Electronic Reporting of Workplace Violence Incidents: Improving the Usability, and gnitive Workload, and Performance Meagan Foster a , Karthik Adapa a , Anna Soloway b , Jeffrey Francki c , Sara Stokes a , Lukasz Mazur a a Division of Healthcare Engineering, Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA b Psych Inpatient Management, UNC Hospitals, Chapel Hill, NC, USA c Office of Quality Excellence, UNC Hospitals, Chapel Hill, NC, USA Abstract A majority of healthcare workers (HCWs) experience workplace violence (WPV) but most WPV events go unreported. Underreporting of WPV is well documented in the literature as a barrier to identifying underlying causes and to evaluating the effectiveness of WPV interventions. Previous studies suggest that WPV reporting data is fragmentary, unreliable, and inconsistent. Also, WPV reporting systems are suboptimally designed making it difficult for healthcare workers to report WPV incidents. This study aims to assess the usability of an electronic WPV report in a large academic medical center and the perceived cognitive workload (CWL) and performance of HCWs associated with reporting WPV events. Findings from this study suggest that our institutional WPV report has suboptimal perceived usability and suboptimal perceived cognitive workload. Further, participants with training reported lower error rates in comparison to participants without training on performance. Keywords: Workplace Violence, Cognitive Ergonomics, Task Performance And Analysis Introduction Healthcare workers (HCWs) are four times more likely to ex- perience workplace violence (WPV) than any other profession accounting for nearly one-half of fatal occupational injuries in United States hospitals [2]. A 2014 study reports that 71% of physicians in the United States experienced at least 1 incident of verbal assault in the past year and 28% experienced physical assault [6]. Further studies also report that 82% of nurses expe- rienced WPV at least once during their career[8] [11]. Thus, WPV is associated with impairment to HCWs physical and mental well-being resulting in increased on-the-job errors, de- creases in performance and productivity, low organizational commitment, staff shortages, and increased healthcare costs[11]. Data-driven process improvements are likely to effectively im- prove both employee work environments and patient-rated quality of care in nursing homes, primary care, and hospital set- tings [3]. The results of a randomized control study suggest a positive impact on the severity of WPV events in intervention units where supervisors were provided WPV reports to develop mitigation strategies [3]. Furthermore, an interventional study conducted in a single emergency department aimed to increase the reporting of WPV and but resulted in a decrease in overall reporting, thus, implying a positive relationship between WPV reporting and decreased WPV incidents [11]. HCWs are exposed to WPV so often that it is commonly con- sidered “part-of-the-job”[9]. Large hospital systems employ systemic, multi-prong initiatives to address this issue. Usability barriers associated with WPV reporting must be addressed to ensure HCWs can report on WPV with ease and with optimal cognitive workload (CWL) through targeted usability-focused enhancements to reporting systems[4; 10]. Therefore, the pri- mary aim of this study is to assess the perceived usability, per- ceived CWL, and performance of HCWs during WPV reporting in a large academic medical center. Secondary study aims in- clude participants’ ability to locate the correct WPV report and explore the influence of self-reported user characteristics on primary study aims. Methods Participants Flyers and email announcements were used to recruit partici- pants to this institutional review board-approved study. Usa- bility testing was conducted with 10 HCWs at a large academic medical center. Study settings Testing sessions were conducted in a playground environment via Zoom/WebEx or in-person in a human factors laboratory conveniently located within the hospital premises. Pre-screening questionnaire Participants were administered an abbreviated version of the World Health Organization Workplace Violence Questionnaire that included age, professional group, and present position[12]. Participants were also asked to denote if they had experienced WPV or received training on WPV reporting. The results of this questionnaire were used to explore participant characteristics along with perceived usability, perceived cognitive workload, and human performance. Think aloud and use case scenarios Participants were asked to complete WPV reporting tasks by finding and submitting a WPV report using use case scenarios developed in consultation with subject matter experts and based on real-world reports of WPV. The eight use case scenarios were designed to omit gender-specific roles and to mitigate cognitive bias by using gender-ambiguous names for involved parties. Initial study participants were asked to think aloud Optimizing Healthcare Workers' Co MEDINFO 2021: One World, One Health – Global Partnership for Digital Innovation P. Otero et al. (Eds.) © 2022 International Medical Informatics Association (IMIA) and IOS Press. This article is published online with Open Access by IOS Press and distributed under the terms of the Creative Commons Attribution Non-Commercial License 4.0 (CC BY-NC 4.0). doi:10.3233/SHTI220105 400