Digital technologies: An exploratory study of their role in the resilience of healthcare services

Managing operational resilience during the implementation of digital transformation in healthcare organisational practices

PURPOSE

The aim of this study is to investigate ways in which healthcare organisations can successfully maintain operational resilience within intricate and varied engagements during digital transformation processes.

DESIGN/METHODOLOGY/APPROACH

The present research applied cultural-historical activity theory as the theoretical framework and the ethnographic account as an approach and strategy to interpret and understand the operational resilience of digital transformation tools in daily practices. Fieldwork was based on the research technique of shadowing, whereby the researcher closely accompanied the participants to record their conduct, activities and exchanges.

FINDINGS

Research results propose that effective operational resilience management in the implementation of digital transformation projects is based on (1) identifying and interpreting internal contradictions in everyday interactions as opportunities for capability developments; (2) navigating through multiple sites in fast and improvised movements, which derives in distributed and emergent practices; (3) interplaying between dyadic interactions and networked dependencies, which is achieved through the articulation of varied interests and (4) implementing novel intermediary tools, roles and regulations that facilitate the reduction of disturbances.

ORIGINALITY/VALUE

The propositions of the present study indicate that the management of operational resilience extends beyond conventional adaptive and socio-technical models in healthcare services. The study emphasises the significance of expressing and converting differing interests into mutual advantages. It additionally demonstrates the intricacy of this obstacle, as it entails navigating through uncertain information, concealed interpretations and conflicting interests.

The impact of digital technology use on nurses' professional identity and relations of power: a literature review

AIM

This study seeks to review how the use of digital technologies in clinical nursing affects nurses' professional identity and the relations of power within clinical environments.

DESIGN

Literature review.

DATA SOURCES

PubMed and CINAHL databases were searched in April 2023.

METHODS

We screened 874 studies in English and German, of which 15 were included in our final synthesis reflecting the scientific discourse from 1992 until 2023.

RESULTS

Our review revealed relevant effects of digital technologies on nurses' professional identity and power relations. Few studies cover outcomes relating to identity, such as moral agency or nurses' autonomy. Most studies describe negative impacts of technology on professional identity, for example, creating a barrier between nurses and patients leading to decreased empathetic interaction. Regarding power relations, technologically skilled nurses can yield power over colleagues and patients, while depending on technology. The investigation of these effects is underrepresented.

CONCLUSION

Our review presents insights into the relation between technology and nurses' professional identity and prevalent power relations. For future studies, dedicated and critical investigations of digital technologies' impact on the formation of professional identity in nursing are required.

IMPLICATIONS FOR THE PROFESSION

Nurses' professional identity may be altered by digital technologies used in clinical care. Nurses, who are aware of the potential effects of digitized work environments, can reflect on the relationship of technology and the nursing profession.

IMPACT

The use of digital technology might lead to a decrease in nurses' moral agency and competence to shape patient-centred care. Digital technologies seem to become an essential measure for nurses to wield power over patients and colleagues, whilst being a control mechanism. Our work encourages nurses to actively shape digital care.

REPORTING METHOD

We adhere to the JBI Manual for Evidence Synthesis where applicable. EQUATOR reporting guidelines were not applicable for this type of review.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Identifying system adaptations to overcome technology-based workflow challenges in a telephone triage organization

Call-center-based telephone triage is an example of a complex sociotechnical system relying on successful interactions between patients, callers, and the integration of many digital technologies. Digital technologies such as computer decision support systems are used to standardize triage outcomes with little consideration of how these unique healthcare systems adapt to maintain functionality in response to real-world operating challenges. Using structured observations of call handlers in two call centers and guided by usability heuristics and the concept of 'workarounds', this paper aims to investigate the effects of technology design on workflow and system adaptations. Opportunities for improvement are highlighted, particularly, assessment prompts, and updating software to reflect dynamic real-world situations. Interactions between system components, especially technological and organizational processes affected workflow, making adaptations at the individual and organizational levels necessary to ensure callers could be triaged safely. System designers could consider these findings to improve systems and procedures during challenging periods.

Workspace Layout for Resilient Performance using Social Network Analysis: A Case Study

Purpose: To present the social network analysis-based approach used to create a new workspace layout for three hospital services as part of a campus expansion at a large tertiary care public hospital. Objective: To analyze the relationships among service members across four healthcare resilience abilities (monitor, anticipate, respond, and learn) and utilize network metrics to indicate the suitability of a shared workspace layout for the services. Background: The hospital expanded by 70%, providing space for relocating key services-the rapid response team, medical on-call team, and nursing supervision. Initial observations suggested a shared workspace layout based on anecdotal evidence. Method: Stakeholders have reached a consensus on a three-stage process to assess the suitability of a shared workspace layout for these services: first, collecting data on social interactions with a focus on resilience abilities; second, presenting layout alternatives based on sociograms; and third, evaluating these alternatives and devising a strategy for allocating personnel to shifts based on a resilience score derived from social network metrics. Case Study: The examination of social network metrics allowed identifying key individuals contributing to the overall resilience of the three services. Sociograms provided visual representations of how these individuals were spatially distributed within the shared layout. Discussion: The process was designed to shape a resilient layout and incorporated initial data, preferences, and constraints into layout proposals. Additionally, it utilized a resilience score from existing literature to formulate a strategy for staff allocation to shifts, ensuring consistent collective resilience ability across all shifts.

Comparison of proactive and reactive interaction modes in a mobile robotic telecare study

Mobile robotic telepresence systems require that information about the environment, the task, and the robot be presented to a remotely located user (operator) who controls the robot for a specific task. In this study, two interaction modes, proactive and reactive, that differ in the way the user receives information from the robot, were compared in an experimental system simulating a healthcare setting. The users controlled a mobile telepresence robot that delivered and received items (medication, food, or drink), and also obtained metrics (vital signs) from a simulated patient while the users performed a secondary healthcare-related task (they compiled health records which were displayed to them on the screen and answered related questions). The effect of the two interaction modes on overall performance and user perception was evaluated through a within-participant study design conducted with 50 participants belonging to two different types of populations (with and without a technological background). Efficiency, effectiveness, understanding, satisfaction, and situation awareness were defined as the dependent variables measured both objectively and subjectively. The proactive mode increased user performance, and understanding of the system and reduced the workload compared to the reactive mode. However, several of the users valued the option of increased user control experienced in the reactive mode. We, therefore, proposed design suggestions to highlight some of the benefits of factoring the reactive mode into the design as a hybrid mode.

Resilience of hospitals in an age of disruptions: a systematic literature review on resources and capabilities

Hospitals play a critical role in ensuring continuous and effective healthcare delivery, especially during crises. However, the COVID-19 pandemic exposed vulnerabilities in hospital systems, prompting a need to enhance resilience-the ability to withstand, absorb, respond to, recover from, and learn from disasters. A systematic literature review, grounded in the resource-based view, identified organizational characteristics, in terms of resources and capabilities, and their synergistic effects that bolster hospital resilience. The results demonstrate that digital technologies impact on anticipation and adaptation abilities, organizational capabilities to reorganize roles, tasks, and spaces enhance adaptability, and Inter-organizational collaborations increase the responsiveness of the hospitals. The study provides substantial theoretical and practical contributions. It expands knowledge of hospital resilience in light of recent disruptive events and promotes integration capabilities as determinants for the majority of resilience dimensions. All organisational and inter-organisational collaboration, cooperation, and coordination are deemed crucial for hospital resilience.

Impact of industry 4.0 on healthcare systems of low- and middle- income countries: a systematic review

Purpose

A growing body of empirical research has emerged, focused on leveraging Industry 4.0 technologies to develop and optimise systems within various operational contexts, including healthcare delivery. However, even though a significant number of studies have been published on application of digital technologies in enhancing delivery and health outcomes of health systems, systematic studies that review how extensively these technologies have been applied within a low- and middle-income economies' context remain scarce in the literature. This work attempts to close that gap by investigating the impact of industry 4.0 on healthcare systems in emerging economies.

Methods

The study follows a systematic review approach and uses PRISMA guidelines to conduct the research and synthesise its findings. A final sample of 72 articles is selected for in-depth review following a systematic screening from an initial list of 597 results.

Results

The study successfully synthesises the latest research in the subject area and reveals that, hitherto, approaches to use of digital tools have been fragmented and thus unable to provide holistic optimisation solutions for healthcare systems in low-resource settings. The analysis exposes a heavy skew towards adoption of mobile health and telemedicine technologies, with conspicuous research gaps in the use of augmented reality, additive manufacturing as well as simulation and digital twin technologies.

Conclusions

The study provides researchers, health-care practitioners and systems engineers with knowledge on the state-of-the-art in healthcare systems optimisation and points out research gaps that may be addressed through future empirical studies.

A Scoping Review of Integrated Medical Devices and Clinical Decision Support in the Acute Care Setting

BACKGROUND

Seamless data integration between point-of-care medical devices and the electronic health record (EHR) can be central to clinical decision support systems (CDSS).

OBJECTIVE

The objective of this scoping review is to (1) examine the existing evidence related to integrated medical devices, primarily medication pump devices, and associated clinical decision support (CDS) in acute care settings and (2) to identify how acute care clinicians may use device CDS in clinical decision-making. The rationale for this review is that integrated devices are ubiquitous in the acute care setting, and they generate data that may help to contribute to the situational awareness of the clinical team necessary to provide individualized patient care.

METHODS

This scoping review was conducted using the Joanna Briggs Institute Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extensions for Scoping Review guidelines. PubMed, CINAHL, IEEE Xplore, and Scopus databases were searched for scholarly, peer-reviewed journals indexed between January 1, 2010 and December 31, 2020. A priori inclusion criteria were established.

RESULTS

Of the 1,924 articles screened, 18 were ultimately included for synthesis, and primarily included articles on devices such as intravenous medication pumps and vital signs machines. Clinical alarm burden was mentioned in most of the articles, and despite not including the term "medication" there were many articles about smart pumps being integrated with the EHR. The Revised Technology, Nursing & Patient Safety Conceptual Model provided the organizational framework. Ten articles described patient assessment, monitoring, or surveillance use. Three articles described patient protection from harm. Four articles described direct care use scenarios, all of which described insulin administration. One article described a hybrid situation of patient communication and monitoring. Most of the articles described devices and decision support primarily used by registered nurses (RNs).

CONCLUSION

The articles in this review discussed devices and the associated CDSS that are used by clinicians, primarily RNs, in the daily provision of care for patients. Integrated device data provide insight into user-device interactions and help to illustrate health care processes, especially the activities when providing direct care to patients in an acute care setting. While there are CDSS designed to support the clinician while working with devices, RNs and providers may disregard this guidance, and defer to their own expertise. Additionally, if clinicians perceive CDSS as intrusive, they are at risk for alarm and alert fatigue if CDSS are not tailored to sync with the workflow of the end-user. Areas for future research include refining inclusion criteria to examine the evidence for devices and their CDS that are most likely used by other groups' health care professionals (i.e., doctors and therapists), using integrated device metadata and deep learning analytics to identify patterns in care delivery, and decision support tools for patients using their own personal data.

Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review

Despite the increasing utilization of lean practices and digital technologies (DTs) related to Industry 4.0, the impact of such dual interventions on healthcare services remains unclear. This study aims to assess the effects of those interventions and provide a comprehensive understanding of their dynamics in healthcare settings. The methodology comprised a systematic review following the PRISMA guidelines, searching for lean interventions supported by DTs. Previous studies reporting outcomes related to patient health, patient flow, quality of care, and efficiency were included. Results show that most of the improvement interventions relied on lean methodology followed by lean combined with Six Sigma. The main supporting technologies were simulation and automation, while emergency departments and laboratories were the main settings. Most interventions focus on patient flow outcomes, reporting positive effects on outcomes related to access to service and utilization of services, including reductions in turnaround time, length of stay, waiting time, and turnover time. Notably, we found scarce outcomes regarding patient health, staff wellbeing, resource use, and savings. This paper, the first to investigate the dual intervention of DTs with lean or lean–Six Sigma in healthcare, summarizes the technical and organizational challenges associated with similar interventions, encourages further research, and promotes practical applications.

Impact analysis of COVID-19 outbreak on cold supply chains of perishable products using a SWARA based MULTIMOORA approach

The present study aims to analyze the impact of the COVID-19 outbreak resulting in Cold Supply Chain (CSC) disruptions and shed new light on the potential opportunities yielded from the pandemic. In addition, the work also aims to explore the most appropriate strategies to minimize CSC disruption due to the COVID-19 outbreak and to repurpose to create conditions as they were before the pandemic. The impact of the COVID-19 outbreak on CSCs has been analyzed theoretically and empirically, considering seven broader assessment criteria. To diminish the disruption due to COVID-19, eight of the most appropriate remedial strategies have been proposed in this study. A new hierarchical model was developed to articulate the analysis and consolidate various issues pertinent to CSC disruption caused by COVID-19 in one frame. The developed model was analyzed using a hybrid approach of SWARA-based MULTIMOORA methods. The SWARA method has been used to analyze the significance of considered assessment criteria, while the MULTIMOORA method has been used to analyze the mutual importance of proposed strategies. The findings of this paper show that ‘structural impact’ and ‘business and financial impact’ are the two most affected traits of CSC during the COVID-19 pandemic throughout the world. Meanwhile, the strategies ‘development of safe and healthier work scenario for partners of the cold chain’ and ‘successful monitoring and implementation of COVID-19 protocols’ are the two most important proposed strategies that might help management to mitigate the influence of the COVID-19 outbreak on CSCs. Findings of this research enable CSC managers and policy-makers to develop potential and robust plans for their operations to respond to disruptive situations like COVID-19 and turn them into opportunities for organizational growth and improving the health of society.

Resilience development and digitalization of the healthcare supply chain: an exploratory study in emerging economies

Purpose

Healthcare supply chains (HSCs) have been adopting Industry 4.0 (I4.0) as a means to boost their resilience. The first objective of this study is to identify the effect of contextual variables of HSCs on resilience development and I4.0 adoption. Second, the paper examines the pervasiveness of the relationship between resilience and I4.0 across different contextual characteristics.

Design/methodology/approach

179 organizations from the HSC in Brazil and India were surveyed. Responses were analyzed using multivariate data techniques.

Findings

Large HSC agents are more likely to develop resilience abilities and adopt I4.0 technologies when these factors are analyzed independently. However, the joint analysis of resilience and I4.0 displayed a large number of significant correlations among small organizations.

Originality/value

Findings provide managers of HSC arguments to enhance resilience through the digitalization. HSC organizations can identify HSC organizations' context to tailor initiatives on resilience and digitalization.

Contributions of Healthcare 4.0 digital applications to the resilience of healthcare organizations during the COVID-19 outbreak

In this paper, we examine the contributions of digital applications to the resilience of healthcare organizations during the COVID-19 outbreak. The studied applications are framed as Healthcare 4.0 (H4.0), comprising bundles of information and communication technologies used to improve operations in the health value chain. Data collection was carried out through semi-structured interviews with 10 senior managers from clinician and non-clinician departments of two large-sized Brazilian hospitals treating patients infected with SARS-CoV-2. Interviews were analyzed through content analysis, using data analysis categories related to the application focus (i.e., supply chain, patient diagnosis, patient treatment, and patient follow-up) and targeted resilience ability (i.e., monitor, anticipate, respond, and learn). Results indicate that applications oriented to supply chain and patient diagnosis contribute to all resilience abilities. Furthermore, depending on the resilience ability to be improved, different applications may be prioritized. Four research propositions for theory-testing in future studies are also presented.

Exogenous Shocks and Business Process Management

Business process management (BPM) drives corporate success through effective and efficient processes. In recent decades, knowledge has been accumulated regarding the identification, discovery, analysis, design, implementation, and monitoring of business processes. This includes methods and tools for tackling various kinds of process change such as continuous process improvement, process reengineering, process innovation, and process drift. However, exogenous shocks, which lead to unintentional and radical process change, have been neglected in BPM research although they severely affect an organization’s context, strategy, and business processes. This research note conceptualizes the interplay of exogenous shocks and BPM in terms of the effects that such shocks can have on organizations’ overall process performance over time. On this foundation, related challenges and opportunities for BPM via several rounds of idea generation and consolidation within a diverse team of BPM scholars are identified. The paper discusses findings in light of extant literature from BPM and related disciplines, as well as present avenues for future (BPM) research to invigorate the academic discourse on the topic.