Systemic barriers and enablers in humanitarian technology transfer

Purpose – The purpose of this paper is to collect information about barriers and enablers experienced by international experts when transferring medical equipment to countries affected by humanitarian emergencies and to discuss the suitability of the principles of “openness”, “interconnections” and “non-linearity” of systems to understand the nature of the barriers and enablers as described by the international experts. Design/methodology/approach – In this study, six semi-structured interviews were conducted with experts from humanitarian organizations. The interviews were based on a simplified model of the transfer of medical equipment adapted from supply chain literature. The model ensured that all the process steps undertaken by humanitarian organizations were considered. Afterwards, the interviews were transcribed and structurally analysed to derive barriers and enablers. Finally, the results were described in light of three theoretical principles of systems thinking. Findings – In total, 14 types of...

[1]  Donald A. Norman,et al.  Human-centered design considered harmful , 2005, INTR.

[2]  Steve Evans,et al.  Product Service Systems and supply network relationships: an exploratory case study , 2019 .

[3]  Michelle M. Robertson,et al.  MACROERGONOMICS: A WORK SYSTEM DESIGN PERSPECTIVE , 2001 .

[4]  R. Malkin.  Design of health care technologies for the developing world. , 2007, Annual review of biomedical engineering.

[5]  W. Patrick Neumann,et al.  The Strategic Business Value of Ergonomics**Parts of this chapter have been previously published in Dul and Neumann [38] and Neumann and Dul [24]. , 2007 .

[6]  D. Reider,et al.  Leverage Points: Places to Intervene in a System , 2012 .

[7]  Robert Racadio,et al.  Competing Constraints: The Operational Mismatch between Business Logistics and Humanitarian Effectiveness , 2012, 2012 IEEE Global Humanitarian Technology Conference.

[8]  Anthony D Redmond,et al.  Disasters and a register for foreign medical teams , 2011, The Lancet.

[9]  James R Ward,et al.  Design for patient safety: a systems-based risk identification framework , 2018, Ergonomics.

[10]  P. Joore,et al.  The V-Cycle for system innovation translating a broad societal need into concrete product service solutions: the multifunctional centre Apeldoorn case , 2008 .

[11]  B. Karsh,et al.  A human factors engineering paradigm for patient safety: designing to support the performance of the healthcare professional , 2006, Quality and Safety in Health Care.

[12]  Ana Laura R. Santos,et al.  Designing products and services for challenging societal contexts , 2014 .

[13]  K. Weick.  The social psychology of organizing , 1969 .

[14]  K. Green,et al.  System Innovation and the Transition to Sustainability: Theory, Evidence and Policy , 2005 .

[15]  Joachim Gardemann,et al.  Primary health care in complex humanitarian emergencies: Rwanda and Kosovo experiences and their implications for public health training. , 2002, Croatian medical journal.

[16]  J. Reason.  Human error: models and management , 2000, BMJ : British Medical Journal.

[17]  T. Adam,et al.  Systems thinking for strengthening health systems in LMICs: need for a paradigm shift. , 2012, Health policy and planning.

[18]  Hal Hendrick,et al.  An Overview of Macroergonomics , 2002 .

[19]  R. Oloruntoba,et al.  Customer service in emergency relief chains , 2009 .

[20]  A. Blackwell,et al.  Graphic elicitation: using research diagrams as interview stimuli , 2006 .

[21]  Luk N. Van Wassenhove,et al.  From preparedness to partnerships: case study research on humanitarian logistics , 2009, Int. Trans. Oper. Res..

[22]  Kathleen M. MacQueen,et al.  Applied Thematic Analysis , 2011 .

[23]  M. J. Rice,et al.  Anesthetic Practice in Haiti After the 2010 Earthquake , 2010, Anesthesia and analgesia.

[24]  Elizabeth Murphy,et al.  Medical device development: the challenge for ergonomics. , 2008, Applied ergonomics.

[25]  P. Carayon,et al.  SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients , 2013, Ergonomics.

[26]  Richard Buchanan,et al.  Wicked Problems in Design Thinking , 1992 .

[27]  P. Carayon,et al.  Work system design for patient safety: the SEIPS model , 2006, Quality and Safety in Health Care.

[28]  L. Bertalanffy.  AN OUTLINE OF GENERAL SYSTEM THEORY , 1950, The British Journal for the Philosophy of Science.

[29]  L E Mahoney,et al.  Catastrophic disasters and the design of disaster medical care systems. , 1987, Annals of emergency medicine.

[30]  Michael Jackson,et al.  Systems Thinking: Creative Holism for Managers , 2003 .

[31]  Barry Bozeman,et al.  Technology transfer and public policy: a review of research and theory , 2000 .

[32]  M X Powell,et al.  Plan ahead , 1981, Journal of the American Optometric Association.

[33]  Anita L. Tucker,et al.  Why Hospitals Don't Learn from Failures: Organizational and Psychological Dynamics That Inhibit System Change , 2003 .

[34]  Elizabeth Murphy,et al.  A user-centred approach to requirements elicitation in medical device development: a case study from an industry perspective. , 2012, Applied ergonomics.

[35]  Dieter Fuhrmann.  User Centered Design An Integrated Approach , 2016 .

[36]  Gijsbertus J Verkerke,et al.  Treating natural disaster victims is dealing with shortages: an orthopaedics perspective. , 2008, Technology and health care : official journal of the European Society for Engineering and Medicine.

[37]  C W Clegg,et al.  Sociotechnical principles for system design. , 2000, Applied ergonomics.

[38]  Jayne Webster,et al.  Introducing vouchers for malaria prevention in Ghana and Tanzania: context and adoption of innovation in health systems. , 2012, Health policy and planning.

[39]  James T. Reason,et al.  Managing the risks of organizational accidents , 1997 .

[40]  P. Rosseel,et al.  Safety challenges of medical equipment in nurse anaesthetist training in Haiti. , 2016, Applied ergonomics.

[41]  G. Kovács,et al.  Identifying challenges in humanitarian logistics , 2009 .

[42]  Russell L. Ackoff,et al.  The systems revolution , 1974 .

[43]  Stéphane Kluser,et al.  Reducing Disaster Risk: a challenge for development , 2004 .

[44]  Deanna J. Richards,et al.  The Industrial green game : implications for environmental design and management , 1997 .

[45]  Andrew Peter Wallace McCarthy.  E DITOR ’ S C OMMENTS Diversity of Design Science Research , 2022 .

[46]  Gianmarco Baldini,et al.  Disaster Prevention and Management : An International Journal Securing disaster supply chains with cryptography enhanced RFID , 2016 .

[47]  R. Kahn,et al.  The Social Psychology of Organizations , 1966 .

[48]  Jan Carel Diehl,et al.  The value of collaborative design to address the challenges of the humanitarian sector , 2013 .

[49]  Amydee M. Fawcett,et al.  Benchmarking the state of humanitarian aid and disaster relief , 2013 .

[50]  Jenny Dankelman,et al.  Evaluation of a New Surgical Light Source for Difficult Visibility Procedures , 2011, Surgical innovation.

[51]  Han Brezet,et al.  A Multilevel Design Model: The mutual relationship between product-service system development and societal change processes , 2015 .

[52]  Harry McCarthy,et al.  Human factors analysis of a near-miss event: oxygen supply failure during cardiopulmonary bypass. , 2015, Journal of cardiothoracic and vascular anesthesia.

[53]  Trond Are Øritsland,et al.  A Collaborative Systems Design Project With The Norwegian Postal Service , 2006 .

[54]  Houshang Shahnavaz,et al.  Ergonomics of technology transfer , 1987 .

[55]  R. Mahajan,et al.  Critical incident reporting and learning. , 2010, British journal of anaesthesia.

[56]  Luke Houghton,et al.  The wicked problem of humanitarian logistics and disaster relief aid , 2011 .

[57]  Ezio Manzini,et al.  Product-service Systems and Sustainability: Opportunities for Sustainable Solutions , 2002 .

[58]  W. Ashby,et al.  An Introduction to Cybernetics , 1957 .

[59]  Brita Nielsen,et al.  Key challenges of product development for humanitarian markets , 2013, 2013 IEEE Global Humanitarian Technology Conference (GHTC).

[60]  Erik Stolterman,et al.  The Design Way: Intentional Change in an Unpredictable World , 2002 .

[61]  Pierre Falzon,et al.  A strategy for human factors/ergonomics: developing the discipline and profession , 2012, Ergonomics.

[62]  Brita Fladvad Nielsen,et al.  Designing for multiple stakeholder interests within the humanitarian market: the case of off-grid energy devices , 2013 .

[63]  Robert N. Stern,et al.  The External Control of Organizations: A Resource Dependence Perspective. , 1979 .

[64]  Asim Rajpura,et al.  Pakistan Earthquake: Experiences of a Multidisciplinary Surgical Team , 2010, Prehospital and Disaster Medicine.

[65]  S. Dekker,et al.  The complexity of failure: Implications of complexity theory for safety investigations , 2011 .

[66]  Ann Taket,et al.  Creative Problem Solving: Total Systems Intervention. , 1991 .

[67]  Arthur L Kellermann,et al.  Emergency medical care in developing countries: is it worthwhile? , 2002, Bulletin of the World Health Organization.

[68]  Christopher Guly.  Haiti emerging from chaos to face health care crisis , 2004, Canadian Medical Association Journal.

[69]  Han Brezet,et al.  Medical emergency dynamics in disaster-prone countries – implications for medical device design , 2013 .

[70]  Birger Sevaldson,et al.  GIGA-Mapping: Visualisation for complexity and systems thinking in design , 2011, Nordes 2011: Making Design Matter.

[71]  Enid Mumford,et al.  A Socio-Technical Approach to Systems Design , 2000, Requirements Engineering.

[72]  Eddy Rahardjo,et al.  Toward more efficient multinational work on rescue and aid for disasters: lessons learned during the Aceh tsunami and Yogya earthquake. , 2008, Prehospital and disaster medicine.

[73]  J. Meara,et al.  Shortage of Doctors, Shortage of Data: A Review of the Global Surgery, Obstetrics, and Anesthesia Workforce Literature , 2014, World Journal of Surgery.

[74]  Johnny Saldaña,et al.  The Coding Manual for Qualitative Researchers , 2009 .

[75]  Jeffrey R. Alcock,et al.  Product–service systems in health care: case study of a drug–device combination , 2011 .

[76]  Rana Chreyh,et al.  A proposed framework to improve the safety of medical devices in a Canadian hospital context , 2014, Medical devices.

[77]  Thierry Pauyo,et al.  Emergency Surgical Care Delivery in Post-earthquake Haiti: Partners in Health and Zanmi Lasante Experience , 2011, World Journal of Surgery.

[78]  Patricia L. Spath,et al.  Error Reduction in Health Care: A Systems Approach to Improving Patient Safety, Second Edition , 2011 .

[79]  Anthony D Redmond,et al.  Best Practice Guidelines on Surgical Response in Disasters and Humanitarian Emergencies: Report of the 2011 Humanitarian Action Summit Working Group on Surgical Issues within the Humanitarian Space , 2011, Prehospital and Disaster Medicine.

[80]  Pascale Carayon,et al.  Handbook of human factors and ergonomics in health care and patient safety , 2006 .

[81]  Patrick Waterson,et al.  A critical review of the systems approach within patient safety research , 2009, Ergonomics.

[82]  F. Visser,et al.  Lost in CO-X - Interpretations of Co-Design and Co-Creation , 2011 .

[83]  I. Svedung,et al.  Proactive Risk Management in a Dynamic Society , 2000 .

[84]  Charles Vincent,et al.  Systems Approaches to Surgical Quality and Safety: From Concept to Measurement , 2004, Annals of surgery.

[85]  Chris W. Clegg,et al.  A Sociotechnical Method for Designing Work Systems , 2002, Hum. Factors.

[86]  Roger Dzwonczyk,et al.  Medical equipment donations in Haiti: flaws in the donation process. , 2012, Revista panamericana de salud publica = Pan American journal of public health.

[87]  Miguel Trelles,et al.  Improving Effective Surgical Delivery in Humanitarian Disasters: Lessons from Haiti , 2011, PLoS medicine.

[88]  Dap Hartmann,et al.  Innovating the innovation process , 2006, Int. J. Technol. Manag..

[89]  Leon Straker,et al.  Cultural hazards in the transfer of ergonomics technology , 1998 .

[90]  Christian Wright,et al.  EMERGENCY medical services. , 2018, On the state of the public health. Great Britain. Ministry of Health.

[91]  Guy H. Walker,et al.  Human Factors Methods: A Practical Guide for Engineering and Design , 2012 .

[92]  Klaus J Zink,et al.  Designing sustainable work systems: the need for a systems approach. , 2014, Applied ergonomics.

[93]  Oksana Mont,et al.  Clarifying the Concept of Product-Service System , 2002 .

[94]  Alla Keselman,et al.  Attitudes toward medical device use errors and the prevention of adverse events. , 2007, Joint Commission journal on quality and patient safety.

[95]  Roderic Alley,et al.  Humanitarian Negotiations Revealed: The MSF Experience , 2012 .

[96]  T. Manser,et al.  Analysing Action Sequences: Variations in Action Density in the Administration of Anaesthesia , 2002, Cognition, Technology & Work.

[97]  P. Senge.  The fifth discipline : the art and practice of the learning organization/ Peter M. Senge , 1991 .

[98]  Paul Cilliers,et al.  Complexity and Postmodernism , 1998 .

[99]  Linda S. G. L. Wauben,et al.  Systems Design Perspective of Healthcare Provision in Humanitarian Aid , 2014 .

[100]  Elizabeth Murphy,et al.  Capturing user requirements in medical device development: the role of ergonomics , 2006, Physiological measurement.

[101]  Enid Mumford,et al.  The story of socio‐technical design: reflections on its successes, failures and potential , 2006, Inf. Syst. J..

[102]  Miguel Trelles,et al.  Ten Years of Experience Training Non-Physician Anesthesia Providers in Haiti , 2010, World Journal of Surgery.

[103]  François Villeneuve,et al.  Proposal of a New Design Methodology in the Surgical Domain , 2007 .

[104]  R. Richey.  The supply chain crisis and disaster pyramid: A theoretical framework for understanding preparedness and recovery , 2009 .

[105]  Anna-Lisa Osvalder,et al.  Setting the Requirements for a User-Friendly Infusion Pump , 2000 .

[106]  Pascale Carayon,et al.  Performance Obstacles of Intensive Care Nurses , 2007, Nursing research.

[107]  Charles Mock,et al.  Increasing Access to Surgical Services in Sub-Saharan Africa: Priorities for National and International Agencies Recommended by the Bellagio Essential Surgery Group , 2009, PLoS medicine.

[108]  P. J. Owens,et al.  Challenges of international disaster relief: use of a deployable rapid assembly shelter and surgical hospital. , 2005, Disaster management & response : DMR : an official publication of the Emergency Nurses Association.

[109]  Peter Hoonakker,et al.  Human factors systems approach to healthcare quality and patient safety. , 2014, Applied ergonomics.

[110]  J. Leow,et al.  Inter-Rater Reliability of the PIPES Tool: Validation of a Surgical Capacity Index for Use in Resource-Limited Settings , 2014, World Journal of Surgery.

[111]  Jean-Marc Robert,et al.  What Is Prospective Ergonomics? A Reflection and a Position on the Future of Ergonomics , 2009, HCI.

[112]  T. Blackwell,et al.  Use of an innovative design mobile hospital in the medical response to Hurricane Katrina. , 2007, Annals of emergency medicine.

[113]  Karin Garmer,et al.  Arguing for the Need of Triangulation and Iteration when Designing Medical Equipment , 2002, Journal of Clinical Monitoring and Computing.

[114]  Steve Walker,et al.  Appropriate response to humanitarian crises , 2010, BMJ : British Medical Journal.

[115]  David H Peters,et al.  The application of systems thinking in health: why use systems thinking? , 2014, Health Research Policy and Systems.

[116]  Jan Carel Diehl,et al.  AN ANALYSIS OF PUBLIC USE BICYCLE SYSTEMS FROM A PRODUCT- SERVICE SYSTEM PERSPECTIVE , 2008 .

[117]  D. Edge,et al.  The social shaping of technology , 1988 .

[118]  Ulrich Matern,et al.  Safety, hazards and ergonomics in the operating room , 2007, Surgical Endoscopy.

[119]  J. Pye,et al.  Asian earthquake: report from the first volunteer British hospital team in Pakistan , 2007, Emergency Medicine Journal.

[120]  Brian M Kleiner,et al.  Macroergonomics: analysis and design of work systems. , 2006, Applied ergonomics.

[121]  Steven A. Melnyk,et al.  Disaster Relief Supply Chain Management: New Realities, Management Challenges, Emerging , 2010 .

[122]  Chris W. Clegg,et al.  Advancing socio-technical systems thinking: a call for bravery. , 2014, Applied ergonomics.

[123]  Mike Kuniavsky,et al.  Observing the User Experience: A Practitioner's Guide to User Research (Morgan Kaufmann Series in Interactive Technologies) (The Morgan Kaufmann Series in Interactive Technologies) , 2003 .

[124]  Ben Ramalingam,et al.  Innovations in international humanitarian action , 2009 .

[125]  G. Hofstede.  Culture′s Consequences: Comparing Values, Behaviors, Institutions and Organizations Across Nations , 2001 .

[126]  Yu Cao,et al.  The Dragon Strikes: Lessons from the Wenchuan Earthquake , 2010, Anesthesia and analgesia.

[127]  Mala Bridgelal Ram,et al.  Issues and challenges of involving users in medical device development , 2008, Health expectations : an international journal of public participation in health care and health policy.

[128]  Tony Lloyd-Jones,et al.  Mind the Gap! Post-disaster reconstruction and the transition from humanitarian relief , 2006 .

[129]  Debarati Guha-Sapir,et al.  Natural disasters, armed conflict, and public health. , 2013, The New England journal of medicine.

[130]  E. Quarantelli.  Needed Innovation In The Delivery Of Emergency Medical Services: Present And Future , 1987 .

[131]  Pamela H. Mitchell,et al.  Defining Patient Safety and Quality Care , 2008 .

[132]  P. Senge.  The leader's new work: Building learning organizations. , 1998 .

[133]  J Gosbee,et al.  Human factors engineering and patient safety , 2002, Quality & safety in health care.

[134]  Alvaro D. Taveira,et al.  Social and Organizational Foundations of Ergonomics , 2012 .

[135]  J. Ryan,et al.  Natural Disasters: The Surgeon's Role , 2005, Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society.

[136]  Evan S. Garfein,et al.  Increasing Access to Surgical Services for the Poor in Rural Haiti: Surgery as a Public Good for Public Health , 2008, World Journal of Surgery.

[137]  Jan Marco Leimeister,et al.  Analysis of value creation through product-service-systems in the German medical engineering industry , 2009 .

[138]  F. Geels.  From sectoral systems of innovation to socio-technical systems: Insights about dynamics and change from sociology and institutional theory , 2004 .

[139]  Linda S. G. L. Wauben,et al.  Human factors perspective on the safety environment of nurse anaesthetist training in Haiti , 2014 .

[140]  Hugh Dubberly.  The space of design , 2010, INTR.

[141]  Stanley E. Fawcett,et al.  Benchmarking the State of Humanitarian Aid and Disaster Relief: A Systems Design Perspective and Research Agenda , 2013 .

[142]  Birger Sevaldson,et al.  Discussions & Movements in Design Research , 2010 .

[143]  Sarmad Alshawi,et al.  THE ROLE OF USER REQUIREMENTS RESEARCH IN MEDICAL DEVICE DEVELOPMENT , 2010 .

[144]  Joe B. Hanna,et al.  Research in humanitarian logistics , 2011 .

[145]  S. Bradshaw.  What is a disaster , 2013 .

[146]  Leysia Palen,et al.  Participatory design in emergency medical service: designing for future practice , 2006, CHI.

[147]  Gerold Martone.  Earthquake relief in Pakistan , 2006 .

[148]  J Rasmussen,et al.  Human factors in a dynamic information society: where are we heading? , 2000, Ergonomics.

[149]  Kees Dorst,et al.  Design Problems and Design Paradoxes , 2006, Design Issues.

[150]  Rjoè,et al.  Activity theory as a framework for analyzing and redesigning work , 2005 .

[151]  Wm. E. Souder,et al.  A guide to the best technology-transfer practices , 1990 .

[152]  Gunesh Rajan,et al.  Earthquakes and Trauma: Review of Triage and Injury-Specific, Immediate Care , 2008, Prehospital and Disaster Medicine.

[153]  W. Bennis,et al.  The Social Psychology of Organizations , 1966 .

[154]  C. Vincent,et al.  Analysis of clinical incidents: a window on the system not a search for root causes , 2004, Quality and Safety in Health Care.

[155]  Timothy Hoff,et al.  A Review of the Literature Examining Linkages between Organizational Factors, Medical Errors, and Patient Safety , 2004, Medical care research and review : MCRR.

[156]  N. Adjabu,et al.  A study of medical equipment donations from canada to developing countries: progress and challenges , 2014 .

[157]  Josée Hansen,et al.  Medical devices: managing the mismatch : an outcome of the priority medical devices project , 2010 .

[158]  Haim Reuveni,et al.  Earthquake disasters--lessons to be learned. , 2002, The Israel Medical Association journal : IMAJ.

[159]  Maaike Kleinsmann,et al.  Barriers and enablers for creating shared understanding in co-design projects , 2008 .

[160]  Stéphane Du Mortier,et al.  Support to Primary Health Care in Transitional Situations: Lessons Learned from the Field , 2010 .

[161]  Mieke van der Bijl-Brouwer,et al.  Strategies to design for dynamic usability , 2009 .

[162]  Richard J. Holden,et al.  Automation and adaptation: nurses’ problem-solving behavior following the implementation of bar-coded medication administration technology , 2012, Cognition, Technology & Work.

[163]  Peter H. Jones,et al.  Systemic Design Principles for Complex Social Systems , 2014 .

[164]  William W O'Neill,et al.  Rapid medical relief--Project Medishare and the Haitian earthquake. , 2010, The New England journal of medicine.

[165]  John R Wilson,et al.  Fundamentals of systems ergonomics/human factors. , 2014, Applied ergonomics.

[166]  Eric L. Trist.  Socio-technical Systems , 1978, Encyclopedia of Social Network Analysis and Mining. 2nd Ed..

[167]  Pascale Carayon,et al.  New Technology Implementation in Health Care , 2006 .

[168]  A. Tukker,et al.  Product-services as a research field: past, present and future. Reflections from a decade of research , 2006 .

[169]  D. Hilhorst.  Being good at doing good? Quality and accountability of humanitarian NGOs. , 2002, Disasters.

[170]  P. Bucklea,et al.  Patient safety, systems design and ergonomics , 2006 .

[171]  S. Lennquist,et al.  Management of major accidents and disasters: an important responsibility for the trauma surgeons. , 2007, The Journal of trauma.

[172]  D. O’Neill.  Ergonomics in industrially developing countries: does its application differ from that in industrially advanced countries? , 2000, Applied ergonomics.

[173]  R. Stacey.  The science of complexity: An alternative perspective for strategic change processes , 1995 .

[174]  Gavriel Salvendy,et al.  Handbook of Human Factors and Ergonomics , 2005 .

[175]  Eric Brangier,et al.  Innovation and design approaches within prospective ergonomics. , 2012, Work.

[176]  I Gaziulusoy,et al.  System innovation for sustainability at product development level: a conceptual framework , 2011 .