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Every year, more than 200,000 patients in Canada acquire an infection while receiving healthcare and more than 8,000 die as a result (Public Health Agency of Canada, 2013). Infections can arise from the entry and multiplication of a microorganism in a person’s tissue (Public Health Ontario, 2012a, 2012b). As healthcare workers perform tasks, they circulate among patients, objects, and surfaces, thereby creating opportunities for transmitting microorganisms and possibly contributing to the spread of hospital-acquired infections. Newborns hospitalized in neonatal intensive care units are particularly vulnerable because of inherent risk factors such as low birth weight, underlying illness, undeveloped immune systems, and greater skin permeability. Other risk factors include poor staff-topatient ratios, crowded environments, and exposure to invasive devices (Public Health Ontario, 2012a, 2012b). Infection prevention and control has been the subject of much study in medical and epidemiological research and a variety of best practice guidelines have been developed to support healthcare workers and related stakeholders. Yet, despite the availability of information, managing healthcare-associated infections remains a challenge because the relevant explicit knowledge is not being adequately developed and mobilized as tacit knowledge for use "on the front lines". Some researchers have called for a human factors perspective to help address challenges in designing for infection prevention and control, but relatively few studies have been conducted to date. Researchers also suggest that empirical inquiry is needed to better inform the design process, and particularly the design of complex systems where attention to detailed processes and interactions can support the success of an intervention. A human factors approach can help designers develop a deeper understanding of work processes, technology considerations, as well as physiological, psychological, cultural, and organizational factors. The need is particularly pressing in low-resource healthcare environments where funds, time, and human resources may be scarce and strategic design decisions based on evidence are needed to support meaningful and effective changes. With this in mind, a human factors study was conducted in an existing neonatal intensive care unit to identify the influence of product and environment design on infection prevention and control and to inform recommendations for improvement. In this case study, we illustrate how the application of an empirical, methodical approach can help design professionals and stakeholders develop tacit knowledge of complex systems – knowledge that can be used to better inform design priorities, the design process, decision making, and the allocation of resources to help maximize improvements. “ ” To know that you do not know is the best. To think you know when you do not is a disease. Recognizing this disease as a disease is to be free of it.

Developing Tacit Knowledge of Complex Systems: The Value of Early Empirical Inquiry in Healthcare Design