according to human factors and ergonomic principles) or does not fit with the rest of the work system.

For example, while microprocessor-controlled medication infusion pumps eliminate many cumbersome processes that are often the source of errors, they also introduce new demands, such as complicated set-up and operation procedures, that can lead to new sources of error. Bar coding technology can prevent patient misidentification, but the possibility exists that an error committed during patient registration may be disseminated throughout the information system and may be more difficult to detect and correct than with conventional systems (Wald and Shojania, 2001). Whenever a technology is implemented, then, the human factors characteristics of its design and its potential positive and negative influences on other work system elements should be studied.

Paying ongoing attention to work design Successful implementation of work redesign is not a one-time effort. Few changes in complex organizations work perfectly when first introduced; virtually all require modification over time to achieve optimum results. Ongoing monitoring, feedback, and redesign are therefore needed to create and sustain effective change (Goodman, 2001). Work (re)design should be considered a continuous process.

Moreover, it is not unusual for organizations or departments that have implemented innovations most recently to perform worse than those that implemented comparable innovations a year or two before. Macduffie and Pil (1996) point out that in the automobile industry, plants struggle in the first year following adoption of a new work system with the right mix of incentives, managerial supports, and training needs, as well as coordination difficulties with other units. Those that sustain the change into the second year begin to see cost and quality improvements. New practices often initially undermine existing routines and competencies and require ongoing learning, redesign of the change, and creation of support practices to capture the promised benefits.

Workspace Design for Safety and Efficiency

An example: Methodist Hospital, Clarian Health Partners In the mid-1990s, the Methodist campus of Clarian Health had two floors of nursing unit shell space available as the result of a consolidation process. An interdisciplinary planning effort employed continuous quality improvement principles and systems thinking, along with evidence from the literature, to determine how to best use this space. In addition, two work process and patient flow studies were conducted. The first was a 1,000-hour video capture of time and motion on a medical–surgical unit that simultaneously



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