This chapter explores the perceived barriers to the use of research for human factors and ergonomics (HF/E) professionals, examines the implications of the research-practice gap for HF/E as a profession and discipline, and suggests ways to strengthen the value of HF/E research into practice. Barriers for practitioners to actively apply research evidence in their everyday work relate to access and time for research, relevance of research, and organisational pressures. Barriers for researchers to conduct and apply research relate to access to operational settings that allow research to be implemented, lack of appreciation of the usefulness of research, and translation of research findings into practice. However, the development of the discipline needs research and practice to be integrated. Suggestions from practitioners to overcome these barriers include: forming partnerships; networking; reading, applying, and publishing more research; and promoting the need for HF/E research in organisations. The effectiveness of any efforts to improve the application of research into practice will depend on the motivation of both researchers and practitioners.
“Clearly, there is a pervasive view within the field of HF/E that a research-practice gap exists and practitioners and researchers have somewhat different views about the reasons for the gap.”
“The drift into silos must not be accepted as normal. It threatens the mutuality of research and practice, and thus the integrity of the discipline and profession of HF/E.”
“To a large extent the origins of the problem of relevance have been laid at the door of researchers. Meister (1999), who has had the most to say on this topic, argued that psychology’s control over many HF/E concepts has led to a disconnect between research (primarily human-centred) and application (primarily equipment-centred).”
“Evidence from the healthcare, and industrial, work and organisational psychology literature suggests that practitioner involvement in the research process makes practitioners more likely to find the research useful and implement it, and other academics are more likely to cite the work.”
“Continuing to develop both theory-driven and practice-driven underpinnings, with a dynamic interplay between science, craft, and engineering, will increase appreciation of the contribution of HF/E to system performance and human wellbeing.”
Reflection by Ken Catchpole
Many HF/E practitioners coming into healthcare will be unprepared for the focus on patient outcomes and the need to legitimize what they do as evidence-based practice, based serious science. There are no randomized-controlled trials of HF/E. Many inroads have been made, but there is much to do.
In healthcare, research is highly valued as a way to demonstrate the need for change. Indeed, it is the way in which large-scale changes in healthcare are made. Doctors trust science if they can see ‘p-values’. There is a growing and justifiably important emphasis on evidence-based medicine. In the eyes o clinicians this is the only way to distinguish between quackery or evangelism and genuine progress. Empiricism is also a fundamentally important method for making financial judgements about trade-offs between prevention, cure and palliation – and thus to create the financial need for HF/E. Thus, research – and demonstrating the benefits of HF/E, at a population level (or at least the level of patient outcomes) is vitally needed. Ethically, it is our duty to generate this evidence. Every $ spent on HF/E is a dollar that cannot be spent on treating patients. So we’d better make sure we justify that. This is not a game.
Thus, any career or work healthcare HF/E should be accompanied with an approach to some type of publication. Publishing in clinical journals is a great way to get the HF/E message out there, to spread good practice, and to leigitimize the discipline in the eyes of clinicians. However, there will be little room for theorietical meanderings. Even discussing situational awareness may seem like jargon to a healthcare audience. Furthermore, the uncertainty and complexity of healthcare is far greater, I would argue, than most contexts.
Surgeons started to treat me more seriously after publishing about OR teamwork in Annals of Surgery; and in doing so I learnt much about how to communicate to a healthcare audience in a language they would understand. However, for a ‘classic’ academic career, it would not be advisable to take this path. It is relatively easy to apply HF/E techniques to describe a problem, or develop a new model. It is a far far greater challenge to develop an intervention, implement it, measure a change, and get such a study published – but it is what we need to do to be taken seriously in healthcare.
My motivation comes not from the desire to have an academic career, but from a desire to reduce accidents in surgery. Quickly, I realized that much resistance would come from a ‘lack of evidence’ about the suggested practices (such as the value of teamwork or user-centered design for patient outcomes). Thus, research, published in clinical journals (NOT HF/E journals) became the way to generate evidence AND to spread good ideas that would yield the systems changes needed for safer care. The healthcare audience is not interested in theoretical models; they are focused on improving outcomes. Thus, my focus also became on testing HF/E interventions empirically. I also realized that this required me to immerse myself in the challenges of heathcare systems and base myself at hospitals. I have gained much, and my research and practice has benefitted enormously, from just being able to turn up in an operating room, or and ICU, or a patient safety meeting, and start talking about and practicing HF/E. Working on a by-project basis from a university where I could only make planned & chaperoned visits to hospitals, would have provided a huge barrier to success. Taking a difficult path – as a sole HF/E practitioner in a sea of clinicians – has given me the workplace laboratory to practice and research HF/E, even if it has not given me the collegiality or the security of an academic or practice environment.