Understanding Barriers and Facilitators to Living Kidney Donation Within a Sociotechnical Systems Framework

The objective of this study was to investigate factors influencing one's decision to become a live kidney donor under the framework of sociotechnical systems, by expanding the focus to include larger organizational influences and technological considerations. Semi-structured interviews were conducted with live kidney donors who donated through University of Louisville Health, Trager Transplant Center, a mid-scale transplant program, in the years 2017 through 2019. The interview transcripts were analyzed for barriers and facilitators to live kidney donation within a sociotechnical system. The most salient facilitators included: having an informative, caring, and available care team; the absence of any negative external pressure toward donating; donating to a family or friend; and the ability to take extra time off work for recovery. The most recurrent barriers included: short/medium-term (<1 year) negative health impacts because of donation; the need to make minor lifestyle changes (e.g., less alcohol consumption) after donation; and mental health deterioration stemming from the donation process. The sociotechnical systems framework promotes a balanced system comprised of social, technical, and environmental subsystems. Assessing the facilitators and barriers from the sociotechnical system perspective revealed the importance of and opportunities for developing strategies to promote integration of technical subsystem, such as social media apps and interactive AI platforms, with social and environmental subsystems to enable facilitators and reduce barriers effectively.

Usability of a Human Factors-based Clinical Decision Support in the Emergency Department: Lessons Learned for Design and Implementation

OBJECTIVE

To evaluate the usability and use of human factors (HF)-based clinical decision support (CDS) implemented in the emergency department (ED).

BACKGROUND

Clinical decision support can improve patient safety; however, the acceptance and use of CDS has faced challenges. Following a human-centered design process, we designed a CDS to support pulmonary embolism (PE) diagnosis in the ED. We demonstrated high usability of the CDS during scenario-based usability testing. We implemented the HF-based CDS in one ED in December 2018.

METHOD

We conducted a survey of ED physicians to evaluate the usability and use of the HF-based CDS. We distributed the survey via Qualtrics, a web-based survey platform. We compared the computer system usability questionnaire scores of the CDS between those collected in the usability testing to use of the CDS in the real environment. We asked physicians about their acceptance and use of the CDS, barriers to using the CDS, and areas for improvement.

RESULTS

Forty-seven physicians (56%) completed the survey. Physicians agreed that diagnosing PE is a major problem and risk scores can support the PE diagnostic process. Usability of the CDS was reported as high, both in the experimental setting and the real clinical setting. However, use of the CDS was low. We identified several barriers to the CDS use in the clinical environment, in particular a lack of workflow integration.

CONCLUSION

Design of CDS should be a continuous process and focus on the technology's usability in the context of the broad work system and clinician workflow.

Organizational Adaptive Capacity during a Large-Scale Surprise Event: A Case Study at an Academic Institution during the COVID-19 Pandemic

OCCUPATIONAL APPLICATIONSThe COVID-19 pandemic caused large organizations and institutions to adapt their decision-making procedures and hierarchical structures to address pandemic-specific concerns. By examining a large public university, we found that effective adaptation occurred through restructuring the decision-making processes, coordinating decisions between departments, and effective monitoring of prior decisions. When considering the COVID-19 pandemic as a fundamental surprise event, our work identified strategies and decision-making that both maintained and increased adaptive capacity through the course of such an event. Through this case study, we highlight decisions that can be made by similar large organizations, to increase adaptive capacity when they are faced with similar surprise events.

IT and the Quality and Efficiency of Mental Health Care in a Time of COVID-19: Case Study of Mental Health Providers in England

BACKGROUND

In England, COVID-19 has significantly affected mental health care and tested the resilience of health care providers. In many areas, the increased use of IT has enabled traditional modes of service delivery to be supported or even replaced by remote forms of provision.

OBJECTIVE

This study aimed to assess the use and impact of IT, in remote service provision, on the quality and efficiency of mental health care during the pandemic. We drew on sociotechnical systems theory as a conceptual framework to help structure the gathering, analysis, and interpretation of data.

METHODS

We conducted a national scoping survey that involved documentary analysis and semistructured interviews with 6 national stakeholders and case studies of 4 purposefully selected mental health providers in England involving interviews with 53 staff members.

RESULTS

Following the outbreak of COVID-19, mental health providers rapidly adjusted their traditional forms of service delivery, switching to digital and telephone consultations for most services. The informants provided nuanced perspectives on the impact on the quality and efficiency of remote service delivery during the pandemic. Notably, it has allowed providers to attend to as many patients as possible in the face of COVID-19 restrictions, to the convenience of both patients and staff. Among its negative effects are concerns about the unsuitability of remote consultation for some people with mental health conditions and the potential to widen the digital divide and exacerbate existing inequalities. Sociotechnical systems theory was found to be a suitable framework for understanding the range of systemic and sociotechnical factors that influence the use of technology in mental health care delivery in times of crisis and normalcy.

CONCLUSIONS

Although the use of IT has boosted mental health care delivery during the pandemic, it has had mixed effects on quality and efficiency. In general, patients have benefited from the convenience of remote consultation when face-to-face contact was impossible. In contrast, patient choice was often compromised, and patient experience and outcomes might have been affected for some people with mental health conditions for which remote consultation is less suitable. However, the full impact of IT on the quality and efficiency of mental health care provision along with the systemic and sociotechnical determinants requires more sustained and longitudinal research.

Translating ethnographic data into knowledge, skills, and attitude statements for medical scribes: a modified Delphi approach

OBJECTIVE

While the use of medical scribes is rapidly increasing, there are not widely accepted standards for their training and duties. Because they use electronic health record systems to support providers, inadequately trained scribes can increase patient safety related risks. This paper describes the development of desired core knowledge, skills, and attitudes (KSAs) for scribes that provide the curricular framework for standardized scribe training.

MATERIALS AND METHODS

A research team used a sequential mixed qualitative methods approach. First, a rapid ethnographic study of scribe activities was performed at 5 varied health care organizations in the United States to gather qualitative data about knowledge, skills, and attitudes. The team's analysis generated preliminary KSA related themes, which were further refined during a consensus conference of subject-matter experts. This was followed by a modified Delphi study to finalize the KSA lists.

RESULTS

The team identified 90 descriptions of scribe-related KSAs and subsequently refined, categorized, and prioritized them for training development purposes. Three lists were ultimately defined as: (1) Hands-On Learning KSA list with 47 items amenable to simulation training, (2) Didactic KSA list consisting of 32 items appropriate for didactic lecture teaching, and (3) Prerequisite KSA list consisting of 11 items centered around items scribes should learn prior to being hired or soon after being hired.

CONCLUSION

We utilized a sequential mixed qualitative methodology to successfully develop lists of core medical scribe KSAs, which can be incorporated into scribe training programs.

How Are Techno-Stressors Associated with Mental Health and Work Outcomes? A Systematic Review of Occupational Exposure to Information and Communication Technologies within the Technostress Model

The technostress model has introduced different factors to consider when assessing how information and communication technologies impact individuals in different work settings. This systematic review gathers evidence regarding associations between occupational exposure to technostress and health or work outcomes. In addition, we highlight typical methodological constraints of the technostress model. We conducted electronic literature searches in June 2020 (PubMed, PubMed Central, Web of Science, Scopus, PsycInfo, PsycArticles) and independently screened 321 articles. We report on 21 articles meeting eligibility criteria (working population, technostress exposure, health or work outcome, quantitative design). The most frequently examined techno-stressors, i.e., factors of technostress, were techno-overload and techno-invasion. Techno-stressors were consistently associated with adverse health and work outcomes, apart from a positive impact on work engagement. However, studies may be subject to considerable conceptual overlap between exposure and outcome measures. Future technostress research would benefit from reducing heterogeneity in technostress measures, assessing their external validity and focussing on specific techno-stressors.

A qualitative study of provider burnout: do medical scribes hinder or help?

Objective

Provider burnout is a crisis in healthcare and leads to medical errors, a decrease in patient satisfaction, and provider turnover. Many feel that the increased use of electronic health records contributes to the rate of burnout. To avoid provider burnout, many organizations are hiring medical scribes. The goal of this study was to identify relevant elements of the provider–scribe relationship (like decreasing documentation burden, extending providers’ careers, and preventing retirement) and describe how and to what extent they may influence provider burnout.

Materials and Methods

Qualitative methods were used to gain a broad view of the complex landscape surrounding scribes. Data were collected in 3 phases between late 2017 and early 2019. Data from 5 site visits, interviews with medical students who had experience as scribes, and discussions at an expert conference were analyzed utilizing an inductive approach.

Results

A total of 184 transcripts were analyzed to identify patterns and themes related to provider burnout. Provider burnout leads to increased provider frustration and exhaustion. Providers reported that medical scribes improve provider job satisfaction and reduce burnout because they reduce the documentation burden. Medical scribes extend providers’ careers and may prevent early retirement. Unfortunately, medical scribes themselves may experience similar forms of burnout.

Conclusion

Our data from providers and managers suggest that medical scribes help to reduce provider burnout. However, scribes are not the only solution for reducing documentation burden and there may be potentially better options for preventing burnout. Interestingly, medical scribes sometimes suffer from burnout themselves, despite their temporary roles.

Safe use of the EHR by medical scribes: a qualitative study

OBJECTIVE

Hiring medical scribes to document in the electronic health record (EHR) on behalf of providers could pose patient safety risks because scribes often have no clinical training. The aim of this study was to investigate the effect of scribes on patient safety. This included identification of best practices to assure that scribe use of the EHR is not a patient safety risk.

MATERIALS AND METHODS

Using a sociotechnical framework and the Rapid Assessment Process, we conducted ethnographic data gathering at 5 purposively selected sites. Data were analyzed using a grounded inductive/hermeneutic approach.

RESULTS

We conducted site visits at 12 clinics and emergency departments within 5 organizations in the US between 2017 and 2019. We did 76 interviews with 81 people and spent 80 person-hours observing scribes working with providers. Interviewees believe and observations indicate that scribes decrease patient safety risks. Analysis of the data yielded 12 themes within a 4-dimension sociotechnical framework. Results about the "technical" dimension indicated that the EHR is not considered overly problematic by either scribes or providers. The "environmental" dimension included the changing scribe industry and need for standards. Within the "personal" dimension, themes included the need for provider diligence and training when using scribes. Finally, the "organizational" dimension highlighted the positive effect scribes have on documentation efficiency, quality, and safety.

CONCLUSION

Participants perceived risks related to the EHR can be less with scribes. If healthcare organizations and scribe companies follow best practices and if providers as well as scribes receive training, safety can actually improve.

The adaptive capacity of public space under COVID-19: Exploring urban design interventions through a sociotechnical systems approach

The coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on the way in which the community interacts within public spaces. Consequently, the design of these urban environments requires new approaches. It is our view that Human Factors and Ergonomics approaches can be used to provide these insights. This article explores the opportunities for making public spaces safer and more accessible for community use under pandemic conditions. The study utilizes a sociotechnical systems model of an archetype public space, developed pre-COVID-19, to explore the infrastructure and activities that are impacted by the introduction of the virus to the public space system. The aim was to identify those elements of the system that are completely unavailable under pandemic conditions, those elements that become limited in use, and those which remained unaffected by the presence of the virus. The findings show that under pandemic conditions pre-COVID-19 public spaces were surprisingly resilient with proportionally few elements within the model completely unavailable. They also demonstrate that overall, the public spaces system, while still operating, is significantly constrained in achieving and optimizing community and individual health and well-being. The insertion of five (5) urban design interventions within the system model presented unique insights into the possibilities for optimizing adaptive capacity. These interventions revealed design opportunities across several levels of the systems model. Such insights are argued to assist in not only re-establishing community access under pandemic conditions but also more inclusive access to a broader range of the community under all conditions.

Comparative lessons in regenerative medicine readiness: learning from the UK and Japanese experience

This paper explores how 'regenerative readiness' varies between different national research and healthcare systems. Here, 'readiness' refers to both the readiness of a given technology and the ability of a given setting to adopt a new technology. We compare two settings that have taken active yet dissonant approaches to improve readiness: the UK and Japan. Existing scholarship observes that disruptive technologies such as regenerative medicine require many adaptations to become useable and function along the principles of their design. We incorporate the sociotechnical systems framework to consider the range of adaptive measures taken across elements of the sociotechnical system for novel technological adoption. Building upon existing works on technology readiness and institutional readiness, we also expand the conceptualization of readiness toward system-wide readiness.

Combatting human trafficking in the United States: how can medical informatics help?

OBJECTIVE

Human trafficking is a global problem taking many forms, including sex and labor exploitation. Trafficking victims can be any age, although most trafficking begins when victims are adolescents. Many trafficking victims have contact with health-care providers across various health-care contexts, both for emergency and routine care.

MATERIALS AND METHODS

We propose 4 specific areas where medical informatics can assist with combatting trafficking: screening, clinical decision support, community-facing tools, and analytics that are both descriptive and predictive. Efforts to implement health information technology interventions focused on trafficking must be carefully integrated into existing clinical work and connected to community resources to move beyond identification to provide assistance and to support trauma-informed care.

RESULTS

We lay forth a research and implementation agenda to integrate human trafficking identification and intervention into routine clinical practice, supported by health information technology.

CONCLUSIONS

A sociotechnical systems approach is recommended to ensure interventions address the complex issues involved in assisting victims of human trafficking.

Care Managers and Role Ambiguity: The Challenges of Supporting the Mental Health Needs of Patients with Chronic Conditions

As U.S. healthcare organizations transition to value-based healthcare, they are increasingly focusing on supporting patients who have difficulties managing chronic care, including mental health, through the growing role of care managers (CMs). CMs communicate with patients, provide access to resources, and coach them toward healthy behaviors. CMs also coordinate patient-related issues internally with healthcare practitioners and externally with community organizations and insurance providers. While there have been many interaction design studies regarding the work of clinical and non-clinical healthcare providers and how best to design support systems for them, we know little about the work of CMs. In this study, we examine the role of CMs, particularly focusing on their work to support patient mental health, through interviews with 11 CMs who are part of a large Midwestern U.S. health system. Workflow observations were conducted to supplement the interview data. We describe the role of CMs and identify challenges that they face in supporting patient mental health. A key challenge is a high degree of role ambiguity in this professional role. We discuss sociotechnical implications to better support care delivery processes and technologies for the delivery of mental health services by CMs.

With Crisis Comes Opportunity: Redesigning Performance Departments of Elite Sports Clubs for Life After a Global Pandemic

The suspension of major sporting competitions due to the global COVID-19 pandemic had a substantial negative impact on the sporting industry. As such, a successful and sustainable return to sport will require extensive modifications to the current operations of sporting organizations. In this article we argue that methods from the realm of sociotechnical systems (STS) theory are highly suited for this purpose. The aim of the study was to use such methods to develop a model of an Australian Football League (AFL) club's football department. The intention was to identify potential modifications to the club's operations to support a return to competition following the COVID-19 crisis. Subject Matter Experts from an AFL club participated in three online workshops to develop Work Domain Analysis and Social Organization and Cooperation Analysis models. The results demonstrated the inherent complexity of an AFL football department via numerous interacting values, functions and processes influencing the goals of the system. Conflicts within the system were captured via the modeling and included pursing goals that may not fully reflect the state of the system, a lack of formal assessment of core values, overlapping functions and objects, and an overemphasis on specialized roles. The current analysis has highlighted potential areas for modification in the football department, and sports performance departments in general.

Using system dynamics modelling to show the effect of nurse workload on nurses' health and quality of care

The objective of the current study is to explore System Dynamics modelling to quantify and understand the effects of nursing workload on nurse burnout, absenteeism, and quality of patient care. A literature search was performed to identify the causal relationships between factors related to the problem and build a conceptual causal loop diagram. Each of these factors was then operationalised and a simulation model was built using quantitative empirical data from the literature, supplemented with expert input. The model results showed that long nurse shifts and work weeks double nurse fatigue levels, while increasing burnout by up to 6 times, absenteeism by up to 5 times, and medical errors for the patients increasing by up to 150%. The study demonstrates a novel application of System Dynamics in healthcare to examine the impact of management strategies and healthcare system design on nurses' wellbeing and on care quality. Practitioner summary: System Dynamics Modelling allows for the integration of available scientific evidence and expertise to reveal the relationship between nurse workload, burnout and care quality in terms of medical errors. Such models can reveal possible responses from proposed policy or system design changes that could not be quantified with conventional approaches. Abbreviations: HF: human factors; SD: system dynamics; CLD: causal loop diagram; OFAT: one factor at a time.

A systems thinking perspective on the barriers to treatment access for people with eating disorders

Treatment access remains low for people with eating disorders. In addressing the complexity inherent in this challenge, this article introduces systems thinking and argues that it could provide new insights. Systems thinking views behavior as an emergent property of a system and considers the relationships between technical, organizational, and social components. Several methods used in safety science incorporate this thinking. For example, AcciMap draws focus to the influence of decisions and actions made across hierarchical levels of a system, including those by government, regulatory bodies, management, services, and individuals. By examining the findings of the existing literature on barriers to eating disorder treatment access according to these levels, it is evident that most identified barriers relate to individuals and that further research is needed to consider the influence of high-level stakeholders. Research using systems thinking should consider the causal networks of influence from government, regulatory, and organizational decisions and actions through to outcomes for clinicians and individuals. The understanding of how barriers operate within specific healthcare systems also warrants investigation. Systems thinking is yet to be formally applied in the area of eating disorders and thus represents an opportunity to inform the development and implementation of more effective, system wide interventions.

A Sociotechnical Systems Approach Toward Tailored Design for Personal Health Information Management

We used a sociotechnical systems approach-which conceptualizes a system of interacting people, technologies, and tasks, to identify individual differences in personal health information management (PHIM) that can inform the design for patient-friendly environments, tools and technologies. We conducted a secondary thematic analysis of data collected as part of a parent project, vizHOME. The goal of vizHOME was to improve health and health outcomes through identifying key features in the environment that will inform the design of consumer health information technology HIT. We analyzed interview data collected from 20 individuals with diabetes. We found seven dimensions of PHIM: (1) level of privacy preferred for PHIM; (2) amount of engagement in PHIM; (3) extent of guidance preferred for PHIM; (4) level of documentation preferred for PHIM; (5) degree of physical distribution of PHIM; (6) amount of flexibility in PHIM routine; and (7) use of external cues to manage PHIM. Our results suggest that each dimension exists as a continuum, which are anchored from low to high. Exploring the interaction between PHIM and the sociotechnical system in which PHIM is performed revealed key dimensions of PHIM as well as individual differences in those PHIM dimensions. Identification of individual differences in PHIM can support the creation of human-centered design considerations for tailored environments, products, processes, and technologies that support PHIM. Future research will seek to validate PHIM dimensions in a larger population and develop a PHIM-typing measure to identify PHIM types toward tailoring processes, products, and to individual needs in context.

The Last Mile: Where Artificial Intelligence Meets Reality

Although much effort is focused on improving the technical performance of artificial intelligence, there are compelling reasons to focus more on the implementation of this technology class to solve real-world applications. In this “last mile” of implementation lie many complex challenges that may make technically high-performing systems perform poorly. Instead of viewing artificial intelligence development as a linear one of algorithm development through to eventual deployment, there are strong reasons to take a more agile approach, iteratively developing and testing artificial intelligence within the context in which it finally will be used.

Integrating Operational and Organizational Aspects in Interdependent Infrastructure Network Recovery

Managing risk in infrastructure systems implies dealing with interdependent physical networks and their relationships with the natural and societal contexts. Computational tools are often used to support operational decisions aimed at improving resilience, whereas economics-related tools tend to be used to address broader societal and policy issues in infrastructure management. We propose an optimization-based framework for infrastructure resilience analysis that incorporates organizational and socioeconomic aspects into operational problems, allowing to understand relationships between decisions at the policy level (e.g., regulation) and the technical level (e.g., optimal infrastructure restoration). We focus on three issues that arise when integrating such levels. First, optimal restoration strategies driven by financial and operational factors evolve differently compared to those driven by socioeconomic and humanitarian factors. Second, regulatory aspects have a significant impact on recovery dynamics (e.g., effective recovery is most challenging in societies with weak institutions and regulation, where individual interests may compromise societal well-being). And third, the decision space (i.e., available actions) in postdisaster phases is strongly determined by predisaster decisions (e.g., resource allocation). The proposed optimization framework addresses these issues by using: (1) parametric analyses to test the influence of operational and socioeconomic factors on optimization outcomes, (2) regulatory constraints to model and assess the cost and benefit (for a variety of actors) of enforcing specific policy-related conditions for the recovery process, and (3) sensitivity analyses to capture the effect of predisaster decisions on recovery. We illustrate our methodology with an example regarding the recovery of interdependent water, power, and gas networks in Shelby County, TN (USA), with exposure to natural hazards.

Using the Event Analysis of Systemic Teamwork (EAST) broken-links approach to understand vulnerabilities to disruption in a darknet market

Darknet markets provide an anonymous, online platform for users to trade illicit drugs, fraudulent identity data, and other commodities. Although law enforcement agencies have been successful in seising many markets, the Darknet is an agile and dynamic environment and market activities often persist and emerge in a new form. Given this constantly changing environment, new ways of disrupting darknet markets are required. This study used Event Analysis of Systemic Teamwork (EAST) to analyse market activity and understand vulnerabilities to disruption. This involved using the EAST broken-links approach to assess the effects of compromising the transmission of information between tasks and between agents. The analysis identified critical vulnerabilities in the system, which included information involved in registering, depositing funds, communicating listing details to buyers, and communicating dispute resolution messages. This study indicates that systems ergonomics methods-in particular, EAST-can provide insight into system vulnerabilities that might be targeted for disruption. Practitioner summary This study provides a conceptualisation of the processes, people, structures, and information involved in the buying and selling of goods on a darknet market. Law enforcement agencies may use broken-links analyses to systematically consider the effects of their interventions.

Rehabilitation culture and its impact on technology: unpacking practical conditions for ultrabilitation

Purpose: It has been proposed that rehabilitation practice expand its aims beyond recovery to "ultrabilitation," but only if certain biological, technological, and psychosocial conditions are met. There is thus an opportunity to connect ultrabilitation, as a concept, to adjacent literature on assistive technology and sociotechnical systems.Method: We draw on insights from sociology of technology and responsible innovation, as well as concrete examples of neural devices and the culture of rehabilitation practice, to further refine our understanding of the conditions of possibility for ultrabilitation.Results: "Assistive" technologies can indeed be re-imagined as "ultrabilitative," but this shift is both psychosocial and technological in nature, such that rehabilitation professionals will likely play a key role in this shift. There is not, however, sufficient evidence to suggest whether they will support or hinder ultrabilitative uses of technology.Conclusion: Advancing the idea and project of ultrabilitation must be grounded in a nuanced understanding of actual rehabilitation practice and the norms of broader society, which can be gained from engaging with adjacent literatures and by conducting further research on technology use in rehabilitation contexts.Implications for rehabilitation"Assistive" technologies can be conceptually re-imagined as "ultrabilitative" technologies, expanding their utility from recovery to enhancement and flourishing.Actual development and use of ultrabilitative technology is both a technical and psychosocial challenge, and its success depends on the cultural context in which technology is situated.Further empirical research is needed on the ways in which rehabilitation culture and the norms of broader society might impact or even inhibit the use of ultrabilitative technology.

Bots increase exposure to negative and inflammatory content in online social systems

Societies are complex systems, which tend to polarize into subgroups of individuals with dramatically opposite perspectives. This phenomenon is reflected-and often amplified-in online social networks, where, however, humans are no longer the only players and coexist alongside with social bots-that is, software-controlled accounts. Analyzing large-scale social data collected during the Catalan referendum for independence on October 1, 2017, consisting of nearly 4 millions Twitter posts generated by almost 1 million users, we identify the two polarized groups of Independentists and Constitutionalists and quantify the structural and emotional roles played by social bots. We show that bots act from peripheral areas of the social system to target influential humans of both groups, bombarding Independentists with violent contents, increasing their exposure to negative and inflammatory narratives, and exacerbating social conflict online. Our findings stress the importance of developing countermeasures to unmask these forms of automated social manipulation.

Bots increase exposure to negative and inflammatory content in online social systems

Social media can deeply influence reality perception, affecting millions of people’s voting behavior. Hence, maneuvering opinion dynamics by disseminating forged content over online ecosystems is an effective pathway for social hacking. We propose a framework for discovering such a potentially dangerous behavior promoted by automatic users, also called “bots,” in online social networks. We provide evidence that social bots target mainly human influencers but generate semantic content depending on the polarized stance of their targets. During the 2017 Catalan referendum, used as a case study, social bots generated and promoted violent content aimed at Independentists, ultimately exacerbating social conflict online. Our results open challenges for detecting and controlling the influence of such content on society.

Societies are complex systems, which tend to polarize into subgroups of individuals with dramatically opposite perspectives. This phenomenon is reflected—and often amplified—in online social networks, where, however, humans are no longer the only players and coexist alongside with social bots—that is, software-controlled accounts. Analyzing large-scale social data collected during the Catalan referendum for independence on October 1, 2017, consisting of nearly 4 millions Twitter posts generated by almost 1 million users, we identify the two polarized groups of Independentists and Constitutionalists and quantify the structural and emotional roles played by social bots. We show that bots act from peripheral areas of the social system to target influential humans of both groups, bombarding Independentists with violent contents, increasing their exposure to negative and inflammatory narratives, and exacerbating social conflict online. Our findings stress the importance of developing countermeasures to unmask these forms of automated social manipulation.

A Socio-Technical Exploration for Reducing & Mitigating the Risk of Retained Foreign Objects

A Retained Foreign Object (RFO) is a fairly infrequent but serious adverse event. An accurate rate of RFOs is difficult to establish due to underreporting but it has been estimated that incidences range between 1/1000 and 1/19,000 procedures. The cost of a RFO incident may be substantial and three-fold: (i) the cost to the patient of physical and/or psychological harm; (ii) the reputational cost to an institution and/or healthcare provider; and (iii) the financial cost to the taxpayer in the event of a legal claim. This Health Research Board-funded project aims to analyse and understand the problem of RFOs in surgical and maternity settings in Ireland and develop hospital-specific foreign object management processes and implementation roadmaps. This project will deploy an integrated evidence-based assessment methodology for social-technical modelling (Supply, Context, Organising, Process & Effects/ SCOPE Analysis Cube) and bow tie methodologies that focuses on managing the risks in effectively implementing and sustaining change. It comprises a multi-phase research approach that involves active and ongoing collaboration with clinical and other healthcare staff through each phase of the research. The specific objective of this paper is to present the methodological approach and outline the potential to produce generalisable results which could be applied to other health-related issues.

Distributed improvisation: a systems perspective of improvisation 'epics' by led outdoor activity leaders

Improvisation represents the spontaneous and real-time conception and execution of a novel response to an unanticipated situation. In order to benefit from the positive safety potential of this phenomenon, it is necessary to understand what influences its appropriateness and effectiveness. This study has applied the system-based methodology Impromaps to analysing accounts of improvisation aimed at mitigating adverse safety outcomes. These accounts were obtained from led outdoor activity (LOA) leaders through critical decision method interviews. Influencing factors and interactions have been identified across all system levels. The factors most influential to leaders' ability to improvise are 'Policy, procedures and rules', 'Organisation culture', 'Training', 'Role responsibilities', 'Communication/instruction/demonstration', 'Situation awareness', 'Leader experience', 'Mental simulation', 'Equipment, clothing & PPE' and 'Terrain/physical environment'. To enhance the likelihood of effective, appropriate improvisation, LOA providers are recommended to focus on higher level factors over which they are able to exert greater control. Practitioner Summary: To enhance resilience in safety-critical situations, organisations need to understand what influences appropriate, effective improvisation. To elucidate this, the Impromaps methodology is applied to in-depth interview data. The Impromap affords a graphical depiction of the influencing factors and interactions across the system, providing a basis for the development of interventions.

Sociotechnical Resilience: A Preliminary Concept

This article presents the concept of sociotechnical resilience by employing an interdisciplinary perspective derived from the fields of science and technology studies, human factors, safety science, organizational studies, and systems engineering. Highlighting the hybrid nature of sociotechnical systems, we identify three main constituents that characterize sociotechnical resilience: informational relations, sociomaterial structures, and anticipatory practices. Further, we frame sociotechnical resilience as undergirded by the notion of transformability with an emphasis on intentional activities, focusing on the ability of sociotechnical systems to shift from one form to another in the aftermath of shock and disturbance. We propose that the triad of relations, structures, and practices are fundamental aspects required to comprehend the resilience of sociotechnical systems during times of crisis.

Ordering theories: Typologies and conceptual frameworks for sociotechnical change

What theories or concepts are most useful at explaining socio technical change? How can - or cannot - these be integrated? To provide an answer, this study presents the results from 35 semi-structured research interviews with social science experts who also shared more than two hundred articles, reports and books on the topic of the acceptance, adoption, use, or diffusion of technology. This material led to the identification of 96 theories and conceptual approaches spanning 22 identified disciplines. The article begins by explaining its research terms and methods before honing in on a combination of fourteen theories deemed most relevant and useful by the material. These are: Sociotechnical Transitions, Social Practice Theory, Discourse Theory, Domestication Theory, Large Technical Systems, Social Construction of Technology, Sociotechnical Imaginaries, Actor-Network Theory, Social Justice Theory, Sociology of Expectations, Sustainable Development, Values Beliefs Norms Theory, Lifestyle Theory, and the Unified Theory of Acceptance and Use of Technology. It then positions these theories in terms of two distinct typologies. Theories can be placed into five general categories of being centered on agency, structure, meaning, relations or norms. They can also be classified based on their assumptions and goals rooted in functionalism, interpretivism, humanism or conflict. The article lays out tips for research methodology before concluding with insights about technology itself, analytical processes associated with technology, and the framing and communication of results. An interdisciplinary theoretical and conceptual inventory has much to offer students, analysts and scholars wanting to study technological change and society.

Grappling with the future: The messiness of pilot implementation in information systems design

Pilot implementation is a method for avoiding unintended consequences of healthcare information systems. This study investigates how learning from pilot implementations is situated, messy, and therefore difficult. We analyze two pilot implementations by means of observation and interviews. In the first pilot implementation, the involved porters saw their improved overview of pending patient transports as an opportunity for more self-organization, but this opportunity hinged on the unclear prospects of extending the system with functionality for the porters to reply to transport requests. In the second pilot implementation, the involved paramedics had to print the data they had entered into the system because it had not yet been integrated with the electronic patient record. This extra work prolonged every dispatch and influenced the paramedics' experience of the entire system. We discuss how pilot implementations, in spite of their realism, leave room for uncertainty about the implications of the new system.

The Automation-by-Expertise-by-Training Interaction

OBJECTIVE

I introduce the automation-by-expertise-by-training interaction in automated systems and discuss its influence on operator performance.

BACKGROUND

Transportation accidents that, across a 30-year interval demonstrated identical automation-related operator errors, suggest a need to reexamine traditional views of automation.

METHOD

I review accident investigation reports, regulator studies, and literature on human computer interaction, expertise, and training and discuss how failing to attend to the interaction of automation, expertise level, and training has enabled operators to commit identical automation-related errors.

RESULTS

Automated systems continue to provide capabilities exceeding operators' need for effective system operation and provide interfaces that can hinder, rather than enhance, operator automation-related situation awareness. Because of limitations in time and resources, training programs do not provide operators the expertise needed to effectively operate these automated systems, requiring them to obtain the expertise ad hoc during system operations. As a result, many do not acquire necessary automation-related system expertise.

CONCLUSION

Integrating automation with expected operator expertise levels, and within training programs that provide operators the necessary automation expertise, can reduce opportunities for automation-related operator errors.

APPLICATION

Research to address the automation-by-expertise-by-training interaction is needed. However, such research must meet challenges inherent to examining realistic sociotechnical system automation features with representative samples of operators, perhaps by using observational and ethnographic research. Research in this domain should improve the integration of design and training and, it is hoped, enhance operator performance.

Fitting methods to paradigms: are ergonomics methods fit for systems thinking?

The issues being tackled within ergonomics problem spaces are shifting. Although existing paradigms appear relevant for modern day systems, it is worth questioning whether our methods are. This paper asks whether the complexities of systems thinking, a currently ubiquitous ergonomics paradigm, are outpacing the capabilities of our methodological toolkit. This is achieved through examining the contemporary ergonomics problem space and the extent to which ergonomics methods can meet the challenges posed. Specifically, five key areas within the ergonomics paradigm of systems thinking are focused on: normal performance as a cause of accidents, accident prediction, system migration, systems concepts and ergonomics in design. The methods available for pursuing each line of inquiry are discussed, along with their ability to respond to key requirements. In doing so, a series of new methodological requirements and capabilities are identified. It is argued that further methodological development is required to provide researchers and practitioners with appropriate tools to explore both contemporary and future problems. Practitioner Summary: Ergonomics methods are the cornerstone of our discipline. This paper examines whether our current methodological toolkit is fit for purpose given the changing nature of ergonomics problems. The findings provide key research and practice requirements for methodological development.

The Evolving Role of Medical Scribe: Variation and Implications for Organizational Effectiveness and Safety

Increasing use of medical scribes is an unintended consequence of electronic health record adoption in the U.S. The role of scribe is not universally defined, leading to variations in scribe training and operations, as well as questions about scribe efficiency, effectiveness, and safety. Studies published since 2009 have primarily focused on the financial aspects of scribe use, but no published studies have taken an organizational view of this phenomenon. This paper describes stakeholder perspectives on scribes working in outpatient settings within an urban tertiary academic medical center. It places factors associated with of scribe systems within an eight-dimension sociotechnical framework for evaluating health information technology, and discusses key aspects of those perspectives.

Macroergonomic factors in the patient work system: examining the context of patients with chronic illness

Human factors/ergonomics recognises work as embedded in and shaped by levels of social, physical and organisational context. This study investigates the contextual or macroergonomic factors present in the health-related work performed by patients. We performed a secondary content analysis of findings from three studies of the work of chronically ill patients and their informal caregivers. Our resulting consolidated macroergonomic patient work system model identified 17 factors across physical, social and organisational domains and household and community levels. These factors are illustrated with examples from the three studies and discussed as having positive, negative or varying effects on health and health behaviour. We present three brief case studies to illustrate how macroergonomic factors combine across domains and levels to shape performance in expected and unexpected ways. Findings demonstrate not only the importance of context for patients' health-related activities but also specific factors to consider in future research, design and policy efforts. Practitioner Summary: Health-related activities of patients are embedded in and shaped by levels of social, physical and organisational context. This paper combined findings from three studies to specify 17 contextual or macroergonomic factors in home- and community-based work systems of chronically ill patients. These factors have research, design and policy implications.

When paradigms collide at the road rail interface: evaluation of a sociotechnical systems theory design toolkit for cognitive work analysis

The Cognitive Work Analysis Design Toolkit (CWA-DT) is a recently developed approach that provides guidance and tools to assist in applying the outputs of CWA to design processes to incorporate the values and principles of sociotechnical systems theory. In this paper, the CWA-DT is evaluated based on an application to improve safety at rail level crossings. The evaluation considered the extent to which the CWA-DT met pre-defined methodological criteria and aligned with sociotechnical values and principles. Both process and outcome measures were taken based on the ratings of workshop participants and human factors experts. Overall, workshop participants were positive about the process and indicated that it met the methodological criteria and sociotechnical values. However, expert ratings suggested that the CWA-DT achieved only limited success in producing RLX designs that fully aligned with the sociotechnical approach. Discussion about the appropriateness of the sociotechnical approach in a public safety context is provided. Practitioner Summary: Human factors and ergonomics practitioners need evidence of the effectiveness of methods. A design toolkit for cognitive work analysis, incorporating values and principles from sociotechnical systems theory, was applied to create innovative designs for rail level crossings. Evaluation results based on the application are provided and discussed.

Never blame the umpire - a review of Situation Awareness models and methods for examining the performance of officials in sport

As sport becomes more complex, there is potential for ergonomics concepts to help enhance the performance of sports officials. The concept of Situation Awareness (SA) appears pertinent given the requirement for officials to understand what is going on in order to make decisions. Although numerous models exist, none have been applied to examine officials, and only several recent examples have been applied to sport. This paper examines SA models and methods to identify if any have applicability to officials in sport (OiS). Evaluation of the models and methods identified potential applications of individual, team and systems models of SA. The paper further demonstrates that the Distributed Situation Awareness model is suitable for studying officials in fastball sports. It is concluded that the study of SA represents a key area of multidisciplinary research for both ergonomics and sports science in the context of OiS. Practitioner Summary: Despite obvious synergies, applications of cognitive ergonomics concepts in sport are sparse. This is especially so for Officials in Sport (OiS). This article presents an evaluation of Situation Awareness models and methods, providing practitioners with guidance on which are the most suitable for OiS system design and evaluation.

Capturing complexity in work disability research: application of system dynamics modeling methodology

BACKGROUND

Work disability (WD) is characterized by variable and occasionally undesirable outcomes. The underlying determinants of WD outcomes include patterns of dynamic relationships among health, personal, organizational and regulatory factors that have been challenging to characterize, and inadequately represented by contemporary WD models.

METHOD

System dynamics modeling (SDM) methodology applies a sociotechnical systems thinking lens to view WD systems as comprising a range of influential factors linked by feedback relationships. SDM can potentially overcome limitations in contemporary WD models by uncovering causal feedback relationships, and conceptualizing dynamic system behaviors. It employs a collaborative and stakeholder-based model building methodology to create a visual depiction of the system as a whole. SDM can also enable researchers to run dynamic simulations to provide evidence of anticipated or unanticipated outcomes that could result from policy and programmatic intervention.

DISCUSSION

SDM may advance rehabilitation research by providing greater insights into the structure and dynamics of WD systems while helping to understand inherent complexity. Challenges related to data availability, determining validity, and the extensive time and technical skill requirements for model building may limit SDM's use in the field and should be considered.

IMPLICATIONS FOR REHABILITATION

Contemporary work disability (WD) models provide limited insight into complexity associated with WD processes. System dynamics modeling (SDM) has the potential to capture complexity through a stakeholder-based approach that generates a simulation model consisting of multiple feedback loops. SDM may enable WD researchers and practitioners to understand the structure and behavior of the WD system as a whole, and inform development of improved strategies to manage straightforward and complex WD cases.

Modelling and simulation of complex sociotechnical systems: envisioning and analysing work environments

Accurate comprehension and analysis of complex sociotechnical systems is a daunting task. Empirically examining, or simply envisioning the structure and behaviour of such systems challenges traditional analytic and experimental approaches as well as our everyday cognitive capabilities. Computer-based models and simulations afford potentially useful means of accomplishing sociotechnical system design and analysis objectives. From a design perspective, they can provide a basis for a common mental model among stakeholders, thereby facilitating accurate comprehension of factors impacting system performance and potential effects of system modifications. From a research perspective, models and simulations afford the means to study aspects of sociotechnical system design and operation, including the potential impact of modifications to structural and dynamic system properties, in ways not feasible with traditional experimental approaches. This paper describes issues involved in the design and use of such models and simulations and describes a proposed path forward to their development and implementation.

PRACTITIONER SUMMARY

The size and complexity of real-world sociotechnical systems can present significant barriers to their design, comprehension and empirical analysis. This article describes the potential advantages of computer-based models and simulations for understanding factors that impact sociotechnical system design and operation, particularly with respect to process and occupational safety.

Combining network analysis with Cognitive Work Analysis: insights into social organisational and cooperation analysis

Cognitive Work Analysis (CWA) allows complex, sociotechnical systems to be explored in terms of their potential configurations. However, CWA does not explicitly analyse the manner in which person-to-person communication is performed in these configurations. Consequently, the combination of CWA with Social Network Analysis provides a means by which CWA output can be analysed to consider communication structure. The approach is illustrated through a case study of a military planning team. The case study shows how actor-to-actor and actor-to-function mapping can be analysed, in terms of centrality, to produce metrics of system structure under different operating conditions.

PRACTITIONER SUMMARY

In this paper, a technique for building social network diagrams from CWA is demonstrated.The approach allows analysts to appreciate the potential impact of organisational structure on a command system.

Striving for safety: communicating and deciding in sociotechnical systems

How do communications and decisions impact the safety of sociotechnical systems? This paper frames this question in the context of a dynamic system of nested sub-systems. Communications are related to the construct of observability (i.e. how components integrate information to assess the state with respect to local and global constraints). Decisions are related to the construct of controllability (i.e. how component sub-systems act to meet local and global safety goals). The safety dynamics of sociotechnical systems are evaluated as a function of the coupling between observability and controllability across multiple closed-loop components. Two very different domains (nuclear power and the limited service food industry) provide examples to illustrate how this framework might be applied. While the dynamical systems framework does not offer simple prescriptions for achieving safety, it does provide guides for exploring specific systems to consider the potential fit between organisational structures and work demands, and for generalising across different systems regarding how safety can be managed.

PRACTITIONER SUMMARY

While offering no simple prescriptions about how to achieve safety in sociotechnical systems, this paper develops a theoretical framework based on dynamical systems theory as a practical guide for generalising from basic research to work domains and for generalising across alternative work domains to better understand how patterns of communication and decision-making impact system safety.

Sociotechnical attributes of safe and unsafe work systems

Theoretical and practical approaches to safety based on sociotechnical systems principles place heavy emphasis on the intersections between social-organisational and technical-work process factors. Within this perspective, work system design emphasises factors such as the joint optimisation of social and technical processes, a focus on reliable human-system performance and safety metrics as design and analysis criteria, the maintenance of a realistic and consistent set of safety objectives and policies, and regular access to the expertise and input of workers. We discuss three current approaches to the analysis and design of complex sociotechnical systems: human-systems integration, macroergonomics and safety climate. Each approach emphasises key sociotechnical systems themes, and each prescribes a more holistic perspective on work systems than do traditional theories and methods. We contrast these perspectives with historical precedents such as system safety and traditional human factors and ergonomics, and describe potential future directions for their application in research and practice.

PRACTITIONER SUMMARY

The identification of factors that can reliably distinguish between safe and unsafe work systems is an important concern for ergonomists and other safety professionals. This paper presents a variety of sociotechnical systems perspectives on intersections between social--organisational and technology--work process factors as they impact work system analysis, design and operation.

Defining the methodological challenges and opportunities for an effective science of sociotechnical systems and safety

An important part of the application of sociotechnical systems theory (STS) is the development of methods, tools and techniques to assess human factors and ergonomics workplace requirements. We focus in this paper on describing and evaluating current STS methods for workplace safety, as well as outlining a set of six case studies covering the application of these methods to a range of safety contexts. We also describe an evaluation of the methods in terms of ratings of their ability to address a set of theoretical and practical questions (e.g. the degree to which methods capture static/dynamic aspects of tasks and interactions between system levels). The outcomes from the evaluation highlight a set of gaps relating to the coverage and applicability of current methods for STS and safety (e.g. coverage of external influences on system functioning; method usability). The final sections of the paper describe a set of future challenges, as well as some practical suggestions for tackling these.

PRACTITIONER SUMMARY

We provide an up-to-date review of STS methods, a set of case studies illustrating their use and an evaluation of their strengths and weaknesses. The paper concludes with a 'roadmap' for future work.

Sociotechnical approaches to workplace safety: Research needs and opportunities

The sociotechnical systems perspective offers intriguing and potentially valuable insights into problems associated with workplace safety. While formal sociotechnical systems thinking originated in the 1950s, its application to the analysis and design of sustainable, safe working environments has not been fully developed. To that end, a Hopkinton Conference was organised to review and summarise the state of knowledge in the area and to identify research priorities. A group of 26 international experts produced collaborative articles for this special issue of Ergonomics, and each focused on examining a key conceptual, methodological and/or theoretical issue associated with sociotechnical systems and safety. In this concluding paper, we describe the major conference themes and recommendations. These are organised into six topic areas: (1) Concepts, definitions and frameworks, (2) defining research methodologies, (3) modelling and simulation, (4) communications and decision-making, (5) sociotechnical attributes of safe and unsafe systems and (6) potential future research directions for sociotechnical systems research.

PRACTITIONER SUMMARY

Sociotechnical complexity, a characteristic of many contemporary work environments, presents potential safety risks that traditional approaches to workplace safety may not adequately address. In this paper, we summarise the investigations of a group of international researchers into questions associated with the application of sociotechnical systems thinking to improve worker safety.

Editorial: emerging issues in sociotechnical systems thinking and workplace safety

The burden of on-the-job accidents and fatalities and the harm of associated human suffering continue to present an important challenge for safety researchers and practitioners. While significant improvements have been achieved in recent decades, the workplace accident rate remains unacceptably high. This has spurred interest in the development of novel research approaches, with particular interest in the systemic influences of social/organisational and technological factors. In response, the Hopkinton Conference on Sociotechnical Systems and Safety was organised to assess the current state of knowledge in the area and to identify research priorities. Over the course of several months prior to the conference, leading international experts drafted collaborative, state-of-the-art reviews covering various aspects of sociotechnical systems and safety. These papers, presented in this special issue, cover topics ranging from the identification of key concepts and definitions to sociotechnical characteristics of safe and unsafe organisations. This paper provides an overview of the conference and introduces key themes and topics.

PRACTITIONER SUMMARY

Sociotechnical approaches to workplace safety are intended to draw practitioners' attention to the critical influence that systemic social/organisational and technological factors exert on safety-relevant outcomes. This paper introduces major themes addressed in the Hopkinton Conference within the context of current workplace safety research and practice challenges.

Towards social radiology as an information infrastructure: reconciling the local with the global

The current widespread use of medical images and imaging procedures in clinical practice and patient diagnosis has brought about an increase in the demand for sharing medical imaging studies among health professionals in an easy and effective manner. This article reveals the existence of a polarization between the local and global demands for radiology practice. While there are no major barriers for sharing such studies, when access is made from a (local) picture archive and communication system (PACS) within the domain of a healthcare organization, there are a number of impediments for sharing studies among health professionals on a global scale. Social radiology as an information infrastructure involves the notion of a shared infrastructure as a public good, affording a social space where people, organizations and technical components may spontaneously form associations in order to share clinical information linked to patient care and radiology practice. This article shows however, that such polarization establishes a tension between local and global demands, which hinders the emergence of social radiology as an information infrastructure. Based on an analysis of the social space for radiology practice, the present article has observed that this tension persists due to the inertia of a locally installed base in radiology departments, for which common teleradiology models are not truly capable of reorganizing as a global social space for radiology practice. Reconciling the local with the global signifies integrating PACS and teleradiology into an evolving, secure, heterogeneous, shared, open information infrastructure where the conceptual boundaries between (local) PACS and (global) teleradiology are transparent, signaling the emergence of social radiology as an information infrastructure.

Fitness for purpose when there are many different purposes: who are electronic patient records for?

Electronic patient record systems serve many purposes for many different kinds of users. Four case studies are reported of the use made by health-care staff of electronic patient record systems that supported health-care pathways. The results demonstrate that the systems fit the purposes of strategic and managerial users of the record, but they are problematic as tools for use by the frontline staff delivering care. As a result, these staff frequently resort to workarounds to accomplish their work goals. An analysis of the design processes that created these systems shows that the specification of the systems was based on strategic and managerial requirements and there was no formal assessment of the needs of frontline users. Efforts to address the needs of frontline staff in the provisions of electronic systems were most often made after the main system was implemented.

Sociotechnical challenges and progress in using social media for health

Social media tools that connect patients, caregivers, and health providers offer great potential for helping people access health advice, receive and give social support, manage or cope with chronic conditions, and make day-to-day health decisions. These systems have seen widespread adoption, but often fail to support the goals as fully as designers and users would like. Through Ackerman's lens of the "sociotechnical gap" and computer supported cooperative work (CSCW) as a science of the artificial, we review contemporary sociotechnical challenges and progress for using social media to support health. These challenges include a tension between privacy and sharing, policy information credibility, accessibility, and tailoring in social spaces. Those studying, building, deploying, and using social media systems to further health goals will benefit from approaching this work by borrowing from Ackerman's framing of CSCW. In particular, this requires acknowledgment that technical systems will not fully meet our social goals, and then adopting design and educational approaches that are appropriate to fill this gap, building less-nuanced systems as partial solutions and tools for advancing our understanding, and by working with the CSCW research community to develop and pursue key lines of inquiry.

Trust in technology-mediated collaborative health encounters: constructing trust in passive user interactions with technologies

The present study investigated factors that explain patient trust in health technology and the relationship between patient trust in technology and trust in their care provider. Sociotechnical systems theory states that changes in one part of the system are likely related to other parts of the system. Therefore, attitudes about technologies, like trust, are likely related to other aspects of the system. Contributing to appropriate trust at the technological, interpersonal, and system levels can potentially lead to positive health outcomes. The study described in this manuscript used data collected from 101 patients with a Trust in Medical Technology instrument. The instrument measured patients' trust in (1) their providers, (2) the technology, and (3) how their providers used the technology. Measure 3 was positively associated with measures 1 and 2, while measures 1 and 2 were not positively or negatively associated with one another. These results may indicate that patient assessments of the trustworthiness of care providers and technologies are based on their observations of how providers use technologies.

PRACTITIONER SUMMARY

Though patients are not active users of technologies in health care, the results of this study show that their perceptions of how providers use technology are related to their trust in both technology and the care provider. Study findings have implications for how trust is conceptualised and measured in interpersonal relationships and in technologies.

Sociotechnical systems approach to healthcare quality and patient safety

The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is described and selected research and practical applications are presented.

Patient source of learning about health technologies and ratings of trust in technologies used in their care

In order to design effective health technologies and systems, it is important to understand how patients learn and make decisions about health technologies used in their care. The objective of this study was to examine patients' source of learning about technologies used in their care and how the source related to their trust in the technology was used. Individual face-to-face and telephone interviews were conducted with 24 patients. Altogether, 13 unique sources of information about technology were identified and three major themes emerged: outside of the work system vs. inside the work system; when the health information was provided; the medium used. Patients used multiple sources outside of the healthcare work system to learn about technologies that will be used in their care. Results showed a relationship between learning about technologies from web sources and trust in technologies but no relationship between learning about technologies from healthcare providers and trust in technologies. STATEMENT OF RELEVANCE: The value of considering human attitudes about elements in health systems has been illustrated. This research shows a relationship between patient attitudes about medical technologies used in their care and healthcare work system design. Results show that patient attitudes are formed about technologies used in their care by sources within and outside of the sociotechnical work system.

Validation of a trust in medical technology instrument

A patient's trusting attitude towards technology used in their medical care may be a predictor of acceptance or rejection of the technology and, by extension, the physician. The aim of this study was to rigorously determine the validity of an instrument for measuring patients' trust in medical technology. Instrument validity was established based on a framework, which included test and data evidence for validity assessment. The framework for validity assessment evaluates the instrument on content, substantive, structural, generalizability, external and consequential aspects of validity. The results of the current study show that the instrument is reliable and valid for assessing a patient's trust in obstetric medical technology.