1 A primer on the user-centred design of work procedures to improve healthcare performance

Background Inadequate design of work procedures such as clinical protocols or checklists (or failure to adhere to them) is often cited as a significant contributory factor in patient safety incidents. Evidence indicates that this results from limited understanding by frontline healthcare teams on how to design, develop and implement procedures that are usable by all stakeholders. These weaknesses have been exacerbated by the Covid-19 pandemic which by necessity has witnessed a proliferation of procedures as staff adapted to new working conditions, environments and expanded job roles to improve the safety of care systems and human wellbeing. Objectives This study describes a rapidly convened project involving multiple organisations to bring together teams of experts to co-develop practical guidance on the user-centred design of work procedures by and for health and social care teams. Methods Over a 3-week period in April 2020, 66 international clinicians, managers, medical scientists, improvement advisors and human factors experts routinely met virtually online to identify and agree on basic guiding principles to inform the user-centred design of work procedures. Pragmatic consensus building based on a modified-Delphi approach was used. Results Ten key guidance steps were identified and agreed upon to assist health and social care teams in how to design work procedures that were usable, safe and effective e.g., involve the whole team; identify the hazards; capture work-as-done; make it easy to follow; and keep it under review (figure 1). Conclusions For a work procedure to be fully accepted and used, the relevant care team should be involved from the start and throughout the design and implementation process. The developed guidance outlines practical pointers for all care teams in any setting worldwide that are conducive to good design practice in this area.