Interview with Rebecca Butler | #HCS2021Symposium | Bonus Episode

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hi everyone I’m your guest host today Elyse Hallett and I am joined today with Rebecca Butler from MedStar health hi Rebecca hello how's it going good it's nice to be here today thanks for having me having me absolutely really happy to have you on the show so for folks listening in uh you might you know recognize my voice from past uh conferences that I’ve covered uh for the human factors cast um I’m here instead of Nick today um actually interviewing Rebecca who I saw um one of your panels at the past human factors um healthcare symposium uh that took place virtually this year so that was a really awesome experience but through that just you know got to learn a little bit about uh the stuff that Rebecca does and you know thought that having you on the show and talking a little bit about what you do as a human factor specialist in the healthcare field um would be you know an awesome opportunity for you know our listeners to you know learn a little bit more about that great yeah happy to talk about it it's a fun work so it's always fun to share with others well and exciting times right yeah especially this past year has been unlike any other absolutely um but before we get into all that I wanted to start a little bit before your current position at MedStar health um so how did you get involved in human factors initially and what was your background that ultimately led you to the position that you're at now at MedStar health yeah so I i'm in undergrad I studied industrial and systems engineering at Virginia tech go hokies um and one of our classes was the intro to human factors class um that was hands down my favorite class um of all four years and so when i first graduated I worked in a different field for a few years and just kept coming back to the fact that I that's the class that really made me happy that I really liked doing that work and so just looking for a new career path uh google led me to MedStar’s national center for human factors in healthcare and I was able to start there as a usability assistant on their usability services team so um I really got to do hands-on human factors work for the first time with working with manufacturers of medical devices doing the pre-market formative and validation usability testing and in my role there I was able to because we're built in we're part of a hospital system at the human factors center I was able to work with on patient safety event reviews particularly um safety events that involved medical devices and so because of the specializing in usability of the devices we'd get involved in those events event reviews and I found that i really liked patient safety I really liked working on the hospital side um internal to our system and was while I was at the human factor center I was able to get my master's in human factors and then a little over a year ago a full-time position on the quality and safety team at MedStar health opened up and um they have a real desire to really integrate human factors throughout our healthcare system and so I was given the opportunity to join the team and that's where I am now that's awesome and what a cool perspective that your background in you know industrial engineering must bring to you know the field as well yeah it's interesting to have that my undergrads in engineering and my master's is in psychology so it's interesting to have the two sides of human factors um collide so I love it that's awesome well it's definitely a multi-disciplinary field for sure yeah and so then the you know so you mentioned that you work at MedStar health now um under the quality and safety team did I get that right yeah that's correct so can you explain a little bit about what this team is the kind of stuff that you do and really how you as a human factor specialist fit into all of it yeah and so the quality and safety team oversees quality and safety for the whole MedStar health system but our each hospital and our ambulatory service lines they have their own local quality and safety teams and so we see our role um at the system level as really a service organization to those to the hospitals to those teams and we help coordinate improvement efforts that cross multiple hospitals across the whole system and so kind of coordinating the work that all those smaller teams are doing and then I sit uh in particular on the safety team and I help do systems-based event reviews so if there's patient safety event um going out and looking at it from a systems perspective and teaching people how to do that and teaching people at the local level how to do that and then bringing a human factors lens to the uh the solution development piece of it so helping uh create solutions that are more than just retraining people or creating new policies but that actually address those gaps that we have in the system to prevent the safety events from happening in the future and then I mean a growing role uh for working more with our proactive approach to patient safety as well so identifying our hazards and risks before they uh before they reach patients and before they cause any harm identifying those near-misses and coming up with solutions and ways we can we can proactively fix those and remove them from the system that sounds so interesting and it sounds like you're really integrated into you know this larger system as a whole as opposed to being you know some afterthought check in the box later on yeah it's um it's an it's a very I realize i'm very fortunate to be in in MedStar health the way that um we've championed by terry Fairbanks certainly like um just the integration of human factors throughout the system it's nice to be in a place where it's not um I don't usually it's not like people have never heard of human factors uh we certainly some teaching when you when we come into a new place with a new team that maybe hasn't worked with us before but um definitely a unique and great place to be as a human factor specialist that's yeah it's it sounds really awesome um and you mentioned a couple times this concept of uh safety events could you elaborate for the audience of you know what this means and you know maybe an example sure so um I mean a safety event would when I when i say that what I mean is um anytime there's uh what we actually what we look into is anytime there's an unanticipated outcome and so something for that happens something happens to a patient that we didn't anticipate so outside of the normal complications of just whatever their condition might be and they're well we review those to figure out where were there deviations from what we would say the expected standard of care is where there deviations in um in the whatever the work whatever we were doing to treat that patient um did was there something that we could have prevented was the harm that occurred to that patient something we could have prevented and so by reviewing the event um we're looking at the environment the uh the electronic health record was there anything there were usability issues that caused somebody to prescribe the wrong medication to a patient or deliver a medication the wrong route or misdiagnosis all those types of things was there were there things in the system that um made it hard to do the right thing and how can we fix the system to make it easy to do the right thing to prevent those patient safety events where there's unanticipated harm gotcha that makes a lot of sense and really taking that system's perspective and applying it to the analysis of these particular events

so before kova 19 broke out as a global pandemic and I’m sure changed a lot of what you do in you know the healthcare field specifically what did your day-to-day look like as a human factor specialist what types of projects or work were you involved in so i had just recently joined the quality and safety team full time only about a month or two before the pandemic hit oh wow I was still sort of getting uh getting into what my normal day-to-day would look like and a little bit of transition out of my role on the usability services team so I was wrapping up some of those final validation studies so those final usability studies before a product gets approved by the FDA for our manufacturers and then moving into my role with the safety team where my day-to-day was um reviewing event reviews so obviously with a large system we have 10 hospitals we have um 200 ambulatory sites and like I said we have those local teams that are doing event reviews and one of my a lot of my day to day would be assisting with those event reviews where uh necessary particularly ones that might require a human factors lens and then um also reviewing event reviews and actions that other teams have created and come up with and then giving input um and making sure that if there's an action or a problem that's been identified at one hospital um figuring out is that something that we need to make sure all the other hospitals also know about and figuring out the best way to communicate that across the larger system so that's uh what my day-to-day weight was pretty pandemic and when you so you mentioned you know providing that human factors lens what were some of the other types of specialties that you were working with and other specialties like on the event reviews

so i don't have a clinical background and so that I always want to make sure that there are those clinical perspectives in any of these event reviews because I can't speak to um I can't really speak to standard of care or how things should or shouldn't be done or how they're typically done um from that clinical perspective so um there's the there's always working with you know the nursing or whatever specialty it was that that event review um event review took place in I’m working with the information services people that set up the EHR figuring out what we can and can't do within our electronic health record and the product we use uh so definitely interdisciplinary there working with all those teams to review an event um because one perspective you never really paint the whole picture absolutely that makes a lot of sense um and then you know covet 19 breaks out you know you're there for you said about a month how did that change your position the kind of things you were working on what you were doing yeah so uh pretty much our whole team shifted to uh being my whole team i say quality and safety and shifted to be really all hands on deck in the pandemic response um the our leaders sort of oversaw the system's response to coven 19 and so our day-to-day um really shifted to helping people figure out like okay what what's confusing what can we help with uh at the beginning it was very much not a specific ask but we could see that there were uh there was confusion going on and so us more asking like where can we help um we the infection prevention uh is managed at the system level within the quality and safety team as well at MedStar and so seeing our colleagues just get inundated with questions and uh confusion that was going on across the system of people just not knowing what PPE who am i supposed to test how do we manage our patients coming in how do we screen them and so we could see that that they were getting all these questions and all of this is a lot of work for those uh that that team to take on and so we sort of just stepped in and heard what concerns they were hearing what challenges people were having and um tried to figure out was there any way that we could help from the human factors perspective and that's how we that's how we got to the graphics creation that i talked about in my talk at HFES that's where the majority of my time was spent was in developing graphics and documents and workflows um for frontline to use to understand the new policies and procedures yeah and that's a perfect segue into um diving into some of those things so you mentioned um you know the team just getting inundated with all these questions and um one of the challenges that your talk focused on specifically was this this element of communication specifically how do you provide this information to people in a way that is both usable and still um supports the like rapidly changing information um to ensure that they're like trusting that information they know that it's the latest and greatest but we're not overwhelming people um and so you mentioned a couple you know um example products of you know how you got involved can you elaborate a little bit more on um what some of those you know were and some of the strategies you took to um you know help ensure that you know people are getting that that rapidly changing information but in a more usable way yeah sure so um the uh the ppe graphic is one that um one that i shared in the talk and that at the beginning you know that was one of the biggest things that was a change and new and we had um ppe that you just had to wear in different situations needed different ppe and um i had shared on the talk that we initially this was all written down and in a large text document and that had all the information people needed but um we knew that they needed a way to actually be able to look at this and digest it and so um the graphics seemed like a way that that would could communicate to it could communicate multiple situations so we had there's rows for uh all the different situations that people might have and then um including not just text but pictures um and we were able to uh sort of roll that out fairly quickly in the first week or two and then certainly iterate on it as things changed and as we got feedback of things that were still confusing and so that's one of those examples of how we just where we saw that there was a need and we knew that the visual portrayal of that information and organizing it in a chart format it was just easier to digest for people and i loved one of the examples that you had in there of um you didn't just include you know a you know basic picture of say a hospital gown but really like using the different types of hospital gowns across the hospitals knowing that you did support a network of hospitals not just one and making sure that you were representing things um very much in line with how people were used to seeing that in the real world yeah and that was one of those things that we honestly didn't think about at first it was through user feedback that we were able to make that change because um we were just thinking the gown we just need a picture of a gown and there was a lot of fear around the wanting to make sure you're wearing the right ppe at the beginning and so uh people when we had a picture of a blue gown and people were receiving yellow gowns when they got to work they there were just a lot of questions about but this isn't is this the right thing is this what i'm supposed to be wearing is this safe am i actually going to be protected and so in order to build that trust in the documents that we were sharing we had to make sure that we were including what people were actually seeing and actually receiving so that they knew that yes these are equivalent yes they're the same they're both equally safe and both equally correct for you to be able to wear in these situations and i love that you touch on incorporating the user feedback um how did you get user feedback because you know your setting is a little different than someone like you know by background in consulting where i'm setting up you know the whole usability test and bringing in people what's that look like for you so i will say you know particularly with my background coming from the usability services team where that is what we did where we had the full like a week-long user testing and we're setting up scenarios and asking people pointed questions and being able to really iterate um it wasn't like that for the pandemic for sure and so um we didn't we didn't get to do that we didn't get to do uh direct uh user feedback and change those things before we rolled things out and so one of the um one of the teams that we really relied on and used um used a lot was our group of infection preventionists um at the hospital so um all of our 10 hospitals have an infection preventionist and um that their leaders at the system level had a daily call and so we knew that they were going to be on a call an hour every single day at the beginning of the pandemic and so we went to that meeting a lot and would share our graphics um share changes we were making to things and new documents that we were putting together and got feedback from them and we were also able to hear what they were hearing uh because they were you know they were there they were at the front line they were with their staff in the hospital and they were hearing points of confusion and were able to bring those back to us so not as direct user feedback as you may typically want or design a usability study and to have but a group that was certainly invaluable to providing us that that iterative feedback and a great resource that the documents would not have been the way they were without the feedback from that group that's awesome yeah i kind of equate to you know your work is like human factors in the wild you know you're right in the thick of it and you know we go to school and learn the proper methods and then we go out into the wild and you know have to make accommodations but it sounds like the accommodations that you made were you know right exactly where you needed to be given all the like rapidly changing information and um just you know getting people something that's usable that's incorporating some of those challenges yeah and i think uh you know if you're designing something and doing usability testing before you actually roll it out for the first time you're i ideally finding those points of confusion before anybody is trying to use it in the wild uh but when we during the past year of things changing so quickly it was more like okay we think this is this is good enough it's accurate that was really the most important thing was to make sure that the information we were sending out was accurate and then if it still had some usability issues we knew we could get to that later but we'd roll it out people would try to use it in the real world then we'd hear feedback then we'd change and send out a new iteration and they'd do it again and it was more it was cyclical like that but um but we had to actually roll it out so people were using it using it in real life and that's how we would get our feedback which um you know in an ideal world you would figure those things out before you send it out send people to use it um in the real world but right but the real world can be messy and i love how you broke down that you know the different levels like what are you gonna prioritize for this iteration like okay we'll get we'll get to some of the usability things later is it accurate first and i think that's a really good perspective to take when you're trying to figure out how to get this information to people quickly but you know also in a useful manner as well that's great um one of the critical lessons learned that you and your co-presenter had shared was the importance of interdisciplinary collaboration and you've kind of been touching on this a little bit through our discussion today but can you elaborate on what that means and ultimately how you achieved it through um your work supporting um you know the pandemic sure so and by interdisciplinary collaboration what i mean is that um what I’ve what i've said is that i we couldn't have created those documents um on our own like i don't have a background in infection prevention i don't have that clinical specialty and that was that was obviously imperative to the documents that we were creating so as far as document creation we had to um we had to incorporate all the people that actually had that subject matter expert expertise and then as far as rolling the information out to everybody and we that really required close collaboration with the communications team which is not a not a place where human factors has really had to overlap uh we haven't seen a huge need for that in the past so that was a new a new partnership that we were able to build there um but early on uh it with the document creation it wasn't always clear who owned what documents um and local teams were creating resources for their teams and then different specialty lines were creating new processes for their groups and then uh we but we really needed to have a cohesive voice across our system and so what we realized we needed to do was establish a point of contact who is the who owns the nursing documents who owns the ppe documents who owns the clinical new clinical protocols and once we had those clearly defined and the and became a lot easier so my colleague lucy stein she really is the one that uh she took on that creating the website that we had and that we shared a little bit about in our talk and maintaining it on a day-to-day basis as things changed and at the beginning she could get five or six different people emailing her saying hey here's new documents to go on to the website and after we were after we changed and pivoted to having this person can say these are good this person says these are good it was much more streamlined and the document quality went up they were more consistent that way um having more streamlined uh review processes creation processes and then um having one person being able to post them and then know that we're working with communications to be able to send them out at the same time that they're posted on the website so that people are able to access the correct information in the multiple places that we have it posted how many human backers people do you are on your team so uh well i we i'm definitely not an n of one at medstar so that's really helpful um on the work that we shared um in our talk i would say that there are lucy and i are you know the trained and human factors but i would say our whole team really has human factors expertise just based on all the work that we've done and then the human factors center that medstar has uh has 50 or 60 employees that are all specializing in human factors and lucy actually plays a an interesting role where she gets 50 um with the human factor center and 50 of her time with quality and safety so we have that nice bridge from all of the great expertise we have at our human factors center that gets to cross over into the quality and safety team gotcha yeah the reason why i ask is because it sounds like you were involved in so many you know kind of facets of this communication strategy and i can imagine you know just you know human factors alone cannot solve this but really relying on that that expertise and the input from so many different perspectives sounds like it was really one of the big things that you know made this such a great success story yeah i would agree just the collaboration um and people knowing that knowing each other's expertise i think is uh knowing and then deferring to each other's expertise is really beneficial and imperative in getting making this work successful i think um because knowing what you what knowing what you know and knowing what you don't know is really important so you can go to somebody who um who is uh special specializes in that area and you can make sure that you have their input in whatever it is you're working on absolutely okay so now that kova 19 is starting i wouldn't say it's over we're not you know quite out of it yet but maybe more manageable where would you say your focus is now so me personally i've been able to shift most of my work back to that the pre pandemic focus so uh really being able to get more involved in patient safety event reviews working on our proactive approach um proactive solutions to safety hazards that we have and i consult occasionally on new graphics that we create but we really don't have that um that pressing need for constantly creating new material and what we've been able to do is um get those initial graphics that we created to a point where the subject matter expert is able to update those um as needed so the ppe graphics are our infection preventionists can tweak on their own without um they don't need to cut they don't have to come to us every time because it's at a point where they're able to manage those now um but for our team as a whole i'd say quality and safety and uh my pro presenter and catherine is just really leading this making sure that we incorporate the lasting impacts of what we've learned and what we've started um Covid into our routine work moving forward so things like um there's a new quality metric that includes coven numbers and uh we have built this i was not in this so i won't say we but my team you know built up a contact tracing program and that's really now an integrated part of our infection prevention program and then the human factors team so um lucy and the human factors center they have been um really heavily involved in the vaccine rollout and so some of the communications pieces that that she worked on in the beginning of the pandemic's been able to take over to that vaccine rollout piece and they've developed communication tools for frontline associates to be able to communicate information to patients coming up with creative ways to reach more the vulnerable populations where emails and texts about the vaccine just don't reach those patients and then they've also been consulted on workflow and signage and logistics for a large-scale vaccine um site that medstar is running in partnership with some other healthcare systems in the area so the work that we did at the beginning um i think has set us up to see the value of including human factors expertise in in all this work and that's really um i mean all the stuff that the human factor center is doing with the vaccine roll out that really shows that people value that at medstar which is um which is great for us we want to want to be able to bring our human factors knowledge too to all these um all that where all the areas that we can we can help in um but yeah so for the most part i'm back to my pre-pandemic role but um pandemic like you said is not over so there's other initiatives still ongoing that's fantastic um you know and i love what you said you know the work that you did early on really sets the precedence moving forward and um really getting human factors you know continually showing our value and integrating in the process this um has been such a great i think success story because of all the implications that the pandemic has for you know interesting human factors problems you know everything you study about so um Rebecca thank you so much for coming on the podcast today and thank you for having everyone um where can our listeners find you if they you know want more information um definitely find me on LinkedIn and look at my name i know I’ll share the link with you all so you can go there directly but happy to connect with anybody who's interested perfect thank you so much um we always end the podcast with the classic it depends because you know human factors it depends so uh if you wouldn't mind me joining as we conclude um I’ll count off the three and then we can say it to ten so okay one two three it depends thank you so much thank you

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