Skip to main content

Research Repository

Advanced Search

The application of a human factors approach to the evaluation of a novel outpatient parenteral antimicrobial therapy service in Malta.

Bugeja, Sara Jo


Sara Jo Bugeja


Helen Vosper

Derek Stewart


The application of a human factors approach to healthcare has been gaining traction ever since its first mention in the early 1960s. The need for this synergistic collaboration stems from the poor safety and quality outcomes that have been plaguing the history of healthcare, despite continuous efforts by stakeholders to offer patient-centred care at all costs. In recent years, healthcare practitioners have positively contributed to bridging the gap between clinical practices and systems-based approaches. To this end, this research project sets out to apply a human factors approach to the evaluation of a specific niche in healthcare - the newly launched Maltese OPAT service. Considering the high quality attributed to systematic literature reviews (SLRs) in evidence-based medicine, the first phase of this study featured a dual-discipline PROSPERO-registered SLR. Data were critically appraised, synthesised and presented to deduce whether human factors approaches were amenable to OPAT pathways. Data synthesis using the SEIPS 2.0 model successfully extracted facilitators and barriers to OPAT services across the globe, indicating how systems needed to be redesigned to improve service outcomes. At this point during the research journey, the absence of a singular reference source about OPAT episodes made benchmarking and auditing against international service provisions impractical. The second phase addressed this lacuna by conducting a prospective observational cohort study about OPAT episodes, whilst concomitantly compiling a repository (October 2016 to October 2019). Details about the patient cohort and OPAT episodes, completion statuses, OPAT durations and the cost to run the service were inferred. Over the study timeframe, a total of 132 episodes were rendered to 117 patients, equating to a total of 3287 hospital bed days saved. Of these, only 23 episodes resulted in a readmission and so the overall success rate was 82.6%. The OPAT duration was significantly influenced by the presenting infection (p = 0.021), VAD (p < 0.001) and occurrence of a readmission (p = 0.05). Despite the importance of these findings, they offered little knowledge about the patients' and professionals' experiences as end users of the service. This reasoning guided the pursuit of identifying facilitators and barriers attributable to the service from the perspective of these end-users. A cross-sectional questionnaire and a focus group session were conducted to gather data from patients and the OPAT team respectively. Quantitative and qualitative analysis were supplemented by human factors strategies - namely hierarchical task analysis and SEIPS-based modelling. Following quantitative data analysis, a general positive trend in patient satisfaction scores (satisfaction rate of 95.8%) was recorded, therefore favouring the service and the high standard it managed to maintain through the years of provision. Thematic analysis supported this finding and advised caution in terms of focusing on the patient's wellbeing, standardisation of practices, availability of resources and the involvement of informal caregivers. Certain themes were also reiterated from the analysis of the focus group discourse, whereby the OPAT team also stressed the importance of standardising procedures (with specific reference to the referral process and training/education methods), and the team's flexibility and adaptability prior to expanding the service further. SEIPS-based modelling conducted on data collected during the cross-sectional survey and focus group contributed to the mapping of a systems based model applicable to the local service. Comparisons between this and the model created during the SLR about global OPAT services shed light on the requirements for system redesigns of local practices. This doctoral research has contributed both to the practice of OPAT nationally and to the general application of systems-based strategies for the betterment of healthcare outcomes. Future work should focus on the use of new methods to gather more data about the local service, including more robust pharmacoeconomic studies and an in-depth ethnography study from the perspective of the end-users through fieldwork, which could then supplement further human factor approaches such as workflow analysis, thereby ensuring further triangulation of data. On a larger scale, the findings of this research shed light on the amenability of human factors approaches to healthcare practices in general and therefore should be applied across the institution beyond the boundaries set by this case study research.


BUGEJA, S.J. 2020. The application of a human factors approach to the evaluation of a novel outpatient parenteral antimicrobial therapy service in Malta. Robert Gordon University, PhD thesis. Hosted on OpenAIR [online]. Available from:

Thesis Type Thesis
Deposit Date Jun 8, 2021
Publicly Available Date Jun 8, 2021
Keywords Human factors; Health service evaluation; Healthcare provision; Malta
Public URL
Publisher URL
Award Date Nov 30, 2020


You might also like

Downloadable Citations