Human-centred design, social justice, & psychological safety: What about the caring professions where self-sacrifice seems part of one’s work mantra?

It is the process of design and the strategies required to embed design-thinking in an organisation that interested me to pursue my PhD thesis, “Good work design: Strategies to embed human-centred design in organisations”[viii]. Aside from the myriad of important physical benefits associated with participative ergonomics (e.g. Burgess-Limerick, 2011)[ix], the opportunities for improved cognitive performance, emotional well-being, sustainability, and organisational resilience were curious to me. It is known that work provides a means to promote health and well-being[x], [xi], [xii]; [xiii], and having a voice in the design of one’s work leads to self-efficacy, engagement, a sense of meaning at work, improved communication, and positive morale[xiv], [xv], [xvi], [xvii]. However, few organisations engage a broad perspective to associate health and well-being with their own organisational drivers – job design and role assignment, leadership, reward, and the underpinning work climate. In fact, when workplace health or wellness programs are ad-hoc, not integrated with business strategy, and adopt only a lifestyle perspective, they do little to address headline causes of absence: e.g. workplace stress and anxiety, mental health overall, critical events resulting in death or disability, and musculoskeletal disorders[xviii]. The premise of Total Worker Health® initiatives are to provide for integrated health hazard protection and promotion of well-being so that the efforts are targeted and strategic[xix]. The concept of work as health, an elixir (or prescription) for health and well-being (when well designed), is novel.

Design that is iterative means that, at times, solutions will be unclear and ill-formed (a work-in-progress) and mistakes may be made: the question, then, is whether organisations have the risk tolerance for delays and iterative design process where unknown benefits may flow without a structured timeline? Will workers feel protected in a climate of adequate psychological safety to present their ideas without fear of ridicule or reprimand if the solutions arising are not immediate, of great effect, and readily achievable? Will the workplace be tolerant of all dimensions of work (work as done, imagined, prescribed, and disclosed, with congruence or lack thereof)[xx] to have a genuine discussion about work design improvement? A gamble, yes, but the evidence strongly supports the association between high-performing organisations and their embrace of diverse thinking and human-centred design strategies (e.g. ISO 27500: 2016: A Human-centred organisation[xxi], or the program success at Rio Tinto Weipa[xxii]).

Self-Sacrifice as Part of One’s Mantra: The Caring Professions

Productivity, health, happiness, and social connectivity are attributes of ideal working conditions. Workers are most satisfied when they experience a sense of control, job security, adequate workload, and a sense of flexibility in their schedule[xxiii]. However, in the caring professions, such as health care or education, self-sacrifice is indicative of the work culture. Workers in these industries are at risk for burn-out, stress, anxiety, poor performance, work dissatisfaction, isolation, and injury or poor health conditions[xxiv], [xxv], [xxvi], [xxvii]. The Australian Work Health and Safety Strategy 2012–2022 has identified the health care and social assistance industry as a priority to reduce the high number and rate of work-related injuries and illnesses. Since 2009 – 10, this industry has the highest number of claims among all Australian industries. The industry comprises ambulatory health care services, hospitals, nursing and residential care facilities, and social services. The health care industry employs 12% of the workforce in Australia yet accounts for 16% of serious workers’ compensation claims for 2014 – 2015. Since 2003, 35 fatalities have been reported. In FY2001 to FY2015, body stressing claims (musculoskeletal disorders) represented more than half (51%) of workers’ compensation claims; slips, trips, and falls accounted for 19% of claims (such as falling over objects in high traffic areas or stair incidents), and mental stress accounted for 8% of the claims[xxviii].

Health care and education represent people-intensive, -centred, and -driven characteristics[xxix]: there is heavy reliance on the use of self as a therapeutic or educational tool for clients or students, the work is physically demanding and busy with constant interruptions while procedures occur at fast-pace (so human movement and cognitive demands are high), and the regulatory framework is intensive and, as such, organisational strategies are mired in layers of compliance-based administrative work. Unanticipated and unexpected events are regular occurrences[xxx], [xxxi]. These features create a complex system from which it is difficult to employ a single intervention that will result in remarkable change. A multi-factorial, systems-based strategy is required to improve human performance in these industries.

Given that collaborative practices are fundamental to participative ergonomics, the very nature of the user (self-sacrificial) and their job demands (time pressures in a dynamic and changing environment) in these industries means that it is a challenge to secure input from subject matter experts[xxxii]: they (and their organisations) need to value themselves, workers, as important and worthy of self-care and they require time and space to contribute to design strategies. The regulatory push, also, is based on patient/client or student care, and less so on worker well-being (although this may be changing, e.g. per the Australian Work Health and Safety Strategy 2012–2022) [xxxiii]. It may be that strategies that achieve dual or multiple outcomes, also focused on end user care (patient/client or student) and the human input driver of this care (teacher, administrator, maintainer, or health care practitioner), will be a popular approach. For example, colonoscopy procedures underpinned by quality training for competency can be enhanced through a human factors approach[xxxiv], with an assumption that improved understanding of cognitive, perceptual, and motor demands of surgeons will enhance competency frameworks and lead to better surgical outcomes, with a more satisfying, less stressful experience for the health care team (less risk for blame for “human error”). Similarly, educational frameworks indicate design development per a human factors and ergonomics approach (in all but name)[xxxv]. A human factors approach to training suggests that mentoring by experienced workers with a “story board” of contextualised incident review enhances the educational experience of new recruits to prepare for real-world work[xxxvi] (and recognises the skill-set and experience of mature workers). Much research has been undertaken in terms of patient care handling: improvements in manual tasks, including patient handling, resulting in improved work health safety for carers but also a likelihood for safe care for patients through improved handling techniques, methods, and equipment[xxxvii]. So, too, early childcare educators are exposed to musculoskeletal disorders arising from the handling of pre-school aged children[xxxviii]. 

Too often, workplaces investigate adverse events and “root causes” laying blame for “human error” as a conclusion to their findings[xxxix]. If we were to adopt a human-centred approach, the terminology would be updated to reflect compassionate understanding and appreciation of a complex work system, e.g. “mishaps and unintended or detrimental consequences of human work (system variability)”[xl]. This framework leads to design strategies to improve a system and recognition that an unintended consequence is the beginning of an investigation, not the conclusive end[xli]. A human factors approach leads to the development of technology to help improve system performance, such as correct administration of medications in a health care setting via mobile, point-of-care systems (e.g. MedLink)[xlii].

The Nexus Between Good Work Design (i.e. Human-Centred) and Well-Being

When we design for diversity in the organisational, cognitive, and physical work realm of operators, maintainers, management/leaders, administrators, and other such stakeholders (contract suppliers, customers, and industry at large), our approach becomes human-centred. Participative and collaborative physical and environmental task design strategies are recognised as a method of engaging workers, increasing communication, providing for team problem solving and innovation, and essentially providing a forum for cross-over in the realm of psychological interventions (well-being and health) as well as productivity and performance. The medium is furnished by the investigation and design of meaningful daily tasks of workers and, as has been presented, training, learning, and development methods are enhanced through a human-factors approach also.

The ISO 27500:2016 provides these recommendations for a human-centred organisation[xliii]:

• Capitalize on individual differences as an organizational strength (design for diversity)
• Make usability and accessibility strategic business objectives
• Adopt a total system approach
• Ensure health, safety, and well-being are business priorities
• Value personnel and create meaningful work
• Be open and trustworthy
• Act in socially responsible ways

To demonstrate performance in good work design, organisations should employ methods to describe tasks required of workers and contextualised hazards with an understanding of the interaction of risk factors. They should integrate design strategies (e.g. a blend of targeted structural design with well-being and health interventions, per the teachings of Total Worker Health®[xliv]), and actively work on task (re)design or predictive design (workforce strategy and recruitment strategies combined with an active and constructive approach to design equipment, tools, environmental exposures, and work demands to best suit and fortify that strategy).

In conclusion, it is important to recognise that health, through good work design, may extend beyond that of individual workers to the health of team dynamics and the organisation, its good will and reputation, social justice, sustainability practices, quality management, and business objectives. Special challenges may arise in the caring professions, but intervention is particularly important for the well-being of our health care workers and educators: strategies may need to be creatively deployed in these industries.