Designing and Evaluating New Technologies for Usability and Accessibility: The Michigan Workforce Background Check System

Background checks help protect loved ones and health care employees.

One of the most critical aspects of operating long-term care facilities is to assure the safety and well-being of elderly and disabled patients.

A team of MSU researchers at Usability/Accessibility Research and Consulting (UARC) has been working for over ten years with federal and state officials, academic colleagues, and the private sector to design, implement, customize, and enhance the Michigan Workforce Background Check system.

The State of Michigan program uses an online system to assist in determining suitability of prospective employees, independent contractors, or individuals seeking clinical privileges in long-term care settings. The goal is to provide a comprehensive background check that is accurate, easy to use, secure, low cost, and capable of reasonably swift turnaround time.

Phase 1: Project Development (2005 to 2008)

The Medicare Prescription Drug Improvement and Modernization Act of 2003 provided funding for seven states, including Michigan, to pilot the creation of a coordinated, nationwide system of state and federal criminal background checks to improve screening for workers in long-term care jobs.

In Michigan, the original $5.1 million, three-year grant began as a partnership between MSU (Principal Investigators: Drs. Lori Post, James Oehmke, and Sarah Swierenga), the Michigan Department of Community Health, and the Michigan Department of Human Services (both now contained in the Michigan Department of Health and Human Services), the Office of Services to the Aging, and the Michigan State Police. The goal was to design and develop a system that could integrate existing State Police and FBI systems with other registries and databases.

Prior to 2005 there was little coordinated information available to nursing home, assisted living, or hospice employers who wanted to verify the criminal or civil history of potential employees. Specific information was held by individual entities and turnaround time was as much as six to eight weeks per request.

Rapid technological developments at that time were bringing into focus both the ability and the need to consolidate information and design a user-friendly system that could capture accurate, reliable evidence from multiple sources.

User-Centered Design

Swierenga led an MSU development team that included usability specialists who met with users to gather user interface requirements. They assessed the skill disparities among potential end-users, from those with low or limited computer skills to human resources personnel with more extensive technical skills, and determined that preliminary design discussions were critical.

"Co-designing and co-creating with the development team was a major part of our success," said Swierenga. She is now the principal investigator at MSU, and leads the research team that developed the Michigan Workforce Background Check system. Her primary research focus is the application of user-centered design principles throughout an iterative system development process environment. These methodologies include usability testing, accessibility compliance inspections, focus groups, and expert reviews, as part of the system design and development effort.

Multiple partners participate in the Michigan Workforce Background Check System.

"User-centered design is imperative for deploying usable, cost-effective systems. This project involved the creation of a system that is complex from a technical and business process perspective, but must be simple to use at the other end by a diverse group of people with varying computer access and/or proficiencies," said Swierenga.

Among the hallmarks of the collaboration was the participation of providers who would use the system to accomplish their prospective employee background checks. According to Swierenga, working with external partners who use the system is a key component for co-designing a successful system.

Mary Bouchard, human resources coordinator at Burcham Hills, a not-for-profit retirement community in East Lansing, participated in user testing with the integrated team from MSU, the State of Michigan, and area long-term care employers. According to Bouchard, ease of accessing and using the website, accuracy and expediency, as well as timely notifications of results and arrests, were all high priorities as a user.

"We have several important steps in the employment process to ensure we are doing our due diligence in hiring and employment for the care, service, and safety of residents. The background check and ongoing monitoring is important to us, and we take comfort in knowing that if there are employee arrests, we are notified immediately so that we can make appropriate, timely decisions," Bouchard said. "MSU is a very active participant in the design, maintenance, and upgrade of the MWBC website. I have found the contacts at MSU to be very thorough and thoughtful."

A Model for Federal Legislation

The Patient Safety and Abuse Prevention Act of 2007 was introduced in the U.S. Senate, and the Michigan pilot project was cited as the most comprehensive in terms of system functionality and cost-benefit analysis. This dramatic improvement was achieved mainly through innovative communication protocols among the Michigan State Police, the digital fingerprinting vendor, and the Michigan Workforce Background Check online system. Michigan Senator Debbie Stabenow was one of the original co-sponsors of the bill.

"I am proud that much of this legislation is modeled after the successful Michigan pilot program, and working together we can expand on its progress," said Senator Stabenow in a 2007 news release posted on MSU Today^[1].

The Act required each state that screens direct access employees to establish procedures for conducting screenings and background checks, monitor compliance with procedures, provide an independent process for employees to appeal or dispute the accuracy of the information obtained from the screenings or background check, create a system for determining appropriate penalties for violations, specify offenses (for example, "violent crimes," "fraud," etc.), and develop "rap back" capabilities for notification of new charges against existing employees and subsequent criminal convictions.

World Usability Day (WUD) is the largest gathering of industry professionals, academics, government and private sector leaders, and students. The annual event raises awareness of usability, user experience, user-centered design, and accessibility. Each November, the usability community holds more than 150 WUD activities in over 40 countries. The worldwide event was founded in 2005 to explore ways to ensure that the services and products important to life are easy to access and simple to use.

MSU's annual conference recognizing World Usability Day is hosted by Usability/Accessibility Research and Consulting (UARC), and draws preeminent experts as speakers and attendees from all around the world. More information and past presentations are available in the Events section of usability.msu.edu.

The State of Michigan officially supported the bill, as did the AARP, the Elder Justice Coalition, the Healthcare Association of Michigan, Michigan Assisted Living Association, Michigan Home Health Association, and others.

Background Check National Demonstration Program

Swierenga subsequently collaborated with Fuad Abujarad and Post, both at the Yale School of Medicine, and Toni A. Dennis, who served as the Workforce Background Check program manager in the Michigan Department of Licensing and Regulatory Affairs until April 2015, to enhance the Workforce Background Check system under the Background Check National Demonstration Program.

Funded with an additional $1.5 million grant (2013-2016) authorized by the Affordable Care Act of 2010, the program aims to expand the scope of background check requirements to include personal care workers, conduct a pilot of the FBI rap back, expand the Nurse Aide Abuse Registry to include surrounding states, prepare the online system to accept electronic records from Michigan State Police, and establish a legislative advisory committee.

According to Dennis, "Our collaboration with Michigan State University and the Michigan State Police has allowed us to develop a very important and successful tool to protect our parents, other relatives, and friends from criminal predators. I regularly receive calls from other states who are interested in implementing Michigan's background check processes."

"It's been an interesting and rewarding partnership," said Swierenga. "We formed a high performance research and development team early on that remains intact over ten years later; our shared strategic vision to do what we can to protect vulnerable adults underpins the research program. Each success continues to build up to the next step forward. We look forward to sustaining the collaboration."

More information is available at the project website: usability.msu.edu/research/projects.

Sources

1. Michigan State University. (2007, June 27). MSU's long-term care background check system becomes model for federal legislation. MSU Today. Retrieved from http://msutoday.msu.edu/news/2007/msu-4/Return to text