Relieving Cognitive Burdens
Optimizing tools and technology for the user's physical needs has long been a concern in the workplace. In addition to increasing safety and comfort, ergonomic design aims to increase efficiency and productivity and reduce error. As technology advances and the cognitive load of work increases, optimizing the workplace for users’ cognitive needs is increasingly important. This is especially true in the medical field, where the needs of service providers, recipients, and institutions must be considered and where avoidable error on any side can cost lives.
Cognitive ergonomics concerns both how work affects the mind and how the mind affects work. For practitioners at all levels, healthcare tasks, including diagnosis, decision-making, communications, management of emotions and expectations, and so forth, impose a high cognitive load. For patients, the management of one’s own care also carries a cognitive load, which may be exacerbated by a patient’s individual circumstances.
A higher cognitive load means a greater chance for errors and inefficiency. In addition, it contributes to employee fatigue and burnout. Incorporating cognitive ergonomics into design reduces the chances for these and other negative outcomes, for patients, practitioners, and institutions alike.
Healthcare’s Cognitive Burden
The cognitive load for healthcare practitioners has several components. In addition to tasks such as the synthesis and interpretation of information, diagnosis, and communications with patients, peers, staff, and insurance companies–as well as learning and operating medical equipment–practitioners must contend with various systemic stressors. These may include the necessity of multitasking, long hours, low staffing, high-stress safety-critical environments, distractions, interruptions, and more. When the cognitive strain becomes too great, the result can be mistakes, inefficiency, and burnout, all of which can create negative outcomes not only for the practitioner but also for the patient and for the institution.
For patients, management of their own care imposes different cognitive burdens. Patients, many of whom have limited or no formal medical knowledge, may need to learn to operate home medical equipment and interpret, or at least accurately report, the results. They may be working within intellectual, physical, and/or financial constraints. The labyrinthine and sometimes conflicting demands of insurers and medical practices can complicate the process at every step, adding further stress and cognitive strain to an already stressful situation.
Systems and equipment designed with cognitive ergonomics in mind can help to lessen the cognitive load for both practitioners and patients, resulting in a lower burnout rate, greater efficiency, and more effective treatment. Investment in cognitive ergonomics can also pay off for medical institutions in terms of employee retention and excellence in service.
Reducing Systemic Cognitive Strain
Several studies have shown that one key to reducing cognitive strain in a healthcare setting involves addressing systemic issues.
A 2018 study found that inadequate staffing, competing priorities, and the necessity of multitasking directly affected the decision-making capacity of critical care nurses when it came to responding to and managing device alarms. Alarm fatigue also added to the nurses’ cognitive strain, affecting their performance in different ways.
A 2023 study identified several systemic interventions that could be undertaken to improve cognitive ergonomics for practitioners. These include restructuring the workflow to minimize distractions, interruptions and the need for multitasking; optimizing the use of the electronic health records, optimizing the use of health information systems, and fostering good communication and teamwork.
Designing with Cognitive Ergonomics in Mind
When it comes to product design, a solid grounding in cognitive ergonomics can go a long way toward making a better product. Attention to the nuances in human psychology can increase attention, response time, and more. And in the healthcare field, as well as in other fields, this can save lives.
In the 1970s, researchers involved in designing the McDonnell-Douglas F/A-18 Hornet found that male pilots (who comprised the majority at that time) reacted more quickly to an alarm in the form of a stern female voice than to flashing lights. It was theorized that the high pitch of the voice was more easily heard over the lower sounds of radio communication. In addition, the psychological association of a stern female voice with a mother figure conveyed an immediacy and importance that flashing lights alone did not.
This example touches on two concerns of cognitive ergonomics: attention and perception. Attention, in particular, is critical in healthcare, as inattention can lead to a variety of errors. Designing products, for example alarms, that grab attention in novel ways can help to reduce alarm fatigue and the tendency to filter out alarms as environmental noise.
As regards perception, the ability to quickly and accurately perceive (and then process) information is paramount. Simple adjustments to displays, such as increased contrast, larger text, and reduced glare, can make it faster and easier to perceive essential data and to respond to it in a timely manner.
Memory is another facet of cognitive ergonomics. Working memory and prospective memory are of particular importance in a healthcare setting.
Working memory refers to active information from the environment, combined with retrieved knowledge, which is used to make decisions in the present. A 2001 study found that a person can reliably hold three to five chunks of information in working memory at any given time. Design that encourages efficiency in working memory can lessen the user’s cognitive load. Some examples include displays, instructions-for-use, and imaging technologies that support side-by-side comparisons so that users don’t have to navigate back and forth between pages or screens, keeping numbers and letters separate on displays and favoring numbers over letters when possible. Prospective memory involves plans for future action. A design that integrates reminders for future actions can help reduce cognitive load.
Devices, equipment, and systems all have a learning curve. Design elements that can reduce the cognitive strain of learning include consistency–for example, color-coding and consistency in labeling–and structures with familiar, real-world analogs, such as the file-and-folder system utilized by a computer desktop.
The Future of Cognitive Ergonomics in Healthcare
Attention to cognitive ergonomics in the design of both systems and products can help to reduce cognitive strain for practitioners and patients alike. This can translate to better care and better outcomes for everyone.