Infusing Systems Thinking into Health Care: Implications for Patient and Health Care Worker Safety

Ayşe Gürses, Schools of Medicine, Bloomberg Public Health and Whiting Engineering, Johns Hopkins University


Despite advances in science, medicine and technology, progress in patient safety and health care worker safety has been slow. We argue that a major reason for this sluggish pace is the inadequate integration of ‘systems approach’ in health care. In this presentation, we will first describe the Systems Engineering Initiative for Patient Safety (SEIPS) Model, one of the most widely used conceptual models in health care safety literature, which we developed based on human factors and systems engineering, sociotechnical systems theory and health services research. We will then provide examples from a variety of health care settings (i.e., inpatient, outpatient, home care), and focus areas (e.g., safety of care transitions/ handoffs, personal protective equipment use during the COVID-19 pandemic) to demonstrate its use over the last 15 years.

Short Bio

Dr. Gurses is a professor in the Johns Hopkins University Schools of Medicine, Bloomberg Public Health and Whiting Engineering. She is the founding Director of the Armstrong Institute Center for Health Care Human Factors within the Johns Hopkins Medicine. She is an industrial and systems engineer with sub-specialization in human factors engineering, a health services researcher, and an implementation scientist. Her current research efforts focus on improving patientcenteredness of care and medication safety among older adults, improving safety of care transitions, reengineering work systems to improve infection prevention and control, and improving care professionals’ work conditions. Dr. Gurses has been a principal or co-principal investigator on several federally funded research grants and contracts, totaling over $12M. She is the author of more than 100 peer-reviewed publications. She is the recipient of numerous awards including the 2013 Federation of Associations in Behavioral and Brain Sciences Foundation Early Career Investigator Award (for major research contributions to the sciences of mind, brain, and behavior), the 2014 University of Wisconsin-Madison Forward Under 40 award, the 2014 Liberty Mutual Award for the Best Paper in the journal ‘Ergonomics,’ and the 2014 International Ergonomics Association/ Liberty Mutual Best Paper Award in Occupational Safety and Ergonomics. In 2020, Dr. Gurses was appointed as a member of the 2-year National Academies of Sciences, Engineering and Medicine Committee to contribute to a study on processes for ensuring effective and appropriate respiratory protection for individuals facing inhalation hazards outside of workplaces with known respiratory hazards subject to requirements for respiratory protection programs. In addition, Dr. Gurses serves as the Scientific Editor of Applied Ergonomics, a top-level journal in the field of human factors engineering. Dr. Gurses’s scientific research program is not only highly innovative, but also practical in application, and has already positively changed clinical and public health practices. When the Ebola epidemic hit in 2014, for example, she partnered with the CDC to lead a transdisciplinary team of over 40 individuals including researchers and practitioners from various disciplines to combat Ebola. As part of this effort, she and her team developed a web-based training to prepare health care workers for potential Ebola cases by integrating human factors and industrial engineering, implementation science, and public health principles and methods with infection control and prevention and clinical expertise. This Ebola Personal Protective Equipment video was viewed more than 500,000 times within the first six months of its release on the CDC’s website.


Friday, March 26, 2021, 4.00 pm - Zoom Meeting


Announcement Category