: A Systematic Review
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- Authors
- Carayon, P., Schoofs Hundt, A., Karsh, B.-T., Gurses, A. P., Alvarado, C. J., Smith, M., & Flatley Brennan, P.
- Affiliations
- University of Wisconsin–Madison (US)
- Corresponding author
- Carayon, P
- ORCID
- Venue
- Quality in Health Care
- Publisher
- BMJ
- Published
- 2006-12
- Volume
- 15
- Issue
- suppl 1
- Pages
- i50-i58
- ISSN
- 1475-3898 (ISSN-L)
- 1475-3901
- PMC
- PMC2464868
- OpenAlex
- W2163767758
- Semantic Scholar
- d1341354adecf3074cdce8d706ccfec017ac370f
- Cited by
- 1,795
- References
- 53
- Citations by year
- 2026: 199 · 2025: 140 · 2024: 129 · 2023: 122 · 2022: 119 · 2021: 150 · 2020: 132 · 2019: 118 · 2018: 102 · 2017: 93 · 2016: 97 · 2015: 70 · 2014: 77 · 2013: 66 · 2012: 50
- FWCI
- 4.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ Quality & Safety (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (#P20 HS11561-01, P20 HS011561)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Physical Sciences › Engineering › Biomedical Engineering › Ergonomics and Human Factors
- Keywords
- work system design, patient safety, SEIPS model, health care system, outpatient surgery, safety culture
- MeSH terms
- Humans, Ergonomics, Models, Theoretical, Quality Assurance, Health Care, Surgicenters, Systems Analysis, Task Performance and Analysis, United States, Outcome Assessment, Health Care, Safety Management, Medical Errors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.
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