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Asadi M, Ahmadi F, Mohammadi E, Vaismoradi M. Unsafe doctor-nurse interactions in the process of implementing medical orders: A qualitative study. Nurs Open 2023; 10:6808-6816. [PMID: 37353880 PMCID: PMC10495711 DOI: 10.1002/nop2.1927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/25/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023] Open
Abstract
AIM This study aimed to explore challenges faced by clinical nurses in the process of implementing medical orders. DESIGN A qualitative study using inductive content analysis. METHODS Semi-structured individual interviews were carried out with 17 participants including nurses, nurse managers and medical doctors who were purposefully selected. The collected data underwent inductive qualitative content analysis. RESULTS The main research finding was the category of 'unsafe doctor-nurse interaction'. It included three subcategories: 'conflicts in documenting and executing orders', 'not accepting the nurse's suggestions for writing and correcting orders' and 'failure to accept the responsibility of orders by the doctor'. Challenges in the professional relationship between doctors and nurses cause mistrust and conflict. They also enhance nurses' concerns about professional and legal issues in the workplace and endanger patient safety.
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Affiliation(s)
- Monireh Asadi
- Department of Nursing, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
| | - Easa Mohammadi
- Department of Nursing, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
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Li-Wang J, Townsley A, Katta R. Cognitive Ergonomics: A Review of Interventions for Outpatient Practice. Cureus 2023; 15:e44258. [PMID: 37772235 PMCID: PMC10526922 DOI: 10.7759/cureus.44258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
Doctoring is difficult mental work, involving many cognitively demanding processes such as diagnosing, decision-making, parallel processing, communicating, and managing the emotions of others. According to cognitive load theory (CLT), working memory is a limited cognitive resource that can support a finite amount of cognitive load. While the intrinsic cognitive load is the innate load associated with a task, the extraneous load is generated by inefficiency or suboptimal work conditions. Causes of extraneous cognitive load in healthcare include inefficiency, distractions, interruptions, multitasking, stress, poor communication, conflict, and incivility. High levels of cognitive load are associated with impaired function and an increased risk of burnout among physicians. Cognitive ergonomics is the branch of human factors and ergonomics (HFE) focused on supporting the cognitive processes of individuals within a system. In health care, where the cognitive burden on physicians is high, cognitive ergonomics can establish practices and systems that decrease extraneous cognitive load and support pertinent cognitive processes. In this review, we present cognitive ergonomics as a useful framework for conceptualizing an oft-overlooked dimension of labor and apply theory to practice by summarizing evidence-based cognitive ergonomics interventions for outpatient care settings. Our proposed interventions are structured within four general recommendations: 1. minimize distractions, interruptions, and multitasking; 2. optimize the use of the electronic health record (EHR); 3. optimize the use of health information systems (HIS); and 4. support good communication and teamwork. Best practices in cognitive ergonomics can benefit patients, minimize practice inefficiency, and support physician career longevity.
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Affiliation(s)
| | | | - Rajani Katta
- Internal Medicine, Baylor College of Medicine, Houston, USA
- Dermatology, University of Texas Health Science Center at Houston, Houston, USA
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Alkaabi M, Simsekler MCE, Jayaraman R, Al Kaf A, Ghalib H, Quraini D, Ellahham S, Tuzcu EM, Demirli K. Evaluation of System Modelling Techniques for Waste Identification in Lean Healthcare Applications. Risk Manag Healthc Policy 2021; 13:3235-3243. [PMID: 33447104 PMCID: PMC7802016 DOI: 10.2147/rmhp.s283189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Waste identification plays a vital role in lean healthcare applications. While the value stream map (VSM) is among the most commonly used tools for waste identification, it may be limited to visualize the behaviour of dynamic and complex healthcare systems. To address this limitation, system modelling techniques (SMTs) can be used to provide a comprehensive picture of various system-wide wastes. However, there is a lack of evidence in the current literature about the potential contribution of SMTs for waste identification in healthcare processes. Methods This study evaluates the usability and utility of six types of SMTs along with the VSM. For the evaluation, interview-based questionnaires were conducted with twelve stakeholders from the outpatient clinic at the Heart and Vascular Institute at Cleveland Clinic Abu Dhabi. Results VSM was found to be the most useful diagram in waste identification in general. However, some SMTs that represent the system behaviour outperformed the VSM in identifying particular waste types, e.g., communication diagram in identifying over-processing waste and flow diagram in identifying transportation waste. Conclusion As behavioural SMTs and VSM have unique strengths in identifying particular waste types, the use of multiple diagrams is recommended for a comprehensive waste identification in lean. However, limited resources and time, as well as limited experience of stakeholders with SMTs, may still present obstacles for their potential contribution in lean healthcare applications.
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Affiliation(s)
- Maitha Alkaabi
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mecit Can Emre Simsekler
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Raja Jayaraman
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Abdulqader Al Kaf
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Hussam Ghalib
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Dima Quraini
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Samer Ellahham
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Kudret Demirli
- Department of Mechanical, Industrial and Aerospace Engineering, Concordia University, Montreal, Canada
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Bryant R, Chaar B, Schneider C. Differing clinical pharmacy service models: Quantitative and qualitative analysis of nurse perceptions of support from pharmacists. Int J Nurs Stud 2018; 86:90-98. [DOI: 10.1016/j.ijnurstu.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 03/31/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
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Antonacci G, Reed JE, Lennox L, Barlow J. The use of process mapping in healthcare quality improvement projects. Health Serv Manage Res 2018; 31:74-84. [PMID: 29707978 DOI: 10.1177/0951484818770411] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction Process mapping provides insight into systems and processes in which improvement interventions are introduced and is seen as useful in healthcare quality improvement projects. There is little empirical evidence on the use of process mapping in healthcare practice. This study advances understanding of the benefits and success factors of process mapping within quality improvement projects. Methods Eight quality improvement projects were purposively selected from different healthcare settings within the UK's National Health Service. Data were gathered from multiple data-sources, including interviews exploring participants' experience of using process mapping in their projects and perceptions of benefits and challenges related to its use. These were analysed using inductive analysis. Results Eight key benefits related to process mapping use were reported by participants (gathering a shared understanding of the reality; identifying improvement opportunities; engaging stakeholders in the project; defining project's objectives; monitoring project progress; learning; increased empathy; simplicity of the method) and five factors related to successful process mapping exercises (simple and appropriate visual representation, information gathered from multiple stakeholders, facilitator's experience and soft skills, basic training, iterative use of process mapping throughout the project). Conclusions Findings highlight benefits and versatility of process mapping and provide practical suggestions to improve its use in practice.
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Affiliation(s)
- Grazia Antonacci
- 1 Department of Public Health and Primary Care, 4615 Imperial College London , London, UK.,2 NIHR CLAHRC for Northwest London, London, UK.,3 Department of Management and Centre for Health Economics and Policy Innovation, Imperial College Business School, Imperial College London, London, UK
| | - Julie E Reed
- 1 Department of Public Health and Primary Care, 4615 Imperial College London , London, UK.,2 NIHR CLAHRC for Northwest London, London, UK
| | - Laura Lennox
- 1 Department of Public Health and Primary Care, 4615 Imperial College London , London, UK.,2 NIHR CLAHRC for Northwest London, London, UK
| | - James Barlow
- 3 Department of Management and Centre for Health Economics and Policy Innovation, Imperial College Business School, Imperial College London, London, UK
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Developing a user-friendly interface for a self-service healthcare research portal: cost-effective usability testing. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2014.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Esmaeilpour-Bandboni M, Vaismoradi M, Salsali M, Snelgrove S, Sheldon LK. Iranian Physicians' Perspectives Regarding Nurse-Physician Professional Communication: Implications for Nurses. Res Theory Nurs Pract 2017; 31:202-218. [PMID: 28793945 DOI: 10.1891/1541-6577.31.3.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Nurse-physician professional communication affects the effectiveness and performance of the health care team and the quality of care delivered to the patient. This study aimed to explore the perspectives and experiences of physicians on nurse-physician professional communication in an urban area of Iran. METHODS Semistructured interviews were conducted with 15 physicians selected using a purposive sampling method. Physicians from different medical specialties were chosen from 4 teaching hospitals in an urban area of Iran. The data were analyzed with content analysis and themes developed. RESULTS Three themes developed during data analysis: "seeking the formal methods of communication to ensure patient care," "nurses' professional attributes for professional communication," and "patients' health conditions as the mediators of professional communication." IMPLICATIONS FOR PRACTICE Nurses need to be informed of the perspectives and experiences of physicians on professional communication. Our findings can improve nurses' understandings of professional communication that could inform the development of educational and training programs for nurses and physicians. There is a need to incorporate communication courses during degree education and design interprofessional training regarding communication in clinical settings to improve teamwork and patient care. Open discussions between nurses and physicians, training sessions about how to improve their knowledge about barriers to and facilitators of effective professional communication, and key terms and phrases commonly used in patient care are suggested.
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Wooldridge AR, Carayon P, Hundt AS, Hoonakker PLT. SEIPS-based process modeling in primary care. APPLIED ERGONOMICS 2017; 60:240-254. [PMID: 28166883 PMCID: PMC5308799 DOI: 10.1016/j.apergo.2016.11.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/09/2016] [Accepted: 11/18/2016] [Indexed: 05/14/2023]
Abstract
Process mapping, often used as part of the human factors and systems engineering approach to improve care delivery and outcomes, should be expanded to represent the complex, interconnected sociotechnical aspects of health care. Here, we propose a new sociotechnical process modeling method to describe and evaluate processes, using the SEIPS model as the conceptual framework. The method produces a process map and supplementary table, which identify work system barriers and facilitators. In this paper, we present a case study applying this method to three primary care processes. We used purposeful sampling to select staff (care managers, providers, nurses, administrators and patient access representatives) from two clinics to observe and interview. We show the proposed method can be used to understand and analyze healthcare processes systematically and identify specific areas of improvement. Future work is needed to assess usability and usefulness of the SEIPS-based process modeling method and further refine it.
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Affiliation(s)
- Abigail R Wooldridge
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI, United States; Department of Industrial & Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States.
| | - Pascale Carayon
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI, United States; Department of Industrial & Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Ann Schoofs Hundt
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI, United States
| | - Peter L T Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI, United States
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Nedfors K, Borg C, Fagerström C. Communication with physicians in hospital rounds: An interview with nurses. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/0107408315606633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A hospital round is a long tradition in which nurses and physicians communicate to develop an integrated plan of care together with the patient. There is insufficient knowledge of care professionals’ experiences of communication during hospital rounds, particularly in surgical units, where the physician is frequently absent during daily care. Hence, the aim of this study was to describe nurses’ experiences of communication with physicians during hospital rounds in a surgical unit. Nine qualitative unstructured interviews with nurses were conducted and analysed using Burnard’s description of content analysis. ‘An encounter involving opportunities for and challenges to teamwork’ was found to be the predominant theme. The hospital round in a surgical unit is a short encounter that can be challenged by missing patient care goals, difficulties in transmitting messages and frustration over unshared information. Further studies are needed to overcome existing knowledge gaps about communication during hospital rounds.
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Affiliation(s)
- Karin Nedfors
- Blekinge Centre of Competence, Sweden
- Department of Health, Blekinge Institute of Technology, Sweden
| | - Christel Borg
- Department of Health, Blekinge Institute of Technology, Sweden
| | - Cecilia Fagerström
- Blekinge Centre of Competence, Sweden
- Department of Health, Blekinge Institute of Technology, Sweden
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Abstract
BACKGROUND As the care of hospitalized patients becomes more complex, intraprofessional coordination among nurses and among physicians, and interprofessional coordination between these groups are likely to play an increasingly important role in the provision of hospital care. PURPOSE The purpose of this study was to identify the independent effects of organizational factors on provider ratings of overall coordination in inpatient medicine (OCIM). METHODOLOGY/APPROACH This was an exploratory cross-sectional, descriptive study. Primary data were collected between June 2010 and September 2011 through surveys of inpatient medicine nurse managers, physicians, and chiefs of medicine at 36 Veterans Health Administration medical centers. Secondary data from the 2011 Veterans Health Administration national survey of nurses were also used. Individual-level data were aggregated and analyzed at the facility level. Multivariate linear regression models were used to assess the relationship between 55 organizational factors and provider ratings of OCIM. FINDINGS Organizational factors that were common across models and associated with better provider ratings of OCIM included provider perceptions that the goals of senior leadership are aligned with those of the inpatient service and that the facility is committed to the highest quality of patient care, having resources and staff that enable clinicians to do their jobs, and use of strategies that enhance interactions and communication among and between nurses and physicians. PRACTICE IMPLICATIONS To improve intraprofessional and interprofessional coordination and, consequently, patient care, facilities should consider making patient care quality a more important strategic organizational priority; ensuring that providers have the staffing, training, supplies, and other resources they need to do their jobs; and implementing strategies that improve interprofessional communication and working relationships, such as multidisciplinary rounding.
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Simsekler MCE, Card AJ, Ruggeri K, Ward JR, Clarkson PJ. A comparison of the methods used to support risk identification for patient safety in one UK NHS foundation trust. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/1356262215580224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In healthcare, various methods are available to support risk identification in risk management process. However, there is no clear evidence on their contribution to risk identification. In this study, different methods used to support risk identification were therefore analysed to compare their contribution to overall risk identification. The study was conducted at Cambridge University Hospitals Foundation Trust, UK. Three main methods were selected to compare their support in risk identification: incident reports through their Risk Management Information System, risk registers through their Risk Registers system, and safety walkabouts through their internal patient safety assessment process. Where possible, simple comparison tests were run between the different methods of identifying risks as well as by the type of risks identified. It was found that each method has contributed to the risk identification by adding different sets of risk sources despite some overlaps. However, they produced discrete assessments from different aspects and none of them, on its own, could produce adequate results for effective risk identification. In any healthcare setting, having a system to put all risk information in one picture would help maximise the contribution of each method within the scope risk management process. Future studies may benefit from broader use of multiple and system-based risk identification approaches, and coding methods for more powerful analytical test.
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Affiliation(s)
- MC Emre Simsekler
- Department of Management Science and Innovation, University College London, London, UK
| | - Alan J Card
- Evidence-Based Health Solutions, LLC, Notre Dame, IN, USA
| | - Kai Ruggeri
- Engineering Department, Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - James R Ward
- Engineering Department, Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - P John Clarkson
- Engineering Department, Engineering Design Centre, University of Cambridge, Cambridge, UK
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A comparison of the impact of CPOE implementation and organizational determinants on doctor–nurse communications and cooperation. Int J Med Inform 2013; 82:e321-30. [DOI: 10.1016/j.ijmedinf.2012.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 09/01/2012] [Accepted: 09/03/2012] [Indexed: 11/21/2022]
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Flemming D, Hübner U. How to improve change of shift handovers and collaborative grounding and what role does the electronic patient record system play? Results of a systematic literature review. Int J Med Inform 2013; 82:580-92. [DOI: 10.1016/j.ijmedinf.2013.03.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 03/17/2013] [Accepted: 03/24/2013] [Indexed: 10/26/2022]
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Singprasong R, Eldabi T. An Integrated Methodology for Process Improvement and Delivery System Visualization at a Multidisciplinary Cancer Center. J Healthc Qual 2013; 35:24-32. [DOI: 10.1111/j.1945-1474.2011.00174.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Koch SH, Weir C, Haar M, Staggers N, Agutter J, Görges M, Westenskow D. Intensive care unit nurses' information needs and recommendations for integrated displays to improve nurses' situation awareness. J Am Med Inform Assoc 2012; 19:583-90. [PMID: 22437074 DOI: 10.1136/amiajnl-2011-000678] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Fatal errors can occur in intensive care units (ICUs). Researchers claim that information integration at the bedside may improve nurses' situation awareness (SA) of patients and decrease errors. However, it is unclear which information should be integrated and in what form. Our research uses the theory of SA to analyze the type of tasks, and their associated information gaps. We aimed to provide recommendations for integrated, consolidated information displays to improve nurses' SA. MATERIALS AND METHODS Systematic observations methods were used to follow 19 ICU nurses for 38 hours in 3 clinical practice settings. Storyboard methods and concept mapping helped to categorize the observed tasks, the associated information needs, and the information gaps of the most frequent tasks by SA level. Consensus and discussion of the research team was used to propose recommendations to improve information displays at the bedside based on information deficits. RESULTS Nurses performed 46 different tasks at a rate of 23.4 tasks per hour. The information needed to perform the most common tasks was often inaccessible, difficult to see at a distance or located on multiple monitoring devices. Current devices at the ICU bedside do not adequately support a nurse's information-gathering activities. Medication management was the most frequent category of tasks. DISCUSSION Information gaps were present at all levels of SA and across most of the tasks. Using a theoretical model to understand information gaps can aid in designing functional requirements. CONCLUSION Integrated information that enhances nurses' Situation Awareness may decrease errors and improve patient safety in the future.
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Affiliation(s)
- Sven H Koch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
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VAISMORADI M, SALSALI M, ESMAEILPOUR M, CHERAGHI MA. Perspectives and experiences of Iranian nurses regarding nurse-physician communication: A content analysis study. Jpn J Nurs Sci 2011; 8:184-93. [DOI: 10.1111/j.1742-7924.2011.00173.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jun GT, Ward J, Clarkson PJ. Systems modelling approaches to the design of safe healthcare delivery: ease of use and usefulness perceived by healthcare workers. ERGONOMICS 2010; 53:829-847. [PMID: 20582765 DOI: 10.1080/00140139.2010.489653] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The UK health service, which had been diagnosed to be seriously out of step with good design practice, has been recommended to obtain knowledge of design and risk management practice from other safety-critical industries. While these other industries have benefited from a broad range of systems modelling approaches, healthcare remains a long way behind. In order to investigate the healthcare-specific applicability of systems modelling approaches, this study identified 10 distinct methods through meta-model analysis. Healthcare workers' perception on 'ease of use' and 'usefulness' was then evaluated. The characterisation of the systems modelling methods showed that each method had particular capabilities to describe specific aspects of a complex system. However, the healthcare workers found that some of the methods, although potentially very useful, would be difficult to understand, particularly without prior experience. This study provides valuable insights into a better use of the systems modelling methods in healthcare. STATEMENT OF RELEVANCE: The findings in this study provide insights into how to make a better use of various systems modelling approaches to the design and risk management of healthcare delivery systems, which have been a growing research interest among ergonomists and human factor professionals.
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Example of a Human Factors Engineering approach to a medication administration work system: Potential impact on patient safety. Int J Med Inform 2010; 79:e43-57. [DOI: 10.1016/j.ijmedinf.2009.07.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 06/25/2009] [Accepted: 07/18/2009] [Indexed: 11/17/2022]
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Abstract
Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians' individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient's best interest can be viewed as their "agency for safety." However, collective agency for safety and commitment to support nurses in their role of advocacy is missing in many perinatal care settings. This article draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse's role in maintaining safety during labor and birth in acute care settings and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care.
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Affiliation(s)
- Audrey Lyndon
- Department of Family Health Care Nursing, UCSF School of Nursing, 2 Koret Way, Box 0606, San Francisco, CA 94143, , 415-476-4620
| | - Holly Powell Kennedy
- Yale School of Nursing, 100 Church Street South, PO Box 9740, New Haven, CT 06536-0740, , 203-737-1302
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Jun GT, Ward J, Morris Z, Clarkson J. Health care process modelling: which method when? Int J Qual Health Care 2009; 21:214-24. [PMID: 19363123 DOI: 10.1093/intqhc/mzp016] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The role of process modelling has been widely recognized for effective quality improvement. However, application in health care is somewhat limited since the health care community lacks knowledge about a broad range of methods and their applicability to health care. Therefore, the objectives of this paper are to present a summary description of a limited number of distinct modelling methods and evaluate how health care workers perceive them. METHODS Various process modelling methods from several different disciplines were reviewed and characterized. Case studies in three different health care scenarios were carried out to model those processes and evaluate how health care workers perceive the usability and utility of the process models. RESULTS Eight distinct modelling methods were identified and characterized by what the modelling elements in each explicitly represents. Flowcharts, which had been most extensively used by the participants, were most favoured in terms of their usability and utility. However, some alternative methods, although having been used by a much smaller number of participants, were considered to be helpful, specifically in understanding certain aspects of complex processes, e.g. communication diagrams for understanding interactions, swim lane activity diagrams for roles and responsibilities and state transition diagrams for a patient-centred perspective. DISCUSSION We believe that it is important to make the various process modelling methods more easily accessible to health care by providing clear guidelines or computer-based tool support for health care-specific process modelling. These supports can assist health care workers to apply initially unfamiliar, but eventually more effective modelling methods.
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Affiliation(s)
- Gyuchan Thomas Jun
- Engineering Department, University of Cambridge, Trumpington Street, Cambridge CB21PZ, UK.
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Vidal-Gomel C, Rogalski J. Analyser l'activité des formateurs en conduite automobile: une étude exploratoire des aspects collectifs du travail. ACTA ACUST UNITED AC 2009. [DOI: 10.3917/savo.020.0085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Niazkhani Z, van der Sijs H, Pirnejad H, Redekop WK, Aarts J. Same system, different outcomes: comparing the transitions from two paper-based systems to the same computerized physician order entry system. Int J Med Inform 2008; 78:170-81. [PMID: 18760660 DOI: 10.1016/j.ijmedinf.2008.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 06/05/2008] [Accepted: 06/28/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare how nurses in two different paper-based systems perceive the impact of a computerized physician order entry (CPOE) system on their medication-related activities. SETTING 13 non-surgical, adult inpatient wards in a Dutch academic hospital. METHODS Questionnaire survey of 295 nurses before and 304 nurses after the implementation of a CPOE system. These nurses worked with two different paper-based medication systems before the implementation: 'Kardex-system' and 'TIMED-system'. In the Kardex-system, the structure of the nursing medication work was similar to that of after the CPOE implementation, while in the TIMED-system, it was different. 'Adaptive Structuration Theory' (AST) was used to interpret the results. RESULTS The response rates were 52.2% (154/295) before and 44.7% (136/304) after the implementation. Kardex-nurses reported more positive effects than TIMED-nurses. TIMED-nurses reported that the computerized system was more inflexible, more difficult to work with, and slower than the TIMED-system. In the TIMED group, the overall mean score of the computerized process was not significantly different from that of the paper-based process. Moreover, nurses in both groups were more satisfied with the post-implementation process than with the pre-implementation process. Nevertheless, none of groups reported a better workflow support in the computerized system when compared to that of the paper-based systems. CONCLUSIONS Our findings suggest that not only the technology but also large differences between pre- and post-implementation work structure influence the perceptions of users, and probably make the transition more difficult. This study also suggests that greater satisfaction with a system may not necessarily be a reflection of better workflow support.
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Affiliation(s)
- Zahra Niazkhani
- Institute of Health Policy and Management (iBMG), Erasmus University Medical Center, Rotterdam, The Netherlands.
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Hakimzada AF, Green RA, Sayan OR, Zhang J, Patel VL. The nature and occurrence of registration errors in the emergency department. Int J Med Inform 2007; 77:169-75. [PMID: 17560165 PMCID: PMC2259219 DOI: 10.1016/j.ijmedinf.2007.04.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 03/11/2007] [Accepted: 04/29/2007] [Indexed: 11/16/2022]
Abstract
Research into the nature and occurrence of medical errors has shown that these often result from a combination of factors that lead to the breakdown of workflow. Nowhere is this more critical than in the emergency department (ED), where the focus of clinical decisions is on the timely evaluation and stabilization of patients. This paper reports on the nature of errors and their implications for patient safety in an adult ED, using methods of ethnographic observation, interviews, and think-aloud protocols. Data were analyzed using modified "grounded theory," which refers to a theory developed inductively from a body of data. Analysis revealed four classes of errors, relating to errors of misidentification, ranging from multiple medical record numbers, wrong patient identification or address, and in one case, switching of one patient's identification information with those of another. Further analysis traced the root of the errors to ED registration. These results indicate that the nature of errors in the emergency department are complex, multi-layered and result from an intertwined web of activity, in which stress in the work environment, high patient volume and the tendency to adopt shortcuts play a significant role. The need for information technology (IT) solutions to these problems as well as the impact of alternative policies is discussed.
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Affiliation(s)
- A. Forogh Hakimzada
- Laboratory of Decision Making and Cognition, Department of Biomedical Informatics, Columbia University, New York, NY
| | - Robert A. Green
- New York-Presbyterian Hospital/Columbia University Medical Center, Department of Emergency Medicine, New York, NY
| | - Osman R. Sayan
- New York-Presbyterian Hospital/Columbia University Medical Center, Department of Emergency Medicine, New York, NY
| | - Jiajie Zhang
- School of Health Information Sciences, University of Texas Health Science Center at Houston
| | - Vimla L. Patel
- Laboratory of Decision Making and Cognition, Department of Biomedical Informatics, Columbia University, New York, NY
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