scholarly journals Team Cognition as a Barrier and Facilitator in Care Transitions: Implications for Work System Design

2019 ◽  
Vol 63 (1) ◽  
pp. 648-652
Author(s):  
Abigail R. Wooldridge ◽  
Pascale Carayon ◽  
Peter Hoonakker ◽  
Bat-Zion Hose ◽  
Thomas B. Brazelton ◽  
...  
Keyword(s):  
Patient Safety ◽  
System Design ◽  
Systems Engineering ◽  
Care Transitions ◽  
Pediatric Trauma ◽  
Barriers And Facilitators ◽  
Distributed Teams ◽  
Future Research ◽  
Team Cognition ◽  
Work System

Inpatient care of pediatric trauma patients includes care transitions, including from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU, which are important to patient safety and quality of care. Previous research identified work system barriers and facilitators in these transitions; the most common related to team cognition. We conducted interviews with 18 healthcare professionals to better understand how work system design influences team cognition barriers and facilitators. Using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling, we identified when each barrier/facilitator occurred. The ED to OR transition had more barriers in transition preparation, while OR to PICU had more facilitators in the transition. Future research should explore solutions to support team cognition early in the ED to OR transition, such as designing a technology to be used by distributed teams.

scholarly journals Work system design for patient safety: the SEIPS model

2006 ◽  
Vol 15 (suppl 1) ◽  
pp. i50-i58 ◽  
Author(s):  
P Carayon ◽  
A Schoofs Hundt ◽  
B-T Karsh ◽  
A P Gurses ◽  
C J Alvarado ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
System Design ◽  
Systems Engineering ◽  
Care Setting ◽  
Outpatient Surgery ◽  
Work System ◽  
Advance Research

Models and methods of work system design need to be developed and implemented to advance research in and design for patient safety. In this paper we describe how the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety, which provides a framework for understanding the structures, processes and outcomes in health care and their relationships, can be used toward these ends. An application of the SEIPS model in one particular care setting (outpatient surgery) is presented and other practical and research applications of the model are described.

Using Technology to Support Distributed Teams: A Work System-Based Study of an Interdisciplinary Team Responding to COVID-19

2021 ◽  
Vol 65 (1) ◽  
pp. 174-178
Author(s):  
Kaitlyn L. Hale-Lopez ◽  
Abigail R. Wooldridge ◽  
Molly H. Goldstein
Keyword(s):  
System Design ◽  
New Technologies ◽  
Asynchronous Communication ◽  
Interdisciplinary Teams ◽  
Distributed Teams ◽  
Future Research ◽  
Team Members ◽  
Effective Teams ◽  
Work System ◽  
Use Of Technology

Effective teams are essential to meet the complex and dynamic requirements during pandemic response. This case study analyses the work system of mobileSHIELD, a distributed team developing a diagnostic test in response to the COVID-19 pandemic. We conducted interviews with 18 team members to understand how work system design influences the use of technology to support distributed teams. We identified six work system barriers and facilitators. The barriers related to rapidly adopting new technologies and not utilizing features of technologies that support relationships. The facilitators were related to the use of technology to support informal communication, synchronous and asynchronous communication, and mobile technology to improve productivity and collaboration. Our findings indicate technology that is mobile, cloud based, simple and user-friendly can support distributed teams, in particular by improving asynchronous communication. Future research will holistically explore implications for work system design to support interdisciplinary teams responding to societal crises.

scholarly journals Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients

2020 ◽  
Vol 85 ◽  
pp. 103059 ◽  
Author(s):  
Abigail R. Wooldridge ◽  
Pascale Carayon ◽  
Peter Hoonakker ◽  
Bat-Zion Hose ◽  
Benjamin Eithun ◽  
...  
Keyword(s):  
Inpatient Care ◽  
Care Transitions ◽  
Pediatric Trauma ◽  
Barriers And Facilitators ◽  
Trauma Patients ◽  
Work System

scholarly journals Homes of children with medical complexity as a complex work system: outcomes associated with interactions in the physical environment

2019 ◽  
Vol 63 (1) ◽  
pp. 753-757
Author(s):  
Nadejda Doutcheva ◽  
Hannah Thomas ◽  
Reid Parks ◽  
Ryan Coller ◽  
Nicole Werner
Keyword(s):  
Patient Safety ◽  
Systems Engineering ◽  
Physical Environment ◽  
Well Being ◽  
Home Environments ◽  
Children With Medical Complexity ◽  
Work System ◽  
Systems Research ◽  
Physical Environments ◽  
Medical Complexity

Family caregivers provide critical care for children with medical complexity (CMC) at home, yet homes are still a poorly understood healthcare setting. Home environments include diverse physical environments, technologies, tools, tasks, and people, and are therefore complex work systems. Research suggests that home environments can contribute positively and negatively to both individuals’ well-being and the quality of care that families can provide. Our objective for this study was to determine how the physical environment of the home interacts within a work system to affect outcomes related to in-home care of CMC. We used contextual inquiry to interview 30 caregivers in their homes and analyzed our data using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model. We focused on identifying physical environments’ interactions with other work system components and the resulting CMC outcomes. We identified six categories of outcomes that are influenced by work system interactions within the physical environment: 1) Safe or Unsafe delivery of care; 2) Prepared for or Inability to Respond to Care Crisis; 3) Home Mobility or Inaccessibility; 4) Efficient and Inefficient Care; 5) Inclusion and Isolation from Family; and 6) Socioemotional Comfort and Stress. The physical environment influences a range of outcomes from patient safety to families’ emotional well-being. Our results point to the need for adaptation of SEIPS 2.0 to the home environment by incorporating consideration for family and home-based outcomes into the model.

scholarly journals Risk factors associated with medication ordering errors

2020 ◽  
Author(s):  
Joanna Abraham ◽  
William L Galanter ◽  
Daniel Touchette ◽  
Yinglin Xia ◽  
Katherine J Holzer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patient Safety ◽  
Systems Engineering ◽  
Learning Opportunities ◽  
Organizational Level ◽  
Future Research ◽  
Work Systems ◽  
Factors Associated ◽  
Computerized Order Entry ◽  
Response Errors

Abstract Objective We utilized a computerized order entry system–integrated function referred to as “void” to identify erroneous orders (ie, a “void” order). Using voided orders, we aimed to (1) identify the nature and characteristics of medication ordering errors, (2) investigate the risk factors associated with medication ordering errors, and (3) explore potential strategies to mitigate these risk factors. Materials and Methods We collected data on voided orders using clinician interviews and surveys within 24 hours of the voided order and using chart reviews. Interviews were informed by the human factors–based SEIPS (Systems Engineering Initiative for Patient Safety) model to characterize the work systems–based risk factors contributing to ordering errors; chart reviews were used to establish whether a voided order was a true medication ordering error and ascertain its impact on patient safety. Results During the 16-month study period (August 25, 2017, to December 31, 2018), 1074 medication orders were voided; 842 voided orders were true medication errors (positive predictive value = 78.3 ± 1.2%). A total of 22% (n = 190) of the medication ordering errors reached the patient, with at least a single administration, without causing patient harm. Interviews were conducted on 355 voided orders (33% response). Errors were not uniquely associated with a single risk factor, but the causal contributors of medication ordering errors were multifactorial, arising from a combination of technological-, cognitive-, environmental-, social-, and organizational-level factors. Conclusions The void function offers a practical, standardized method to create a rich database of medication ordering errors. We highlight implications for utilizing the void function for future research, practice and learning opportunities.

Improving Care Transitions in Healthcare: A Human Factors/Ergonomics (HFE) Approach

2018 ◽  
Vol 62 (1) ◽  
pp. 551-555 ◽  
Author(s):  
Patrick Waterson ◽  
Abigail Wooldridge ◽  
Abigail Wooldridge ◽  
Mary Sesto ◽  
Ayse Gurses ◽  
...  
Keyword(s):  
Patient Safety ◽  
Elderly Patients ◽  
Medication Management ◽  
Care Transitions ◽  
Pediatric Trauma ◽  
Marrow Transplant ◽  
Different Types ◽  
Hospital To Home ◽  
Orthopedic Patients

Delivering safe healthcare often involves multi-disciplinary teams working across multiple locations. Care transitions are required to provide continuity of care and are often fail due to this type of complexity. Care transitions occur in numerous settings, for example: during shift changes, transfer between wards, or during discharge to the patient’s home (WHO Collaborating Centre for Patient Safety Solutions 2007). The aim of the panel will be to discuss different types of care transitions and how HFE can assist in improving patient safety and efficiency of the process. The panel will discuss and share lessons learnt from a range of projects involving care transitions for pediatric trauma care (Woolridge), and barriers and facilitators to follow-up care for bone marrow transplant survivors (Sesto). In addition, the work system elements for care transitions for elective orthopedic patients (Carman), elderly patients after heart failure hospitalization (Holden) and risks to elderly patients’ safe medication management (Gurses) when transitioning from hospital to home will be discussed.

scholarly journals Human Factors and Ergonomics in Health Care and Patient Safety from the Perspective of Medical Residents

2020 ◽  
pp. 81-89
Author(s):  
Pascale Carayon ◽  
Peter Kleinschmidt ◽  
Bat-Zion Hose ◽  
Megan Salwei
Keyword(s):  
Patient Safety ◽  
Human Factors ◽  
Systems Engineering ◽  
Systems Approach ◽  
Critical Role ◽  
Well Being ◽  
Medical Residents ◽  
Work System ◽  
Educational Processes ◽  
Care Processes

AbstractIt is critical to understand, analyze and improve the work system of medical residents in order to support the care processes in which they are involved, as well as their educational processes. The discipline of human factors (or ergonomics) (HFE) provides systems concepts and methods to improve the multi-faceted work system of medical residents and, therefore, care processes and educational processes, and outcomes for both patients and residents. In this chapter, we apply the SEIPS (Systems Engineering Initiative for Patient Safety) model to the work system of residents, and use it to explain how the outcomes of patient safety and medical resident well-being are related. Various challenges need to be addressed in order to improve residents’ work system. In particular, it is critical to adopt a systems approach that can optimize multiple outcomes for a range of stakeholders. In line with the participatory ergonomics approach, we contend that residents have a critical role to play in improving their work system; we describe various ways that this can be accomplished.

scholarly journals Implementation of a Clostridioides difficile prevention bundle: Understanding common, unique, and conflicting work system barriers and facilitators for subprocess design

2019 ◽  
Vol 40 (8) ◽  
pp. 880-888 ◽  
Author(s):  
Jackson S. Musuuza ◽  
Ann Schoofs Hundt ◽  
Pascale Carayon ◽  
Karly Christensen ◽  
Caitlyn Ngam ◽  
...  
Keyword(s):  
Systems Engineering ◽  
Diagnostic Testing ◽  
Barriers And Facilitators ◽  
Successful Implementation ◽  
Work System ◽  
Clostridioides Difficile ◽  
Contact Isolation ◽  
Management Procedures ◽  
Algorithmic Approaches ◽  
Environmental Disinfection

AbstractObjective:Clostridioides difficile (C. difficile) poses a major challenge to the healthcare system. We assessed factors that should be considered when designing subprocesses of a C. difficile infection (CDI) prevention bundle.Design:Phenomenological qualitative study.Methods:We conducted 3 focus groups of environmental services (EVS) staff, physicians, and nurses to assess their perspectives on a CDI prevention bundle. We used the Systems Engineering Initiative for Patient Safety (SEIPS) model to examine 5 subprocesses of the CDI bundle: diagnostic testing, empiric isolation, contact isolation, hand hygiene, and environmental disinfection. We coded transcripts to the 5 SEIPS elements and ensured scientific rigor. We sought to determine common, unique, and conflicting factors across stakeholder groups and subprocesses of the CDI bundle.Results:Each focus group lasted 1.5 hours on average. Common work-system barriers included inconsistencies in knowledge and practice of CDI management procedures; increased workload; poor setup of aspects of the physical environment (eg, inconvenient location of sinks); and inconsistencies in CDI documentation. Unique barriers and facilitators were related to specific activities performed by the stakeholder group. For instance, algorithmic approaches used by physicians facilitated timely diagnosis of CDI. Conflicting barriers or facilitators were related to opposing objectives; for example, clinicians needed rapid placement of a patient in a room while EVS staff needed time to disinfect the room.Conclusions:A systems engineering approach can help to holistically identify factors that influence successful implementation of subprocesses of infection prevention bundles.

Comparing Physician and Nurse Opinions of Team and Individual Handoffs: Does Role Influence Preference?

2020 ◽  
Vol 64 (1) ◽  
pp. 613-617
Author(s):  
Emily Heuck ◽  
Abigail Wooldridge
Keyword(s):  
Intensive Care Unit ◽  
Safety Issue ◽  
Care Transitions ◽  
Intensive Care Unit Care ◽  
Sociotechnical System ◽  
Health Care Professions ◽  
Work System ◽  
Professional Needs ◽  
Future Work ◽  
System Designs

Care transitions are key to patient safety and remain a safety issue despite previous research. This study examines how the design of care transitions impacts different health care professions. Twenty-nine physicians and nurses were interviewed about operating room to intensive care unit care transitions. We compared relationships between work system elements in positive and negative opinions about two sociotechnical system designs: including team or individual handoffs. Nurses did not express positive opinions of individual handoffs or negative opinions of team handoffs, while physicians expressed positive and negative opinions of both. Relationships between work system elements varied by profession in the positive opinions about team handoffs and negative opinions about individual handoffs. Professional needs and culture may be related to the different perceptions of each handoff. Future work should continue to examine professional differences when developing a flexibly standardized process to ensure all users are considered.

scholarly journals Application of electronic trigger tools to identify targets for improving diagnostic safety

2018 ◽  
Vol 28 (2) ◽  
pp. 151-159 ◽  
Author(s):  
Daniel R Murphy ◽  
Ashley ND Meyer ◽  
Dean F Sittig ◽  
Derek W Meeks ◽  
Eric J Thomas ◽  
...  
Keyword(s):  
Adverse Event ◽  
Patient Safety ◽  
High Risk ◽  
Health Systems ◽  
Language Processing ◽  
Diagnostic Errors ◽  
Diagnostic Process ◽  
Future Research ◽  
Implementation Challenges ◽  
Preventable Harm

Progress in reducing diagnostic errors remains slow partly due to poorly defined methods to identify errors, high-risk situations, and adverse events. Electronic trigger (e-trigger) tools, which mine vast amounts of patient data to identify signals indicative of a likely error or adverse event, offer a promising method to efficiently identify errors. The increasing amounts of longitudinal electronic data and maturing data warehousing techniques and infrastructure offer an unprecedented opportunity to implement new types of e-trigger tools that use algorithms to identify risks and events related to the diagnostic process. We present a knowledge discovery framework, the Safer Dx Trigger Tools Framework, that enables health systems to develop and implement e-trigger tools to identify and measure diagnostic errors using comprehensive electronic health record (EHR) data. Safer Dx e-trigger tools detect potential diagnostic events, allowing health systems to monitor event rates, study contributory factors and identify targets for improving diagnostic safety. In addition to promoting organisational learning, some e-triggers can monitor data prospectively and help identify patients at high-risk for a future adverse event, enabling clinicians, patients or safety personnel to take preventive actions proactively. Successful application of electronic algorithms requires health systems to invest in clinical informaticists, information technology professionals, patient safety professionals and clinicians, all of who work closely together to overcome development and implementation challenges. We outline key future research, including advances in natural language processing and machine learning, needed to improve effectiveness of e-triggers. Integrating diagnostic safety e-triggers in institutional patient safety strategies can accelerate progress in reducing preventable harm from diagnostic errors.

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