The Research On Medical Human Errors Dependence Evaluation Based On Uncertain Decision

Medical industry is a high technology,high risk industry,its service safety and quality has always been a hot topic of social concern,affecting the development of economy and society.With the enhancement of medical technology and the continuous improvement of the reliability of equipment,Chinese medical industry is stepping into the fast lane of development.However,due to the lack of awareness of risk control,controllable risks and hidden dangers have seriously affected the quality of medical service process.Human is the most important part of the medical system,a special organization with high requirements on reliability,security and accuracy.Human error has become an important factor affecting the safety and quality of medical services.Therefore,it is urgent to conduct research on human errors in healthcare to reduce avoidable human risks in the medical system and further improve patient safety.As a systematic risk analysis tool,human reliability analysis(HRA)can be used to identify,quantify and reduce human errors in human-machine systems.Dependence assessment among human failure events(HFEs)is a pivotal component to avoid underestimation of the risk in HRA,which plays a crucial role in reducing human errors and improving the reliability of medical system.Although HRA and its related theories have been widely developed and recognized in the industrial field,it is only in recent years that they have been extensively studied and applied in the medical field.In addition,there are many defects and deficiencies in the existing medical dependence assessment models in dependence information evaluation,weight determination of performance shaping factors(PSFs)and calculation of human error probability(HEP).Therefore,two new medical human error dependence assessment models are proposed,and their reliability and validity are verified by applying them to real case studies.The main work of this thesis is summarized as follows:(1)This thesis systematically reviews the existing literatures on improvement and technical applications of HRA dependence assessment methods.The literature review systematically summarizes the research status of improvement of dependence assessment methods from the perspectives of dependence evaluation information,PSFs and HEP,and discusses the deficiencies of HRA dependence assessment methods in technical applications.(2)Considering the hesitancy of expert evaluation information,a new method based on linguistic hesitant fuzzy sets(LHFSs)and technique for human error rate prediction(THERP)is developed to manage the dependence in HRA.The hesitant and complex evaluation information is given by using LHFSs,and the extended best-worst method(BWM)is applied for the purpose of obtaining the weights of PSFs according to an optimization model.Then,an improved THERP method is proposed to compute the overall dependence levels between consecutive operator actions.In addition,an empirical example from a university teaching hospital in Shanghai and it is concluded that the HFE of “transfusion cannot be completed within the appropriate time” is largely rely on the failure on its preceding task“preparation time before injection is too long”.Healthcare workers can reduce avoidable human risks during blood transfusion and improve the reliability of medical service processes by applying this model to blood transfusion.A comparison analysis with the existing methods is presented to illustrate the feasibility and efficiency of our developed dependence assessment model.The results indicate that the new dependence assessment model can effectively express the hesitancy of expert evaluation and provide valuable information for managers.(3)Considering the comprehensiveness of expert evaluation information,a new medical human error dependence assessment model is proposed based on q-rung orthopair uncertain linguistic sets(q-ROULSs)and THERP method.The uncertainty dependence assessment information between successive tasks is given comprehensively by experts using q-ROULs.An entropy-based combination weighting method is adopted to calculate the weights of PSFs.And the evaluation based on distance from average solution(EDAS)approach with stability is applied to obtain reasonable and reliable dependence appraisal score between medical continuous operations.In addition,the extended THERP method based on q-ROULSs is used to calculate the overall dependence level between medical continuous operations.Finally,the proposed model is applied to the operation of ventilators in a rehabilitation hospital in Shanghai,and it is concluded that “the operator did not adequately inspect the ventilator and parameter settings inconsistent with patient status” are human errors that need to be focused on.The application of the proposed model to the operation process of ventilator can help medical staff find the cause of errors,and reduce avoidable human risks in the healthcare system from the source.The effectiveness and practicability of the proposed method are verified by comparative analysis.The results show that the human error dependence assessment model can express evaluation information in detail and comprehensively,and consider the stability of dependence assessment decision process.