Improving Healthcare Using Engineering Principles

“My career pathway would be much different if AHRQ didn’t exist....”

A childhood of watching her physician parents care for patients in her native Turkey motivated Ayse P. Gurses, Ph.D., M.P.H., M.S., to ask, “How can this be done better?” This quest to understand healthcare processes led her to apply engineering principles—thinking of healthcare settings as complex systems in which social and technical factors interact—to improve safety both for patients and healthcare workers.

Dr. Gurses credits AHRQ with recognizing that healthcare research extends beyond the study of human biology and fostering her interest in how work system design factors, such as information technology and organizational design, impact care. “My career pathway would probably be much different if AHRQ didn’t exist,” she says. “I will always be thankful to AHRQ for supporting our work in patient and healthcare worker safety.”

However, she didn’t initially pursue a career in healthcare. Dr. Gurses studied industrial and systems engineering at Middle East Technical University in Ankara, Turkey, then came to the United States to pursue degrees in the same field at Virginia Tech and the University of Wisconsin–Madison, followed by a Master of Public Health from Johns Hopkins.

As a principal or co-investigator on dozens of grants and contracts, including several from AHRQ, Dr. Gurses is a globally recognized researcher and educator in applying human factors engineering methods to healthcare. She is the founding director of the Johns Hopkins Armstrong Institute for Patient Safety and Quality’s Center for Health Care Human Factors and a professor in three Johns Hopkins University schools.

While she was working on her Ph.D. at Wisconsin, her advisor, AHRQ grantee Pascale Carayon, Ph.D., encouraged her to dig deeper into the field with which she had been familiar since childhood. “Pascale told me, ‘Go stand there in the ICU and figure out what’s happening’.”

She found that healthcare organizations were intricate systems in which multiple internal and external inputs affect the outcome. “These are complex, nonlinear, and open work systems, so it’s not straightforward to model them,” she says. “It’s hard to predict what will happen next. You’ve got individuals with a variety of educational levels and skillsets, teamwork, organizational culture, and physical environment, all interacting with sophisticated technologies. All of that needs to be designed, and often redesigned given the dynamic nature of work, so we can improve processes and, as a result, improve outcomes.”

In 2004, at Dr. Carayon’s urging, Dr. Gurses applied for and received a 1-year grant for AHRQ’s Health Services Research Dissertation Program that allowed her to expand her study of intensive care units and understand the causes and consequences of nursing workload more broadly. “It made the study much stronger,” she says. “I was able to publish five papers out of this grant, and it really supported me and started my career.”

In 2010, Dr. Gurses applied for and received a 5-year AHRQ Mentored Research Scientist Career Development Award to establish a research program to improve patient safety during transitions of care and handoffs. 

This led to another AHRQ grant awarded in 2015 in which Dr. Gurses led a 6-year project to design health-information technology (IT) supported care transitions in pediatric trauma. Her team helped improve the understanding of pediatric care teams’ demanding cognitive work and identify design requirements for future health IT that supports team performance and safety of pediatric trauma care.

With another AHRQ grant awarded in 2015, Dr. Gurses co-led a team on a 4-year project to create a patient-centric risk model of medication safety focusing on older adults. In this project, the team developed and implemented a risk assessment tool to improve medication safety for patients as they transition from inpatient to outpatient care.

In 2019, Dr. Gurses received a 4-year AHRQ grant to understand diagnostic processes in emergency departments and identify improvement strategies using a human factors and systems engineering approach. Diagnostic error is a major public health problem, yet very few studies provide an accurate, in-depth understanding of the details associated with diagnosis in this setting. To achieve this, Dr. Gurses and her interdisciplinary team used cognitive task analysis and field studies in urban, suburban, and rural emergency departments.

Dr. Gurses was awarded a 4-year AHRQ-funded Patient Safety Learning Laboratory grant in 2023. The aim of the Resilient EMS Patient Safety Learning Lab is to enhance and support quality, safety, and equity within pre-hospital emergency care provided by emergency medical services. This project is expected to conclude July 31, 2027.

Currently, Dr. Gurses also is a multiple principal investigator on two other AHRQ grants: one developing an approach for measuring workload of nurses in the neonatal ICU, and another examining the usability and usefulness of electronic health records for critical care nurses and impact of this technology on clinical nursing processes and patient safety. These projects are scheduled to end on February 28, 2026, and May 31, 2027, respectively.

According to Dr. Gurses, it is the Agency’s adaptability and openness to new ideas and innovative thinking that she finds appealing. “AHRQ does not insist on randomized controlled trials. Those are important, but AHRQ also allows for mixed-methods studies that account for the complexities and realities of the healthcare system,” she says. “We’re not dealing with one drug or one treatment at a time to make healthcare reliable and safe. We’re dealing with thousands of drugs and treatments, complex technologies, different organizational structures and physical environments and interactions of all these factors with each other, all simultaneously. This is the crux of systems engineering.”

Principal Investigator: Ayse P. Gurses, Ph.D., M.P.H., M.S.
Institutions: Johns Hopkins Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine
Grantee Since: 2004
Type of Grant: Various

Related AHRQ Resources

• Diagnostic Safety and Quality.
• Medication Safety.
• Transitions of Care.
• Patient Safety Learning Labs.
• Digital Healthcare Research.

Return to AHRQ Grantee Profiles