Papers by Rebecca Randell
<sec> <title>UNSTRUCTURED</title> <p>Objective: Dashboards can support da... more <sec> <title>UNSTRUCTURED</title> <p>Objective: Dashboards can support data-driven quality improvement in healthcare. They visualise data in ways intended to ease cognitive load and support data comprehension, but how they are best integrated into working practices to impact patient care needs further investigation. This paper reports the findings of a realist evaluation of a web-based, interactive quality dashboard (QualDash) developed to support use of national audit data in quality improvement. Methods: QualDash was co-designed with data users and installed in eight clinical services across five healthcare organisations in England between July and December 2019. Local 'champions' were identified to support uptake and adoption. Data to evaluate QualDash were collected between August 2019 and August 2021 and consisted of (1) 148.5 hours of observations including hospital wards and clinical governance meetings, (2) logfiles that captured the extent of use of QualDash and (3) a questionnaire, based on the Technological Acceptance Model, to assess the dashboard's perceived usefulness and ease of use. Guided by the principles of realist evaluation, data were analysed to understand how, why and in what circumstances QualDash best supported use of national audit data in quality improvement. Results: The services into which QualDash was introduced varied in the amount and type of resources available to support data use. These variations, alongside early staff interactions with QualDash, shaped its use and impact during the evaluation period. Well-resourced sites with skilled audit support staff and local data management systems, continued to use established processes to access and use data. Factors constraining use of QualDash in these contexts included the use of local systems to report metrics not configured in QualDash; staff not being fully aware how QualDash could facilitate their work; and champions' initial reluctance to lead use of QualDash until some metrics were reconfigured to reflect user expectations. In services less well-resourced to use data, QualDash automated parts of their routine reporting process, streamlining the work of audit support staff, and, in some cases, it highlighted issues with data completeness that they worked to address. Furthermore, questionnaire responses indicated that QualDash was perceived as useful and easy to use despite its variable use in practice. Conclusions: Interactive, web-based dashboards, such as QualDash, have potential to support use of national audit data in quality improvement by facilitating access to and interactions with data. To optimise use and impact, findings suggest that codesign would benefit from greater scrutiny of dashboard visualisations pre-installation, by site staff knowledgeable about metric configurations. Additionally, further consideration should be given to the processes surrounding dashboard use, including data collection, that underpin user confidence in dashboard functions.</p> </sec> <sec> <title>INTERNATIONAL REGISTERED REPORT</title> <p>RR2-10.1136/bmjopen-2019-033208</p> </sec>
2018 IEEE Evaluation and Beyond - Methodological Approaches for Visualization (BELIV)
Studies in Health Technology and Informatics, 2009
Computerised clinical decision support systems (CDSS) are increasingly being used by nurses to su... more Computerised clinical decision support systems (CDSS) are increasingly being used by nurses to support their clinical practice. One of the factors which may affect how nurses use technology such as CDSS may be their clinical experience. This paper uses data from a wider study examining how nurses use CDSS to examine the role of experience in nurses' use of CDSS. Data was drawn from two sources; a secondary analysis of interviews from a study examining nurses' use of CDSS in telephone triage and the analysis of observations and interviews of nurses using CDSS in two case sites. Two themes arose from the analysis of the data; the integration of knowledge from CDSS and how experience affects CDSS use. The implications of these results are discussed in relation to our knowledge of the characteristics of the development of expertise in nursing.
Cochrane Database of Systematic Reviews
Studies in health technology and informatics, 2019
Healthcare systems worldwide are investing in networked health IT systems that link healthcare pr... more Healthcare systems worldwide are investing in networked health IT systems that link healthcare providers across multiple organisations. Much of the policy arguments in favour of such investment rely on the assumption that networked health IT will lead to improved patient safety. As part of the first stage of a realist review to determine how and in what contexts networked, inter-organisational health IT does lead to improved patient safety, we elicited stakeholders' theories from the literature that reveal possible answers to this question. A key mechanism appears to be that the information provided supports improved decision making. Greatest benefits are likely to be found in relation to medication information, in scenarios where the patient is less able to provide accurate information about their medications themselves. However, access and use of this information depends on ease of access, clinicians' perception of the likelihood that the desired information will be availa...
Studies in health technology and informatics, 2016
Health systems around the world are investing increasing effort in monitoring care quality and sa... more Health systems around the world are investing increasing effort in monitoring care quality and safety. Dashboards can support this process, providing summary data on processes and outcomes of care, making use of data visualization techniques such as graphs. As part of a study exploring development and use of dashboards in English hospitals, we interviewed senior managers across 15 healthcare providers. Findings revealed substantial variation in sophistication of the dashboards in place, largely presenting retrospective data items determined by national bodies and dependent on manual collation from a number of systems. Where real time systems were in place, they supported staff in proactively managing quality and safety.
BMJ Open, 2021
Introduction Falls are the most common type of safety incident reported by acute hospitals and ca... more Introduction Falls are the most common type of safety incident reported by acute hospitals and can cause both physical (eg, hip fractures) and non-physical harm (eg, reduced confidence) to patients. It is recommended that, in order to prevent falls in hospital, patients should receive a multifactorial falls risk assessment and be provided with a multifactorial intervention, tailored to address the patient’s identified individual risk factors. It is estimated that such an approach could reduce the incidence of inpatient falls by 25%–30% and reduce the annual cost of falls by up to 25%. However, there is substantial unexplained variation between hospitals in the number and type of assessments undertaken and interventions implemented. Methods and analysis A realist review will be undertaken to construct and test programme theories regarding (1) what supports and constrains the implementation of multifactorial falls risk assessment and tailored multifactorial falls prevention interventi...
Studies in health technology and informatics, 2019
Policy makers and health system managers in many countries are advocating the deployment of inter... more Policy makers and health system managers in many countries are advocating the deployment of inter-operable health information technology systems, spanning organisations in a health economy, believing that they will be clinically effective. The case for investments has not, however, been made to date. This paper presents early results from a systematic review of the effects of inter-operable systems on patient safety. The review uses the realist synthesis method, which focuses on evidence about the decisions and actions that link interventions and outcomes, as well as the evidence about those outcomes. The evidence base is sufficient to identify plausible arguments for investments in inter-operable systems. This said, there is limited empirical evidence about each of the steps in the sequences of events. We comment on implications for the design of sustainable socio-technical solutions. We suggest that current gaps in the evidence base are in areas where informatics field methods can...
In higher education, programs in specialization in Health Informatics, Medical Informatics, Healt... more In higher education, programs in specialization in Health Informatics, Medical Informatics, Health Engineering are continuously growing. In this research, almost 1800 universities and colleges were checked in order to find related educational programs at all academic levels. Approximately 1000 academic leading degree programs in those domains have already been identified. The detailed records of the related educational programs will help to understand the current educational needs and priorities. Although, the growth of the related educational programs is not the same in each country.
With the increasing adoption of interactive systems in healthcare, there is a need to ensure that... more With the increasing adoption of interactive systems in healthcare, there is a need to ensure that the benefits of such systems are formally evaluated. Traditionally quantitative research approaches have been used to gather evidence on measurable outcomes of health technology. Qualitative approaches have also been used to analyze how or why particular interventions did or did not work in specific healthcare contexts. Mixed methods research provides a framework for carrying out both quantitative and qualitative approaches within a single research study. In this paper an international group of four informatics scholars illustrate some of the benefits and challenges of using mixed methods in evaluation. The diversity of the research experience provides a broad overview of approaches in combining robust analysis of outcome data with qualitative methods that provide an understanding of the processes through which, and the contexts in which, those outcomes are achieved. This paper discusse...
IEEE Transactions on Visualization and Computer Graphics
Fig. 1. A dashboard with four dynamically generated QualCards (left) including one for the Mortal... more Fig. 1. A dashboard with four dynamically generated QualCards (left) including one for the Mortality metric (a); and an expansion of the Mortality QualCard with categorical (b), quantitative (c) and temporal (d) subsidiary views, which are customisable via a popover (e).
Proceedings of the 51st Hawaii International Conference on System Sciences, 2018
Prior research has studied the impact of use of a single computing device, such as a desktop or a... more Prior research has studied the impact of use of a single computing device, such as a desktop or a tablet computer, on patient-provider communication. While some studies have considered how contextual features such as room layout and software interface design affect computer use and patient-provider interaction in the exam room, it is not known how the choice of computing device impacts patient-provider communication. We conducted a within-participant experimental study. Three physicians participated in nine simulated consultations, using a desktop computer, a tablet computer, and a tabletop computer. Consultations were video-recorded and the video data were analyzed using framework analysis. Findings reveal the choice of device impacts the extent to which the consultation is patient-centered. To better support patient-centered communication, a large adjustable horizontal screen can facilitate eye contact and patient engagement. Findings also highlight the need for design of future systems to consider the characteristics of both openness and privacy.
BMJ Open
IntroductionNational audits are used to monitor care quality and safety and are anticipated to re... more IntroductionNational audits are used to monitor care quality and safety and are anticipated to reduce unexplained variations in quality by stimulating quality improvement (QI). However, variation within and between providers in the extent of engagement with national audits means that the potential for national audit data to inform QI is not being realised. This study will undertake a feasibility evaluation of QualDash, a quality dashboard designed to support clinical teams and managers to explore data from two national audits, the Myocardial Ischaemia National Audit Project (MINAP) and the Paediatric Intensive Care Audit Network (PICANet).Methods and analysisRealist evaluation, which involves building, testing and refining theories of how an intervention works, provides an overall framework for this feasibility study. Realist hypotheses that describe how, in what contexts, and why QualDash is expected to provide benefit will be tested across five hospitals. A controlled interrupted ...
Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine
Safe and successful surgery depends on effective teamwork between professional groups, each playi... more Safe and successful surgery depends on effective teamwork between professional groups, each playing their part in a complex division of labour. This article reports the first empirical examination of how introduction of robot-assisted surgery changes the division of labour within surgical teams and impacts teamwork and patient safety. Data collection and analysis was informed by realist principles. Interviews were conducted with surgical teams across nine UK hospitals and, in a multi-site case study across four hospitals, data were collected using a range of methods, including ethnographic observation, video recording and semi-structured interviews. Our findings reveal that as the robot enables the surgeon to do more, the surgical assistant’s role becomes less clearly defined. Robot-assisted surgery also introduces new tasks for the surgical assistant and scrub practitioner, in terms of communicating information to the surgeon. However, the use of robot-assisted surgery does not red...
BMJ Open
ObjectiveTo capture stakeholders’ theories concerning how and in what contexts robot-assisted sur... more ObjectiveTo capture stakeholders’ theories concerning how and in what contexts robot-assisted surgery becomes integrated into routine practice.DesignA literature review provided tentative theories that were revised through a realist interview study. Literature-based theories were presented to the interviewees, who were asked to describe to what extent and in what ways those theories reflected their experience. Analysis focused on identifying mechanisms through which robot-assisted surgery becomes integrated into practice and contexts in which those mechanisms are triggered.SettingNine hospitals in England where robot-assisted surgery is used for colorectal operations.ParticipantsForty-four theatre staff with experience of robot-assisted colorectal surgery, including surgeons, surgical trainees, theatre nurses, operating department practitioners and anaesthetists.ResultsInterviewees emphasised the importance of support from hospital management, team leaders and surgical colleagues. T...
Methods of Information in Medicine
Summary Objective: This paper aims to understand the nature of medical error in highly technologi... more Summary Objective: This paper aims to understand the nature of medical error in highly technological environments and argues that a comparison with aviation can blur its real understanding. Methods: This study is a comparative study between the notion of error in health care and aviation based on the author’s own ethnographic study in intensive care units and findings from the research literature on errors in aviation. Results and Conclusions: Failures in the use of medical technology are common. In attempts to understand the area of medical error, much attention has focused on how we can learn from aviation. This paper argues that such a comparison is not always useful, on the basis that (i) the type of work and technology is very different in the two domains; (ii) different issues are involved in training and procurement; and (iii) attitudes to error vary between the domains. Therefore, it is necessary to look closely at the subject of medical error and resolve those questions lef...
BMJ Open
ObjectiveTo assess developments over time in the capture, curation and use of quality and safety ... more ObjectiveTo assess developments over time in the capture, curation and use of quality and safety information in managing hospital services.SettingFour acute National Health Service hospitals in England.Participants111.5 hours of observation of hospital board and directorate meetings, and 72 hours of ward observations. 86 interviews with board level and middle managers and with ward managers and staff.ResultsThere were substantial improvements in the quantity and quality of data produced for boards and middle managers between 2013 and 2016, starting from a low base. All four hospitals deployed data warehouses, repositories where datasets from otherwise disparate departmental systems could be managed. Three of them deployed real-time ward management systems, which were used extensively by nurses and other staff.ConclusionsThe findings, particularly relating to the deployment of real-time ward management systems, are a corrective to the many negative accounts of information technology ...
Information Visualization
Large, high-resolution displays allow orders of magnitude more data to be visualized at a time th... more Large, high-resolution displays allow orders of magnitude more data to be visualized at a time than ordinary computer displays. Previous research is inconclusive about the circumstances under which large, high-resolution displays are beneficial and lacks behavioural data to explain inconsistencies in the findings. We conducted an experiment in which participants searched maps for densely or sparsely distributed targets, using 2-million-pixel (0.4 m × 0.3 m), 12-million-pixel (1.3 m × 0.7 m) and 54-million-pixel (3.0 m × 1.3 m) displays. Display resolution did not affect the speed at which dense targets were found, but participants found sparse targets in easily identifiable regions of interest 30% faster with the 54-million-pixel display than with the other displays. This was because of the speed advantage conferred by physical navigation and the fact that the whole dataset fitted onto the 54-million-pixel display. Contrary to expectations, participants found targets at a similar sp...
Health Services and Delivery Research
Background The implementation of robot-assisted surgery (RAS) can be challenging, with reports of... more Background The implementation of robot-assisted surgery (RAS) can be challenging, with reports of surgical robots being underused. This raises questions about differences compared with open and laparoscopic surgery and how best to integrate RAS into practice. Objectives To (1) contribute to reporting of the ROLARR (RObotic versus LAparoscopic Resection for Rectal cancer) trial, by investigating how variations in the implementation of RAS and the context impact outcomes; (2) produce guidance on factors likely to facilitate successful implementation; (3) produce guidance on how to ensure effective teamwork; and (4) provide data to inform the development of tools for RAS. Design Realist process evaluation alongside ROLARR. Phase 1 – a literature review identified theories concerning how RAS becomes embedded into practice and impacts on teamwork and decision-making. These were refined through interviews across nine NHS trusts with theatre teams. Phase 2 – a multisite case study was cond...
Archives of Pathology & Laboratory Medicine, 2016
Context.—Light microscopy (LM) is considered the reference standard for diagnosis in pathology. W... more Context.—Light microscopy (LM) is considered the reference standard for diagnosis in pathology. Whole slide imaging (WSI) generates digital images of cellular and tissue samples and offers multiple advantages compared with LM. Currently, WSI is not widely used for primary diagnosis. The lack of evidence regarding concordance between diagnoses rendered by WSI and LM is a significant barrier to both regulatory approval and uptake. Objective.—To examine the published literature on the concordance of pathologic diagnoses rendered by WSI compared with those rendered by LM. Data Sources.—We conducted a systematic review of studies assessing the concordance of pathologic diagnoses rendered by WSI and LM. Studies were identified following a systematic search of Medline (Medline Industries, Mundelein, Illinois), Medline in progress (Medline Industries), EMBASE (Elsevier, Amsterdam, the Netherlands), and the Cochrane Library (Wiley, London, England), between 1999 and March 2015. Conclusions.—...
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Papers by Rebecca Randell