Richard J. Holden, Ph.D.

Richard Holden
  • Assistant Professor, Health Informatics


rjholdeniupui [dot] edu
WK 190

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  • Postdoctoral Fellowship, Royal Institute of Technology (Sweden) and University of Wisconsin School of Medicine and Public Health
  • Joint Ph.D. Industrial Engineering and Psychology, University of Wisconsin-Madison, 2009
  • M.S. Industrial Engineering, University of Wisconsin-Madison, 2006
  • M.S. Psychology, University of Wisconsin-Madison, 2004
  • B.S. Psychology, University of Wisconsin-Madison, 2003


Dr. Holden is an engineer and psychologist who has worked in the areas of health and healthcare since 2001. Health and healthcare have always interested him because of the deficits in quality, safety, and well-being in those domains and the enormous value of addressing these. He was also drawn to the complexity of health and healthcare systems, which makes them ideal application areas for advancing the theory and practice of his discipline, human factors.

Human factors is a person-centered, systems-oriented scientific discipline and profession. It is concerned with studying and improving work performance in sociotechnical systems such as the operating room, primary care clinic, airplane cockpit, or patient home. Human factors professionals use many existing methods and often develop new ones based on theory and practice. Human factors professionals pride themselves on strong methodology and an ability to adapt their principles, theories, methods, tools, and approaches to solve important emerging problems.

Prior to coming here, Dr. Holden completed his graduate work at the University of Wisconsin, completed a postdoctoral fellowship at Sweden’s Royal Institute of Technology, and was Assistant Professor of Medicine and Biomedical Informatics at Vanderbilt University School of Medicine.


Five most recent journal papers:

  • Holden, R.J.•, Valdez, R.S., Schubert, C.C.,† Thompson, M.J.,† Hundt, A.S. (In press). Macroergonomic Factors in the Patient
    Work System: Examining the Context of Patients with Chronic Illness. Ergonomics.
  • Eriksson, A., Holden, R.J., Williamsson, A.†, & Dellve, L. (In press). A case study of three Swedish hospitals’ strategies for
    implementing lean production. Nordic Journal of Working Life Studies.
  • Valdez, R. & Holden, R.J. (In press). Health care human factors, homeward bound: Practical considerations for research and practice in home
    and community settings. Ergonomics in Design.
  • Mickelson, R.S.†, Willis, M.†, & Holden, R.J.•. (2015). Medication-related cognitive artifacts used by older adults with
    heart failure. Health Policy & Technology, 4, 387-398.
  • Holden, R.J.•, Brown, R.L., Scanlon, M.C., Rivera, A.J., & Karsh, B. (2015). Micro- and macroergonomic changes in mental workload and
    medication safety following the implementation of new health IT. International Journal of Industrial Ergonomics, 49, 131-143.

Additional journal publications:

  • Dellve, L., Williamsson, A.†, Strömgren, M.†, Holden,
    R.J., & Eriksson, A.† (2015). Lean implementation approaches at
    different levels in Swedish hospitals: The importance for working conditions
    and stress-related health among employees. International Journal of Human
    Factors and Ergonomics, 3, 235–253.
  • Werner, N.† & Holden, R.J.•. (2015). Interruptions in the wild: Development of a socio technical systems model of interruptions in the emergency department through a systematic review. Applied Ergonomics, 51, 244-254.
  • Holden, R.J.•, Rivera, A.J., & Carayon, P. (2015). Occupational macroergonomics: Principles, scope, value, and methods. IIE Transactions on Occupational Ergonomics and Human Factors, 3, 1-8.
  • Holden, R.J.•, Schubert, C.C.† Eiland, E.C., Storrow, A.B., Miller, K.F., Collins, S.P. (2015). Self-care barriers reported by emergency department patients with acute heart failure: A sociotechnical systems-based approach. Annals of Emergency Medicine, 66, 1-12.
  • Holden, R.J.•, Schubert, C.C.,† Mickelson, R.S.† (2015). The patient work system: An analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers. Applied Ergonomics, 47, 133-150.
  • Holden, R.J.•, Eriksson, A.,† Andreasson, J.,† Williamsson, A.,† Dellve, L. (2015). Healthcare workers’ perceptions of lean: A context-sensitive, mixed methods study in three Swedish hospitals. Applied Ergonomics, 47, 181-192.
  • Valdez, R.S., Holden, R.J., Novak, L.L., & Veinot, T.C. (2015). Transforming consumer health informatics through a patient work framework: connecting patients to context. Journal of the American Medical Informatics Association, 22, 2-10.
  • Holden, R.J.•, McDougald Scott, A.M.,† Hoonakker, P.L.T., Hundt, A.S., & Carayon, P. (2015). Data collection challenges in community settings: Insights from two field studies of patients with chronic disease. Quality of Life Research, 24, 1043-1055.
  • Holden, R.J., Brown, R.L., Scanlon, M.C., Rivera, A.J., & Karsh, B. (In press). Micro- and macroergonomic changes in mental workload and medication safety following the implementation of new health IT. International Journal of Industrial Ergonomics. Doi:10.1016/j.ergon.2014.04.003.
  • Carayon, P., Wetterneck, T.B., Rivera-Rodriguez, A.J., Hundt, A.S., Hoonakker, P., Holden, R.J., & Gurses, A.P. (2014) Human factors systems approach to healthcare quality and patient safety. Applied Ergonomics, 45, 14-25.
  • Karsh, B., Waterson, P., & Holden, R.J. (2014) Crossing levels in systems ergonomics: a framework to support ‘mesoergonomic’ inquiry. Applied Ergonomics, 45, 45-54.
  • Holden, R.J., Carayon, P., Gurses, A.P., Hoonakker, P., Hundt, A.S., Ozok, A.A., & Rivera-Rodriguez, A.J. (2013) SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics, 56, 1669-1686.
  • Novak, L.L., Holden, R.J., Anders, S.H., Hong, J.Y., & Karsh, B. (2013). Using a sociotechnical framework to understand adaptations in health IT. International Journal of Medical Informatics, 82, e331-e344.
  • Carayon, P., Karsh, B., Gurses, A.P., Holden, R.J., Hoonakker, P., Hundt, A.S., Montague, E., et al. (2013). Macroergonomics in healthcare quality and patient safety. Reviews of Human Factors and Ergonomics, 8, 4-54.
  • Holden, R.J., Rivera-Rodriguez, A.J., Faye, H., Scanlon, M.C., & Karsh, B. (2013). Automation and adaptation: Nurses’ problem-solving behavior following the implementation of bar coded medication administration technology. Cognition, Technology & Work, 15, 283-296.
  • Brännmark, M. & Holden, R.J.. (2013). Packages of participation: Swedish employees’ experience of Lean depends on how they are involved. IIE Transactions on Occupational Ergonomics and Human Factors, 1, 93-108.
  • Holden, R.J. & Hackbart, G. (2012). From group work to teamwork: A case study of “Lean” rapid process improvement in the ThedaCare Information Technology Department. IIE Transactions on Healthcare Systems Engineering, 2, 190-201.
  • Holden, R.J., Brown, R.L., Scanlon, M.C., & Karsh, B. (2012). Modeling nurses’ acceptance of bar coded medication administration technology at a pediatric hospital. Journal of the American Medical Informatics Association, 19, 1050-1058.
  • Holden, R.J., Brown, R.L., Scanlon, M.C., & Karsh, B. (2012). Pharmacy employees’ perceptions and acceptance of bar-coded medication technology in a pediatric hospital. Research in Social & Administrative Pharmacy, 8, 509-522.
  • Holden, R.J. (2012). Social and personal normative influences on healthcare professionals to use information technology: Towards a more robust social ergonomics. Theoretical Issues in Ergonomics Science, 13, 546-569.
  • Alper, S.J., Holden, R.J., Scanlon, M.C., Patel, N.R., Kaushal, R., et al. (2012). Self-reported violations during medication administration in two pediatric hospitals. BMJ Quality & Safety, 21, 408-415. PMID. 22447818.
  • Mazzocato, P., Holden, R.J., Brommels, M., Aronsson, H., Bäckman, U., Elg, M., Thor, J. (2012). How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children’s Hospital, Stockholm, Sweden. BMC Health Services Research, 12:28,
  • Holden, R.J., Brown, R.L., Alper, S.J., Scanlon, M.C., Patel, N.R., & Karsh, B. (2011). That’s nice, but what does IT do? Evaluating the impact of bar coded medication administration by measuring changes in the process of care. International Journal of Industrial Ergonomics, 41, 370-379. PMID: 21686318.
  • Holden, R.J., Scanlon, M.C., Patel, N.R., Kaushal, R., Escoto, K.H., et al. (2011). A human factors framework and study of the effect of nursing workload on patient safety and employee quality of working life. BMJ Quality & Safety, 20, 15-24. PMID: 21228071.
  • Holden, R.J. (2011b). Lean thinking in emergency departments: A critical review. Annals of Emergency Medicine, 57, 265-278. PMID: 21035904. • Holden, R.J. (2011c). What stands in the way of technology-mediated patient safety improvements? A study of facilitators and barriers to physicians’ use of electronic health records. Journal of Patient Safety, 7, 193-203. PMID: 22064624.
  • Holden, R.J. (2011a). Cognitive performance-altering effects of electronic medical records: An application of the human factors paradigm for patient safety. Cognition, Technology, & Work, 13, 11-29. PMID: 21479125.
  • Holden, R.J., Patel, N.R., Scanlon, M.C., Shalaby, T.M., Arnold, J.M., & Karsh, B. (2010). Effects of mental demands during dispensing on perceived medication safety and employee well being: A study of workload in pediatric hospital pharmacies. Research in Social & Administrative Pharmacy, 6, 293-306. PMID: 21111387.
  • Holden, R.J. & Karsh, B. (2010). The Technology Acceptance Model: Its past and its future in health care. Journal of Biomedical Informatics, 43, 159-172. PMID: 19615467.
  • Holden, R.J. (2010). Physicians’ beliefs about using EMR and CPOE: In pursuit of a contextualized understanding of health IT use behavior. International Journal of Medical Informatics, 79, 71-80. PMID: 20071219.
  • Karsh, B., Holden, R.J., Escoto, K.H., Alper, S.J., et al. (2009). Do beliefs about hospital technologies predict nurses’ perceptions of quality of care? A study of task-technology fit in two pediatric hospitals. International Journal of Human-Computer Interaction, 25, 374-389.
  • Holden, R.J. & Karsh, B. (2009). A theoretical model of health information technology usage behaviour with implications for patient safety. Behaviour & Information Technology, 28, 21-38.
  • Holden, R.J. (2009). People or systems? To blame is human. The fix is to engineer. Professional Safety, December, 34-41. NIHMSID: 194159.
  • Holden, R.J., Or, C.K.L., Alper, S.J., Rivera, A.J., & Karsh, B. (2008). A change management framework for macroergonomic field research. Applied Ergonomics, 39, 459-474. PMID: 18417095.
  • Holden, R.J., & Karsh, B. (2007). A review of medical error reporting system design considerations and a proposed cross-level systems research framework. Human Factors, 49, 257-276. PMID: 17447667.
  • Karsh, B., Escoto, K.H., Beasley, J.W., & Holden, R.J. (2006). Toward a theoretical approach to medical error reporting system research and design. Applied Ergonomics, 37, 283-295. PMID: 16182233.
  • Karsh, B., Holden, R.J., Alper, S.J., & Or, C.K.L. (2006). A human factors engineering paradigm for patient safety: Designing to support the performance of the healthcare professional. Quality & Safety in Health Care, 15(Suppl I), i59-i65. PMID: 17142611.


Selected presentations:

  • “Understanding and Designing to Support Patient Work.” Panel presentation at Workshop on Interactive Systems in Healthcare (WISH), Washington, D.C., November 16, 2013.
  • “Crossing boundaries: Integrating mesoergonomics into the human factors agenda.” Panel presentation (with P. Waterson) at HFES Annual Meeting, San Diego, CA, October 3, 2013.
  • “Beyond the Simple Mistake: Human Factors and Nurses’ Violations of IT Use Policy.” Presented at HFES 2013 (2nd) International Symposium on Human Factors and Ergonomics in Health Care, Baltimore, MD, USA, March 12, 2013.
  • “Factors shaping the use and acceptance of health information technology: Results from studies of bar-coding technology, electronic health records, and computerized provider order entry.” Presented at HFES 2012 (1st)
  • International Symposium on Human Factors and Ergonomics in Health Care, Baltimore, MD, USA, March 12, 2012.
  • “Macroergonomics in Healthcare,” Presented at the Department of Ergonomics, KTH Royal Institute of Technology, Stockholm, Sweden, June 6, 2013.
  • “Lean Health Care: Prospects and Challenges,” Presented at the HELIX Vinn Excellence Centre, Linköping University, Linköping, Sweden, May 19, 2010.
  • “Technology-driven changes in the cognitive performance of health care work,” Presented at the Work and Organizational Psychology seminar, Department of Psychology, Stockholm University, Stockholm, Sweden, February 15, 2010.

Research Interests

Generally speaking, Dr. Holden investigates how people work. He uses this knowledge to design and evaluate solutions that support workers and improve their performance and well-being. Work is a broad concept and includes the activities of paid professionals such as nurses and other individuals such as patients and families, who invest effort toward achieving important health-related goals. Dr. Holden is particularly interested in understanding and improving:

  1. Patient work. This includes the development and testing of personal technologies, using sensor-based health monitoring, assessing patients’ home and community environments, and adapting work study methods to study patient and family activity in context.
  2. Collaborative work. This includes the use of technologies to support collaborative inter-professional and patient-clinician activities and the redesign of systems and processes to facilitate communication and team cognition.

Dr. Holden approaches these areas of inquiry by applying, adapting, or developing a variety of methods, both quantitative and qualitative. Often, he finds that complex problems require a mix of methods applied by an interdisciplinary team over time and across settings. His work has been supported by the Agency for Healthcare Research and Quality (AHRQ), the National Institute on Aging (NIA/NIH), National Institute of Mental Health (NIMH/NIH), National Center for Advancing Translational Sciences (NCATS/NIH), National Institute of Standards and Technology (NIST), the Swedish Council for Working Life and Social Research (FAS/FORTE), the Patient-Centered Outcomes Research Institute (PCORI), and the Vanderbilt Institute for Clinical and Translational Research (VICTR).

Selected examples of past and current projects:

  • Interviews, surveys, and observations of patient self-care for chronic heart failure.
  • Group interviews with patients and families about experiencing non-routine events during oncology, surgery, or invasive cardiology procedures.
  • Quantitative modeling of technology acceptance by pediatric hospital nurses and pharmacy workers.
  • Case study of a week-long rapid improvement event in a “lean” health system.
  • Semi-structured assessment of emergency room patients’ barriers to self-care.
  • Mixed-method evaluation of the implementation of lean production in Swedish hospitals.
  • Observations of nurse problem solving behavior in critical care, oncology, and medical-surgical units before and after the introduction of technology.
  • Workflow mapping of medication management processes.
  • Survey-based assessment of mental workload among physicians, nurses, pharmacists, and technicians, and assessment of the impact of workload on patient safety and employee well-being.
  • Focus groups with primary care physicians and nurses about their use and perceptions of error reporting systems.

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