article Fall 2020

Supporting Patients with Complex Health Needs Using Human Factors Engineering

An investigation into human factors engineering as applied  by the Werner Lab in their work to design systems to support specialized healthcare users.

A teenager suffered from brain damage and died two weeks after she received an organ transplant because the organs from her donor were incompatible with her blood type. An investigation into the incident determined that a lack of redundancy for checking blood type compatibility was a key factor in the error (Patient Safety: The Role of Human Factors and Systems Engineering, 2010). 

Unfortunately, mistakes in healthcare caused by system failures are common. One study identified 178 medication errors over a 7 month period in a hospital due to failures to follow procedures, written miscommunication, transcription errors, prescriptions misfiling, and calculation errors (Patient Safety: The Role of Human Factors and Systems Engineering, 2010). The success of products, processes, and systems depends on their ability to meet users needs, as opposed to requiring the user to meet the needs of the product or system. 

One field of study that is primarily concerned with designing systems to address the needs of the user is Human Factors (HF) engineering. According to the Human Factors and Ergonomics Society, HF engineering is defined as, “ the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.”  HF is concerned with supporting people in their work, which occurs within complex systems comprised of people, tools, technology, and dynamic environments. With target outcomes such as safety, ease of use, and satisfaction, HF engineers investigate how people actually behave in a system (i.e. work as done) rather than how people are expected to behave (i.e. work as imagined). A deep understanding of work as done provides a critically important basis from which to design and develop technologies, processes, and systems that support and facilitate safe and joyful experiences for those involved. 

Harvey D. Spangler assistant professor Nicole Werner. Photos provided by Werner Lab.

The Werner Lab, directed by Harvey D. Spangler Assistant Professor Nicole Werner, is a multidisciplinary healthcare systems and HF research group  based in the Department of Industrial and Systems Engineering (ISyE) at the University of Wisconsin-Madison. Their mission is to use HF engineering to design human-centered, smart and connected patient journeys. Werner Lab uses HF approaches to identify and design for the needs of vulnerable patient populations, such as older adults with dementia and children with medical complexity. Both of these populations are at increased risk for experiencing poor health outcomes because technologies, processes, and systems are not designed to support their needs. By recruiting human-centered HF approaches to understand the context in which patients and their family caregivers complete tasks, also known as the work system, the lab uncovers issues within work systems that may otherwise go unidentified. This allows for the development of personalized tools and technologies that address the underlying challenges patients and caregivers experience and comprehensively meet their needs.  

“I think one misconception about HF is that it is just making sure that something is usable. This can be a pitfall of design…HF must be integrated within and throughout the design to yield success.” 

– Hanna Barton

Currently, one of the Werner Lab’s main projects, in collaboration with the UW-Madison Department of Pediatrics, aims to understand in-home caregiving for children with medical complexity (CMC) and design applications to support family caregivers. While this population only represents 6% of the Medicaid population, these patients account for 80% of the total hospital days at pediatric academic medical centers (Children’s Hospital Association)– meaning that members of this population frequently require highly skilled care. When CMC are not hospitalized, the home environment in which a CMC receives care is challenging as it requires the family caregiver, who often has received no formal healthcare training, to provide continuous hospital-level care.

To support family caregivers,  team members from Werner Lab and the Department of Pediatrics engaged an interdisciplinary team of clinicians, engineers, and families of CMC  to develop a mobile health application to connect and support families caring for CMC with enteral tubes (e.g., tubes into the stomach or intestines to safely give medications, nutrition and hydration). The design process for this app involved engaging caregivers of CMC for co-design sessions, developing paper prototypes and transferring them to Adobe XD, a wire-framing software, and developing a minimum viable product. Next, the team conducted usability testing by having the families use the minimum viable product to complete example tasks on the app. Usability testing ensured that the caregivers’ needs and expectations were met before finalizing the design and development of the app (Cheng CF, Werner NE, Barton H, Doutcheva N, Coller RJ., Hospital Pediatrics, 2020). PhD student Hanna Barton is a researcher on the project who says, “I think one misconception about HF is that it is just making sure that something is usable. This can be a pitfall of design…HF must be integrated within and throughout the design to yield success.” 

Some members of the lab such as David Wilkins, Hanna Barton, A.J. Lingg, and Priya Loganathar are working to support the mental health of entrepreneurs. In the US, startups create approximately 43% of new jobs annually and small businesses make 8.4 million new net jobs as opposed to the 4.4 million jobs created of small corporations. However, a global health crisis is on the rise as 50% of entrepreneurs suffer from at least one form of mental health condition during their lifetime (World Economic Forum, 2019). Researchers have identified a lack of resources as a key component of this increasing mental health crisis in entrepreneurs (National Council for Behavioral Health, 2018).   

To combat this growing mental health crisis,  the team met with local entrepreneurs and conducted a survey of their needs and experiences. Then, they designed an interactive prototype of an app called Fika using Adobe XD as a first step in helping entrepreneurs manage their stress levels. The app is designed to easily integrate with the volatile schedule of an entrepreneur by reminding the user to take breaks, prompting the user to meditate, and allowing the user to set goals and track their progress. 

The app was developed according to mobile health application heuristics, with a focus on consistency across visual and interactive elements. The team paid special attention to app features that would facilitate behaviors that promote positive health, including customizable break notifications and a progress page to see if users are meeting their personal health goals. To verify their design, the team met with a local entrepreneur to obtain their feedback to ensure the design met their needs since, as one member of the team David Wilkins states, “Fika is intentionally designed to blend into the as-lived lives of entrepreneurs.”

The app was entered into the Mobile Health Applications for Consumers Design Competition in conjunction with the 2019 International Symposium on the Human Factors and Ergonomics in Health Care. The team finished among the top three finalists in the international competition. 

What these two projects share is a deep understanding of the users for whom products are designed and an integration of that understanding throughout the design and development process. By understanding the work system within which users operate, engineers can design tools and technologies to support users in their tasks, making their lives safer and more enjoyable. To keep up with the work of Werner Lab, follow them on Twitter at @WernerLabUW, on Facebook or check out their website (  

Special thanks to PhD student Rachel Rutkowski and Professor Werner for providing feedback!

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