Applying Human Factors/Ergonomics to support change in healthcare - An innovative co-designed approach to conducting antibiotic allergy de-labelling in the intensive care unit

Implementing change in complex healthcare systems is inherently difficult, with most change initiatives failing. Human Factors/Ergonomics can support change processes through better understanding of the current system and designing and implementing new improved ways of working. One in four patients have a documented antibiotic allergy. Inaccurate and unverified antibiotic allergy labels have a negative impact on patient outcomes. The authors have been involved in the successful introduction of a new approach to allergy de-labelling in the intensive care unit. The primary objective of this study was to outline how this change was supported by applying Human Factors/Ergonomics to the change process. The Cube socio-technical systems analysis was used to understand and support this complex change across four domains of culture, system functioning, action and sensemaking and across a change cycle of understanding the current 'as is' problem; co-designing the 'to be' solution; planning and preparing to change; implementing and embedding the change. Over the course of the study 85 patients with either a reported non-immune or low risk antibiotic allergy were successfully de-labelled. This study exemplifies Human Factors/Ergonomics in action and has shown that taking a structured approach to change, that aims to understand and alter different system components, can achieve results.