Quantifying the qualitative with epistemic20190618 111092 12hm83

Health care is fundamentally about people, and therefore, engineering approaches for studying healthcare systems must consider the perspective, concepts and methods offered by the human factors and ergonomics (HFE) discipline. HFE analysis is often qualitative to provide in-depth description of work systems and processes. To deepen our understanding of care processes, we propose the next level of analysis, i.e. quantification of qualitative data. Here, we describe epistemic network analysis (ENA) as a novel method to quantify qualitative data and present a case study applying ENA to assess communication in a primary care team. One high-performing primary care team consisting of a physician, nurse, medical assistant and unit clerk was observed for 15 hours. We analyzed task-allocation communications and identified the sender, receiver, synchronicity and acceptance. We used logistic regression and ENA to evaluate sender, receiver and synchronicity impact on task acceptance. The physician and unit clerk were most successful allocating tasks. Future work should consider the role of synchronous, interruptive communication as potentially useful in time-critical tasks and further investigate the role of the unit clerk. HFE researchers should consider ENA as a tool to expand and deepen their understanding of care processes by quantifying qualitative data.

Applied Sciences, 2022

Healthcare teams act in a very complex environment and present extremely peculiar features since they are multidisciplinary, work under quickly changing conditions, and often stay together for a short period with a dynamically fluctuating team membership. Thus, in the broad discussions about the future of healthcare, the strategy for improving providers’ collaboration and team dynamics is becoming a central topic. Within this context, this paper aims to discuss different viewpoints about the application of network science to teamworking. Our results highlight the potential benefits deriving from network science-enabled analysis, and also show some preliminary empirical evidence through a real case study. In so doing, we intend to stimulate discussions regarding the implications of network science in the investigation and improvement of healthcare teams. The intention is to pave the way for future research in this context by suggesting the potential advantages of healthcare teamwork analysis, as well as recognising its challenges and threats.

BMC Health Services …, 2009

Background: Emergency departments (EDs) are high pressure health care settings involving complex interactions between staff members in providing and organising patient care. Without good communication and cooperation amongst members of the ED team, quality of care is at risk. This study examined the problem-solving, medication advice-seeking and socialising networks of staff working in an Australian hospital ED.

Work (Reading, Mass.), 2012

Work in organizations requires a minimum level of consensus on the understanding of the practices performed. To adopt technological devices to support the activities in environments where work is complex, characterized by the interdependence among a large number of variables, understanding about how work is done not only takes an even greater importance, but also becomes a more difficult task. Therefore, this study aims to present a method for modeling of work in complex systems, which allows improving the knowledge about the way activities are performed where these activities do not simply happen by performing procedures. Uniting techniques of Cognitive Task Analysis with the concept of Work Process, this work seeks to provide a method capable of providing a detailed and accurate vision of how people perform their tasks, in order to apply information systems for supporting work in organizations.

Work

Coordinating care for hospitalized patients requires the use of multiple sources of information. Using a macroergonomic framework (i.e. the work system model), we conducted interviews and observations of care managers involved in care coordination across transitions of care. When information is distributed across multiple health IT applications, care managers experience a range of challenges, including organizational barriers, technology design problems, skills and knowledge issues, and task performance demands (i.e. issues related to individual information processing and management and sharing of information). These challenges can be used as a checklist to evaluate the proposed IT infrastructure that will allow the integration of multiple health IT applications and, therefore, support coordination across transitions of care.

2011

Given the complexity of healthcare and the ‘people’ nature of healthcare work and delivery, STSA (Sociotechnical Systems Analysis) research is needed to address the numerous quality of care problems observed across the world. This paper describes open STSA research areas, including workload management, physical, cognitive and macroergonomic issues of medical devices and health information technologies, STSA in transitions of care, STSA of patient-centered care, risk management and patient safety management, resilience, and feedback loops between event detection, reporting and analysis and system redesign.

Communications of the Association for Information Systems

Lack of communication is a leading root cause of sentinel events (any unanticipated event in a healthcare setting resulting in a patient's death or serious physical or psychological injury and not related to the natural course of the patient's illness). Deficits in communication of essential information when patients transfer between different healthcare services can cause interruptions in the continuity of care, inappropriate treatment, and potential harm to the patient. Research has shown that providing the right information about the right patient to healthcare providers at the right time could eliminate up to 18 percent of the general adverse events. In this paper, we assess the applicability of the work system framework (WSF) to evaluate the health information-exchange processes that occur when patients are transferred from home healthcare services and nursing homes to hospitals. From our analysis, we identify possible improvements in both work practices and the flow of health information among healthcare providers. Further, we propose a modified work system snapshot template tailored for evaluating the health information-exchange process. The proposed modifications include changing the WSF terminology to healthcare terms (including patient safety indicators) and adding new performance measurement indicators that are relevant to healthcare.

International Journal of Medical Informatics, 2013

Background: One of the main challenges to hospital patient flow and treatment includes the lack of a patient-centered approach, which in turn contributes to non-effective teamwork communication. Objectives: To introduce patient-centered approach by implementing electronic clinical pathways to support more effective teamwork communication. To study how to enhance teamwork communication in healthcare by implementing electronic clinical pathways. Methods: We propose a research model, integrating the Donbedian model and the socio-technical theory, to investigate the factors that influence teamwork communication in healthcare. This research applied a quantitative approach using a survey method that was designed along the same principles as in the related work. Preliminary data collection was conducted using the survey method for problem formulation. Results: Designed and developed a model for implementing electronic clinical pathways to enhance teamwork communication in healthcare. Conclusion: This study provides recommendations to hospitals to enhance teamwork communication in healthcare by implementing electronic clinical pathways.

International Journal of Medical Informatics, 2011

Purpose: To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager's work domain.