Evaluating the use of systems thinking methods in healthcare: a RE-AIM analysis of AcciMap and Net-HARMS

There are increasing calls for the application of systems ergonomics methods in healthcare, although evidence for their utility and uptake is limited. In this study, 67 Australian healthcare workers participated in a six-month longitudinal study where they were trained to apply the AcciMap adverse event analysis and Net-HARMS risk assessment methods. Data were gathered in line with the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) evaluation framework, including rates of organisational uptake and method validity, perceived workload, usability, and barriers and facilitators to use in practice. Overall RE-AIM ratings for AcciMap were relatively high, and more moderate for Net-HARMS. Time constraints was the most frequently identified barrier to the use of both methods in practice, while there was more organisational resistance to Net-HARMS uptake. Facilitators for the use of both methods include providing quality training and mentorship, additional time and software resources, and dedicated job roles.