modification requirements, to identify manua l
systems interface problems and to understan d
TO THE MOUNTAIN . . . .A PRACTITIONER'S VIEW
OF THE GAITHERSBURG CONFERENC E
I went to the Human Factors conference i n
Gaithersburg hoping to learn from the experts .
And there were experts, knee deep and crowde d
into the maze that was the Bureau of Standards .
The papers and, presumably the research tha t
preceded them, were thorough and thoughtful .
For me, there wasn't much help, however . Th e
papers were too narrow, the topics in a given
session too diverse, for a beginner to learn
much . There was almost no "situating" of th e
research--the stuff that's put in proposals t o
lead interdisciplinary referee groups t o
understand the significance of a project . I ha d
a lot of trouble judging the importance o f
results being presented and I had hoped that th e
presentations would lead me to some conclusion s
(the cherished dream of all neophytes) . Th e
conference, I decided, was clearly not fo r
people with an operational orientation . Ther e
were a few practical and helpfu l
exceptions--Maguire's presentation on the Publi c
Information System, Hendricks' Darcom study and
Sauter, Gottlieb and Jones on VDT operato r
stress .
My experience as an " outside r " should be kept i n
perspective as just that . I have no reason t o
believe that the conference does not meet the
needs of the initiate . However, as a human, let
me suggest that next year's sessions pay mor e
attention to temperature and crowding . Perhaps
each program session could explore a single are a
of human factors so that interaction b y
presenters could be more useful . Above all ,
some in-place stretch breaks and some actio n
(surveys, workshop exercises, etc .) for th e
audience might relieve physical and intellectua l
stress during long sessions .
And the Reason I Went . . .
Northwestern Memorial Hospital, a 950-bed acut e
care teaching hospital in Chicago, is installin g
a medical information and communication system
that will change the way all patient car e
services are recorded and charges are generated .
Customarily, in the planning for such systems
modification and installation, hospitals conduc t
a procedural analysis of their current manua l
systems . This is done in order to clarify
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training requirements for the new systems .
Because of the expected impact of a
hospital-wide change in methods of charging, w e
at Northwestern Memorial selected an aggressiv e
analytic approach--one that combined procedura l
and functional analysis with an analysis of th e
present and future impacts of the human factor s
in our charging system .
This effort was designed and is bein g
coordinated by a small, internal consultin g
group--the Department of Program Analysis ,
although the work groups are composed of member s
of several departments : data processing ,
internal audit, office systems, financia l
services . The work of the study has bee n
divided into the following tasks :
Analysis of current charging methods .
Documentation of methods possible unde r
the new computerized system .
Development of criteria for judgin g
effectiveness of charging methods .
Recommendation of a uniform method o f
charging for use throughout th e
hospital .
The first task group is conducting a complet e
procedural analysis of all revenue generating
cost centers in the hospital as well as nursin g
units and other patient care areas where order s
originate . Using management engineerin g
techniques, standardized interviews ar e
conducted, narrative procedures are written an d
each ordering and charging method is
flowcharted . All forms and prompting or codin g
sheets are included in this documentation .
Additional instructional materials and/o r
procedure manuals are identified .
The second task group is documenting th e
characteristics of all of the charging method s
that can be implemented under th e
software/communication system purchased by th e
hospital . This involves clarifying limitation s
internal to the system design as well as variou s
technical opportunities for human factor s
enhancements in the interface elements of th e
system . This information will be helpful i n
identifying realistic options for improvements .
It is possible, for example, that having severa l
routes or access strategies for reaching a n
order entry screen may eliminate frustration fo r
experienced users . Prompting and tutorial erro r
messages may assist in departments where hig h
turnover and/or many casual users can b e
expected .
The third task group has the most conceptuall y
difficult and the most innovative work . Their
challenge is to devise a method of evaluating
both manual and automatic charging method s
according to a set of weighted criteria .
Included in these are charge recovery rates ;
flexibility for accommodating new services ;
labor intensity ; requirements of financia l
control and monitoring ; human interface feature s
(e .g ., learnability, self-reinforcement ,
satisfaction of perceived information needs ,
mnemonic coding, field prompting, reduction o f
duplication) ; and consonance between the bes t
performing manual systems and the possibilitie s
of computerized systems .
The final task of the project team will be t o
recommend a single best manual method fo r
charging for all services . This may includ e
several sub-formats and variations but will rel y
on a uniform general procedure . An
implementation plan will be developed which wil l
detail the changes needed in each cost cente r
(using the narratives and flowcharts as th e
starting points) .
Preparation for computerizing order and charg e
entry throughout the hospital will be achieve d
through a staged process : each is planned t o
lead into the next as smoothly as possible . I t
is our hope that the charging project will fla g
any basic problems in the implementation of a
uniform approach before the computer system ca n
be identified as the villain . We believe that a
well-analyzed human factors approach will assis t
us in managing a major change in the way th e
hospital does its work .
Carron M . Maxwell, Directo r
Department of Program Analysi s
Northwestern Memorial Hospita l
Chicago, Illinois 6061 1

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