Interview with Myrtede Alfred | #HCS2021Symposium | Bonus Episode

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all right we are live hello everyone this
is your guest host Elyse Hallett and i am

joined by doctor Myrtede Alfred who uh is
with the medical university of south Carolina

hello how are you hello everyone hello Elyse
it's good to see you it's good to see you

too i know we met in person a couple healthcare
symposiums ago and here we are meeting virtually

so it's good to see your face yeah kindred
spirits since then absolutely um it is so

good to have you on the show um at this conference
in particular i was able to catch quite a

few of your panels and you know just talking
about some of the work that you've been doing

over this past year and even before this past
year um but before we jump into that i was

actually hoping if you could rewind a little
bit further past that and talk a little bit

about how you got involved in human factors
and what ultimately led you to the role that

you're in now well it depends on how far you
want to go back it's quite a convoluted story

so as an undergrad i was actually a history
and a business major right so um i joked that

i was a industrial engineer before i knew
i was an industrial engineer and so i was

actually working in banking um you know checking
folks accounts for you know fraud and you

know mortgage fraud and things like that and
i had a friend who was a IE um at the bank

and so she encouraged me to go back for my
uh graduate degree and so when i went to Clemson

that's when i you know found out about human
factors through my advisor Dave Nians who

taught the intro to human factors class um
and he kind of wrote me in because i went

in just for a master's really because i actually
thought i was going to go back to banking

and then Dave’s like hey i think you should
do a PhD and then my friend Kapil was like

yeah you should definitely do a PhD and i
was like okay yeah that sounds good and so

that was kind of that was kind of my path
to human factors that's awesome and then did

you get your PhD at Clemson as well or i did
i went in for the masters it's funny i did

not even buy furniture in my apartment i had
my plan i was going to be at Clemson for a

year and a half um and then you know i decided
to just stay on and continue to the PhD program

it made sense and it was a great decision
because Clemson did have a pretty strong human

factors program in engineering and also in
psychology yeah it definitely does and it's

so funny always hearing about these stories
of how people get into human factors because

i feel like it's one of those new fields that
not a lot of people know about and it's always

like this very circuitous route it feels like
i doubt there's anyone who kind of went into

school and thinking you know i'm gonna become
a human factors engineer you probably don't

even know about it until you have at least
an undergrad or you're you know working on

your undergrad degree right yeah so when you
were you know getting your PhD at Clemson

did you know that you wanted to go into the
healthcare route or was there a particular

area that was of more interest to you yeah
i actually my dissertation research was looking

at virtual environments how we learn and design
virtual environments but i always had an interest

in health um and then you know when um ken
Dave and ken so Dave’s my advisor ken catch

post my postdoc advisor at musc um Dave and
ken had been working on a project together

and Dave let me know that ken was looking
for a postdoc and i thought it would be a

great opportunity for me to get into healthcare
just because i knew it was an interesting

and growing field and you know i thought you
know why not absolutely um and i know ken

was our mutual contact and how we met each
other um so it's always funny how those things

you know work out and virtual learning and
virtual environments there's definitely some

irony there given the situation we're in right
now i know i might i might pick some of that

research back up actually now you should it's
very relevant i hear um so you know you've

been at um musc uh for uh a few years now
right mm-hmm three and a half so excellent

um so tell me a little bit about you know
the work that you were involved in what your

role looked like you know before kova 19 broke
out so i came into musc as a postdoc um i'm

now a research assistant professor uh but
basically since i've been there i've mostly

worked on you know different patient safety
projects um mostly in perioperative uh safety

or in perioperative care um and so my role
i think has been pretty cool because for the

for the most part i do focus on research but
at the time i actually get to support like

quality improvement in the hospital i get
to kind of meet with our patient safety team

i get to sit in on the root cause analyses
and so it's been this nice kind of balance

of being able to do research project that's
longer and you know you might not readily

see the impact and being able to actually
contribute to patient safety projects in the

hospital so that's been that's been pretty
cool and then um you know we don't work as

closely with students but you know once in
a while we get to work with a couple medical

students and that's always nice because mentoring
um is something you know something i enjoy

and i've missed in this position so it sounds
like a few different areas that you get involved

in and i should have prefaced our conversation
with talking about how you know you have this

unique role as a human factor specialist who's
really embedded in the hospital environment

and you know a lot of times when we talk about
human factors we talk about the work we do

with developers or kind of on the um you know
device side whether that be in industry or

medical devices or wherever but you know i
look at this role as really like human factors

in the wild like in this messy hospital environment 
and you know figuring out how to invoke change

in in that kind of environment whether that
be through the long-term research studies

like you're talking about or like embedded
with you know particular teams at the hospital

so i just i find that to be such a fascinating
and unique position for a human factors person

to be yeah i agree and over the past you know
year or two you know they've really been you

know within healthcare but kind of as a separate
thing there's been a growing kind of recognition

of the differences in the role between the
human factors folks who are embedded in health

care and some who might be at a research institution 
for some of the reasons you just name right

you know we have this this direct kind of
you know opportunity where we're you know

we can be more or less integrated with the
clinical operations but we have this direct

opportunity to impact patient care and patient
safety um and in my case patient equity um

a little bit more readily than we can i think
if we were just focused on research

yeah and some of the projects that you had
mentioned you know both in times you know

conferences past that i've been a part of
and then also this year's um you know you

talked a little bit about your work with you
know setting flow disruptions in the operating

room or evaluating system safety and the non-operating 
room anesthesia um just so many different

realms so you know i'm sure you're involved
in a lot of different projects what are some

you know that have been some of your favorite
to work on again pre-covered and because i

know that has changed a lot of what you do
yeah so um the project that i was brought

in to work on was around surgical instrument
reprocessing um and it doesn't seem interesting

or exciting but it was really a great project
and a you know opportunity for us to really

expose i think the complexity of a work of
the work in a way that that had hadn't been

you know uh previously illuminated and so
i really enjoyed that project i really enjoyed

um the people i met working on that project
and it's been nice because it's been a combination

of research but also a lot of our quality
improvement stuff have has been you know have

been related to sterile processing because
of you know the expansive research project

we did i'm actually working on a project right
now around how do we assemble chest retractors

supporting the reliable assembly of chest
retractors um in sterile processing so that

was a great project that i really enjoyed
working on and then the work i've been doing

recently in you know maternal care looking
at um you know how clinical systems contribute

or you know contribute to maternal health
disparities and just what we can do um to

imp to reduce adverse events and in maternal
care and so um that's you know my first research

project as a as a pi um and so that's been
very exciting and you know i mentioned you

know pivoting into health care and that was
one of the things i knew i would work on you

know if i took a role in health care was it
was maternal health and specifically finding

ways to apply and leverage human factors and
reducing maternal health disparities i love

that so what with that project that you're
um you know focused on right now what kind

of things are you looking into uh with respect
to um maternal care it's pretty wide open

you know um so i think you know i like to
start with just kind of a broad investigation

that there are you know there are factors
that we know we should focus on like urgent

and emergent cesarean deliveries right those
tend to be high risk procedures we know that

they're you know specifically when we're thinking
about um complications for African American

women we know that hemorrhage and you know
transfusion tends to be a challenge so you

know do we do we have a robust massive transfusion
protocol right um you know there are issues

around quickly um identifying women who are
declining and so do we have decisions support

do we have mechanisms to really support um
you know nurses in their decision making around

patients who might you know who might be declining
either slowly or quickly and so those are

some of the areas we know we need to focus
on but i'm sure after we complete our systems

investigation there's going to be you know
a lot more and so it becomes about you know

trying to find those key areas that we can
impact to reduce um adverse outcomes for all

women but specifically to try to reduce the
those outcomes that impact women of color

um you know disproportionately that's fantastic
and such important work um so it sounds like

with that work you've been looking at kind
of the process as a whole and um you know

especially how that process might change depending
on the demographic of women that are coming

in and then kind of pinpointing you know the
challenges across the demographics and then

four particular demographics you know specifically
women of color to then help narrow in your

research and follow on investigations yeah
you said that so well i should i should recruit

you to this team but yeah i think i think
the challenge is you know we talk about you

know we talk about racism and specifically
anti-black racism but you know i always joke

that there aren't like these cartoonish villains
that are existing to hurt you know women of

color and so trying to find out you know how
the design of the system you know negatively

impact certain women easy examples is non-english
speaking women right we don't tend to have

the strongest interpreter services and so
that puts them at a disadvantage um but you

know trying to kind of uncover those ways
that you know the system is designed um and

it negatively impacts certain women versus
you know specifically focus on implicit bias

which is part of the issue but i but i think
the design of the system and how the institutional

the institutionalization of bias is a little
more insidious but also much more difficult

to tease out um but i think human factors
um is that's where we add our value as human

factors right to support all the work that's
being done you know by public health and folks

at the policy level we know that a lot of
maternal um poor maternal outcomes are preventable

um so what's happening in that clinical system
that we can improve to reduce these preventable

adverse events i mean that's you know that's
what patient safety is about right absolutely

and it's so important for a lot of reasons
going on right now at least you know for me

personally um but it's so good and it's such
a good point that you bring up because you

know as human factors professionals you know
we're here focusing on the user right who

is the end user and so you know understanding
the variety that can come with you know who

that user might be and then really using that
to you know inform our systems thinking lens

and perspective that we bring into some of
this problem solving yeah exactly and i think

um i think sometimes we can we tend to think
of systems as a little colorblind and so you

know when we look at our safety efforts it
can be uncomfortable to then try to kind of

break that down by particularly by biracial
and ethnic demographics right because we want

to believe that we're you know we're designing
safety with everybody in mind right and we

are but at the same time we have to recognize
that you know different parts of the system

might have different impacts on certain people
and so if we're you know just because we're

focusing on safety for certain people doesn't
mean that you know we don't we don't care

about the safety of all women it's just recognizing 
that right now the way our system is designed

it's hurting certain women more than others
absolutely um it also kind of jogs in my memory

one of the panels that i sat in on where you
were talking about you know now kind of moving

into the coveted realm um some of the work
that you did there and uh specifically with

hospital wayfinding i think it was called
is that is that the term yeah um so you know

for our audience members just like really
understanding the flow of people traffic how

people are literally going to be moving through
the hospital and you brought up that that

um use case of you know the only door that
you can enter in but it didn't include a ramp

for you know the wheelchair users um which
i found you know interesting and that was

where you like really you know honed in like
we as human factors professionals you know

should be understanding you know the different
demographics and that was one case where i

believe you said human factors you know was
not involved and that was something that had

been kind of uncovered after the fact um but
i was wondering if you could you know elaborate

a little bit more on you know that particular
work and um how your role as a human factors

person uh fit into you know that that project
yes specifically with the wayfinding um and

this involved both ken and i um it was really
around we i think we focus more on foot traffic

than we did you know vehicle traffic um but
yeah so musc like you know a lot of hospitals

um you know limited their entry and exit points
right during covet to try to control traffic

in and outside the hospital and so i already
you know you already pointed out the example

of that including the wheelchair entrance
being closed um and it was interesting um

because it was several months later that that
ramp was finally kind of devel built and it

was like wow like how you know how had our
wheelchair patients been getting in i imagine

they have but with a lot of a lot of unnecessary
um challenges and so yeah it was around you

know finding ways to get you know patients
who needed to get covet testing on patients

who needed to go to the ed patients who needed
to get into the or visitors who needed to

get into the hospital and the same for staff
um and so i think you know when we thought

about our user groups those were you know
those were our two main user groups um patients

and families as well as um staff and so i
think that you know this goes to our point

you know i don't i don't think in any of those
conversations i for example brought up the

wheelchair issue it wasn't something that
i noticed um until later you know and it was

like damn like you know there's there was
no there was no wheelchair thing and as a

human batteries person like you know i didn't
personally bring it up um you know i don't

know if someone else um in the team actually
thought about that but a lot of the work was

really around signage right and so we had
oh my god they were so bad i wish i had i

had pictures but you know we had different
colors and you know different sizes and then

we had signs where there was something written
on the sign then they took a paper and taped

it over the side and wrote something else
it was it was just a nightmare and so um you

know we supported you know um some consistency
in the sign using different colors for you

know use this color for the ed use this color
for uh covet testing use this color for the

main hospital um and be consistent you know
for people who are coming out of the parking

lot and or the parking garage and things like
that so that was that was one of the big projects

that we were involved we were involved in
around covid um we worked on a couple more

i didn't know if you know wanted me to elaborate
on those as well yeah let's dig into it so

the other uh the other two and i'm being mindful
of our time um the other two was around uh

interesting covid icu boot camp and um that
that was a cool project that i wish we had

been involved in a little bit more um but
you know i think our department chair i think

was forward thinking and recognizing that
um you know these our coveted icus were going

to get filled and we were going to need people
to staff those icus who don't normally staff

icus and so how do we get you know our anesthesia
providers quickly trained up to take on this

intensivist role right and so that's why they
you know developed the covet icu boot camp

um after the conference actually someone reached
out to me um in in ontario because they're

going through their third wave and they're
expecting that they might have a similar kind

of shortage where they'll quickly need to
train providers to work with patients that

they haven't normally worked with and then
the same for adults and pees right pediatric

physicians and intensivists are being asked
to care for adult patients that they don't

normally care for and so we really just you
know spoke to them about the design of the

training um who they were selecting and why
who made most who made the most sense um and

so that was a that was a that was a neat project
and i think one that they were able to execute

pretty successfully given how quickly they
were required to do so um then we did we did

a couple projects that involved usability
testing for a cobit tracing app um it was

it was rough but it uh i think it was that
you know that's what happened when you know

when you design things and you don't have
human factors folks involved in in the beginning

but um it i think it came out it turned out
fine and then um around remote ventilator

monitoring we did a bigger you know bigger
usability assessment with nurses and physicians

and you know i think we use sus and tam so
you're kind of real human factor z kind of

assessment a classic right so that was fun
the last thing i talk about and this involved

both me as a human factors professional and
then just me as a you know a black woman who's

very uh vocal about equity was around um you
know just trying to stay on the hospital about

you know being equitable on how we were doing
covid um testing and vaccination right because

we saw a drive through testing sites and you
know some people are going to be left out

right you know people who don't have access
to vehicles i don't i don't know if they were

allowing ubers to drive through drive through
and get those i don't know if you would want

to take an uber to get your covet test um
and then the rollout was mostly through a

virtual platform right so now we're losing
people who you know are not as comfortable

using um technology or who don't have access
to technology or the wi-fi and so you know

we're you know those disparities came out
pretty quickly and then we essentially kind

of did the same thing with vaccinations um
fortunately i think you know we quickly opened

up like a call center um that that you know
supported people being able to um schedule

their vaccinations without having to go through
the virtual visit website um you know which

isn't difficult but is you know is harder
than picking up the phone and calling it and

i want to say we dab spanish spanish-speaking
options for our call center which would also

support equities so those were kind of the
major coven projects that i worked on it's

a good number a good variety there um with
the work that you did early on with testing

and then some of the um issues you know impacting
equity and equal access to the testing did

any lessons learned from there directly go
into considerations for the vaccine rollout

um i can't i can't speak to that 100 right
um you know i can only speak to what i've

seen and so i found it disappointing that
knowing what we knew that that the rollout

still initially offered via virtual platform
right um you know but it's possible it was

you know that was just the easiest way to
do it until the call center could be up and

running but you know we knew we were getting
vaccinations so that that could have been

a little more pro proactive um and then i
think you know the musc black faculty were

the group that i think really um try to um
think about potential hesitancy and concerns

around the vaccination pretty early um i will
say you know our uh i think i think her role

as chief quality officer did have conversations
that that were mostly focused on um hospital

staff around vaccination um to answer any
questions and concerns um but in terms of

community outreach uh we weren't necessarily
ahead of the game and i think the musc black

faculty really took that on hit you know head-on
in terms of being vocal with the hospital

but also reaching out to the community um
you know one of our one of our public health

um uh she's an endowed chair um in public
health you know she actually spoke to my community

group i asked her to come and speak to my
community group um to discuss their concerns

regarding the vaccines um so yeah it's possible
that lessons were learned and that just for

reasons of you know uh ease or simplification
they had to do some of the same things um

drive drive-through vaccinations as well as
virtual roll-out um but they did that and

those disparities once again kind of you know
revealed themselves and so you know efforts

were then kind of made to close the gap but
um i think it could have been it could have

been more proactive gotcha and it's you know
it's definitely a good lesson learned i think

for the human factors community out wide of
you know really making sure that we're considering

all of our end users you know regardless of
uh the variety and you know even if sometimes

that means what we're putting forth makes
it more difficult for us to put it forth um

it's you know ultimately making sure that
you know we're meeting users where they're

at and meeting their needs so it's a good
lesson learn i think for all of us yeah i

agree um and uh yeah i think sometimes there's
we can we can be hesitant to bring up you

know particularly issues of equity you know
we're not the we're not the most well-versed

you know in in those issues but um like i
mentioned in my talk you know because of in

particularly for those folks who are embedded
because of the access we have you know we're

going to be in meetings about you know patient
safety and some of these other hospital related

challenges that you know our colleagues in
public health who are a little bit more um

informed on these equity issues are not um
and so i think being willing to just bring

them up um is important right um and to your
point um you know we just because they're

they are user groups you know thy user is
one of the you know the biggest kind of um

principles of you know design and so being
able to say hey have we thought about you

know folks who might have challenges accessing
you know drive-through sites or you know have

we thought about folks who don't speak english
just being able to just raise those points

um i think is important and it would be valuable 
absolutely um so i mean a lot of great considerations

sounds like you were involved in you know
such important work um through the hospital

as a human factor specialist both in terms
of you know just getting people from point

a to point b but then also raising these issues
of equity and some of the larger scale issues

that you know some of the rollouts may have
implications for out of curiosity you know

how did you get involved um with all these
different projects as you know human factors

you know a professional yeah it was it was
different people really so you know with the

covet icu boot camp that was really our department
chair kind of emailed both ken and i early

and said hey doing this thing i think y'all
can add value so i you know i would like y'all

to be involved um most of the work came through
our patient safety team we work very closely

with them and i think them more than any other
groups in the hospital i think understand

and recognize the value we can bring to some
of these different projects even if it's just

a hey what do you think they're willing to
kind of you know shoot us an email and or

ask us to sit in on a meeting um our informatics
team we worked with more on a research kind

of kind of uh it's more than a research partnership 
and so you know they kind of understood that

we would it would make sense to leverage us
for usability testing um and the equity stuff

stems from you know my role on muscl's black
faculty as well as um some great work being

done by our patient and family centered care
steering committee which i was asked to join

um sometime last year that's awesome it sounds
you know the theme that i hear a lot of times

is it's really you know built on these relationships 
either relationships that um you know the

human factors team has with other teams or
it sounds like in some of your situations

the personal relationships just you know based
on the groups that you are a part of um and

how you know those relationships really turned
into something powerful when this global pandemic

hit out um or you know hit everywhere and
if they you know already had that relationship

and knew to turn to you know that ken and
you um as a human factors team yeah i would

i would agree with that you know when i discussed
one of one of my lessons learned from the

panel at the healthcare symposium um that
was one of the things that was that was clear

like you know when something happens you know
having those relationship in places already

in place helps right um you know be i just
because i think there are other projects we

could have you know the that huge adoption
of telehealth i think we could have really

added you know value there but we hadn't worked
you know with our telehealth folks before

and so that kind of that rapport wasn't already
there and so you know something happens they're

not necessarily going to reach out to us immediately 
um in the where patient safety team would

and so start you know starting to show your
value and build those connections before something

like this happens where um you want to be
involved i think is helpful i will say you

know listening to the panel with other embedded
human factors folks you know they had different

experiences where were you know there were
certain people who were more willing to kind

of pull them in and say yeah we're gonna you
know we're gonna use our human factors team

on this project versus um you know us kind
of depending on some of our personal relationships

so i guess it differs based on you know your
level of integration in the hospital as well

as kind of your champions um in in the hospital
but yeah i think and i think in general having

those relationships already established um
lead to better results in terms of people

really pulling you into projects where you
can add value that's such a great i think

tip for our audience you know all the aspiring
human factors uh folks who are out there um

you know really you know the relationship
aspect is so important because human factors

does not work in a bubble you know that's
something that i've experienced in my work

and it sounds like it's something that you're
experiencing but um it's really built on those

relationships you know across the team across 
disciplines um and then you know those relationships

will ultimately feed it back in them pulling
you into opportunities and um you know various

work based on that so it's such a good point
yeah i mean you know some people don't know

who we are or what we do and you know we've
talked about how it can be a little challenging

to easily demonstrate like you know your value
your roi um but when you do you'll have those

repeat customers absolutely so as you know
someone who is embedded in the hospital are

you out of the covid related projects are
you still working with things related to covid

how is your role looking like now i would
say at this point we're not as involved in

the covet related projects you know Charleston 
um fortunately wasn't hit as hard as we anticipated

you know we had had one period i think probably
in July where the icu's were filled where

you know we were we were reaching out to our
tech schools and saying hey do you have nurses

who are almost done like you know we're dealing
with shortages and such so we had a you know

a period in the summer where it got where
it got rough but once that subsided um you

know it's kind of been business as usual um
and so you know we haven't we haven't had

much covered related work um fortunately so
you can focus on some of the projects that

you talked about in the beginning yes you
know starting to really ramp up on uh you

know my maternal my maternal care research
since uh you know that's a pending funding

right now well i will keep my fingers crossed
for you on that regard thank you um but Myrtede

this has been so awesome having you on the
show and talking about your experiences um

if our listeners have questions or want more
information about any of the research that

you're doing where can they find you where
can they find more information uh easiest

contact is probably LinkedIn um you know search
up Myrtede Alfred i promise you there is not

another Myrtede Alfred in this world you will
you will find me uh assuming you spell my

name right um i'm on twitter but i'm not super
active on twitter and um you know I’ll provide

at least with my with my email address so
you can you can hit me up via email as well

perfect and we will have all those links ready
for everyone in the show notes so that is

awesome uh thank you so much for coming on
the show today really appreciate you taking

the time out of your busy schedule uh to come
chat with us you're welcome thank you for

having me absolutely so before i wrap up completely 
we always end the show with the classic it

depends because as you know in human factors
that is you know my stakeholders know that

that is usually the answer that i will give
them if they have a question for me so i'm

gonna do a countdown and then we'll say it
together and then wrap it up does that sound

okay yeah perfect all right on the count of
three one two three it depends thank you