title: Safety challenges of medical equipment in nurse anaesthetist training in Haiti.
abstract: Safety challenges related to the use of medical equipment were investigated during the training of nurse anaesthetists in Haiti, using a systems approach to Human Factors and Ergonomics (HFE). The Observable Performance Obstacles tool, based on the Systems Engineering Initiative for Patient Safety (SEIPS) model, was used in combination with exploratory observations during 13 surgical procedures, to identify performance obstacles created by the systemic interrelationships of medical equipment. The identification of performance obstacles is an effective way to study the accumulation of latent factors and risk hazards, and understand its implications in practice and behaviour of healthcare practitioners. In total, 123 performance obstacles were identified, of which the majority was related to environmental and organizational aspects. These findings show how the performance of nurse anaesthetists and their relation to medical equipment is continuously affected by more than user-related aspects. The contribution of systemic performance obstacles and coping strategies to enrich system design interventions and improve healthcare system is highlighted. In addition, methodological challenges of HFE research in low-resource settings related to professional culture and habits, and the potential of community ergonomics as a problem-managing approach are described.
authors.affiliation: Faculty of Industrial Design Engineering, Delft University of Technology, The Netherlands. Electronic address: a.l.rodriguessantos@tudelft.nl.
authors.forename: A L R
authors.initials: AL
authors.lastname: Santos
authors.affiliation: Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, The Netherlands; Faculty of Industrial Design Engineering, Delft University of Technology, The Netherlands. Electronic address: l.s.g.l.wauben@tudelft.nl.
authors.forename: L S G L
authors.initials: LS
authors.lastname: Wauben
authors.affiliation: Médecins Sans Frontières, Brussels, Belgium. Electronic address: seydouba@yahoo.fr.
authors.forename: S
authors.initials: S
authors.lastname: Guilavogui
authors.affiliation: Faculty of Industrial Design Engineering, Delft University of Technology, The Netherlands. Electronic address: J.C.Brezet@tudelft.nl.
authors.forename: J C
authors.initials: JC
authors.lastname: Brezet
authors.affiliation: Faculty of Industrial Design Engineering, Delft University of Technology, The Netherlands; Department of Neuroscience, Erasmus University Medical Center, The Netherlands. Electronic address: R.H.M.Goossens@tudelft.nl.
authors.forename: R
authors.initials: R
authors.lastname: Goossens
authors.affiliation: Médecins Sans Frontières, Brussels, Belgium. Electronic address: peterrosseel@telenet.be.
authors.forename: P M J
authors.initials: PM
authors.lastname: Rosseel
mesh_terms: D000776:Anesthesiology / Q000295:instrumentation* / Q000592:standards*; D003906:Developing Countries; D004869:Equipment Safety / Q000592:standards; D006804:Ergonomics; D006205:Haiti; D006801:Humans; D008328:Man-Machine Systems; D009719:Nurse Anesthetists / Q000193:education; D061214:Patient Safety; D017064:Process Assessment, Health Care; D013647:Task Performance and Analysis
keywords: Human factors and ergonomics; Low-income countries; Medical equipment