“Drops Hollowing the Stone”: Workarounds as Resources for Better Task-Artifact Fit

Cabitza, Federico; Simone, Carla

doi:10.1007/978-1-4471-5346-7_6

Cited by 13 publications

(8 citation statements)

References 39 publications

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“…We adopted a qualitative approach consisting of nonparticipant direct observation combined with semistructured follow-up interviews with physicians, nurses, and clerks using the EHR while performing their ordinary medical practice. The observations allowed us to observe workarounds while work practices and EHR use by health care professionals unfold in situ [ 54 ]. The semistructured follow-up interviews allowed us to gain greater insight into each observed workaround, more specifically their scope (ie, patient, professional, and organization) and impact (ie, consequences for patient safety, effectiveness of care, and efficiency of care).…”

Section: Methodsmentioning

confidence: 99%

Workarounds Emerging From Electronic Health Record System Usage: Consequences for Patient Safety, Effectiveness of Care, and Efficiency of Care

et al. 2017

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BackgroundHealth care providers resort to informal temporary practices known as workarounds for handling exceptions to normal workflow unintendedly imposed by electronic health record systems (EHRs). Although workarounds may seem favorable at first sight, they are generally suboptimal and may jeopardize patient safety, effectiveness of care, and efficiency of care.ObjectiveResearch into the scope and impact of EHR workarounds on patient care processes is scarce. This paper provides insight into the effects of EHR workarounds on organizational workflows and outcomes of care services by identifying EHR workarounds and determining their rationales, scope, and impact on health care providers’ workflows, patient safety, effectiveness of care, and efficiency of care. Knowing the rationale of a workaround provides valuable clues about the source of origin of each workaround and how each workaround could most effectively be resolved. Knowing the scope and impact a workaround has on EHR-related safety, effectiveness, and efficiency provides insight into how to address related concerns.MethodsDirect observations and follow-up semistructured interviews with 31 physicians, 13 nurses, and 3 clerks and qualitative bottom-up coding techniques was used to identify, analyze, and classify EHR workarounds. The research was conducted within 3 specialties and settings at a large university hospital. Rationales were associated with work system components (persons, technology and tools, tasks, organization, and physical environment) of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to reveal their source of origin as well as to determine the scope and the impact of each EHR workaround from a structure-process-outcome perspective.ResultsA total of 15 rationales for EHR workarounds were identified of which 5 were associated with persons, 4 with technology and tools, 4 with the organization, and 2 with the tasks. Three of these 15 rationales for EHR workarounds have not been identified in prior research: data migration policy, enforced data entry, and task interference.ConclusionsEHR workaround rationales associated with different SEIPS work system components demand a different approach to be resolved. Persons-related workarounds may most effectively be resolved through personal training, organization-related workarounds through reviewing organizational policy and regulations, tasks-related workarounds through process redesign, and technology- and tools-related workarounds through EHR redesign efforts. Furthermore, insights gained from knowing a workaround’s degree of influence as well as impact on patient safety, effectiveness of care, and efficiency of care can inform design and redesign of EHRs to further align EHR design with work contexts, subsequently leading to better organization and (safe) provision of care. In doing so, a research team in collaboration with all stakeholders could use the SEIPS framework to reflect on the current and potential future configurations of the work system to prevent unfavorabl...

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Section: Methodsmentioning

confidence: 99%

Workarounds Emerging From Electronic Health Record System Usage: Consequences for Patient Safety, Effectiveness of Care, and Efficiency of Care

et al. 2017

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“…In this remark, we then recognised a phenomenon that is getting more and more visibility in the specialist literature (Scott 2005;Nowinski et al 2007;Cabitza and Simone 2013) for its potential high impact on the final adoption and appropriation of electronic tools supporting practice in the medical domain; a phenomenon that apparently calls for new and deeper ways in which end users can modify their daily use artefacts, at least to some extent (Lieberman et al 2006). We really appreciated it.…”

Section: Theme 10 -The Requirement Of Lay-user Autonomymentioning

confidence: 91%

On a QUESt for a web-based tool promoting knowledge-sharing in medical communities

Cabitza

2014

Behaviour & Information Technology

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The paper reports on the design and development of QUESt, a platform that is aimed at enabling lay users to deploy webbased multi-page dynamic questionnaires. The platform requires little effort and no programming skills, as it uses a simple configuration file that can be expressed in an almost unstructured and text-based manner. We have validated the approach and platform in the healthcare domain, where the questionnaires were intended to solicit and collect both structured and unstructured feedback from large communities of practitioners in response to the sharing and dissemination of relevant case studies; more specifically in this paper we use a qualitative research approach, encompassing evaluation questionnaires and a particular kind of focus group, and the incremental prototype-based development that led to the current release of QUESt. The paper also reports on the experimentation of the platform in a real context, involving almost 100 orthopaedics, including the post-use evaluation of the participants. In light of this evaluation, we discuss the specific requirements of openness and flexibility that end-users ask for in order to be autonomous in developing their own tools for knowledge-sharing; in particular, we discuss the role of lightweight tools, like QUESt to support the dissemination and discussion of clinical case reports.

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“…Here, a context-aware prioritization of tasks could be advantageous to reduce the number of void tasks as well as to facilitate the orderlies' anticipation of task and scheduling work [5]. Although the delegation of coordination takes advantage of the proactivity of orderlies and, in principle, helps them with planning and scheduling, it also has some side effects as the orderlies performed workarounds [15] and bypassed PLog to compensate situated misalignments (e.g., inefficient booking) in the information infrastructure [23]. For instance, the data collected by PLog can now facilitate the identification of opportunistic behavior when orderlies decide not to sign up for unpopular tasks, which in turn can provoke a delay on performing those tasks and thus decrease the overall efficiency of the hospital work.…”

Section: From Centralized To a More Decentralized Coordinationmentioning

confidence: 99%

Accounting for the Invisible Work of Hospital Orderlies

Stisen

Verdezoto

Blunck

et al. 2016

Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work &Amp; Social Computing

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The cooperative, invisible non-clinical work of hospital orderlies is often overlooked. It consists foremost of transferring patients between hospital departments. As the overall efficiency of the hospital is highly dependent on the coordination of the work of orderlies, this study investigates the coordination changes in orderlies' work practices in connection to the implementation of a workflow application at the hospital. By applying a mixed methods approach (both qualitative and quantitative studies), this paper calls for attention to the changes in orderlies' coordination activities while moving from a manual and centralized form to a semi-automatic and decentralized approach after the introduction of the workflow application. We highlight a set of cross-boundary (spatial and organizational) informationsharing breakdowns and the challenges of orderlies in maintaining local and global coordination. We also present design recommendations for future design of coordination tools to support orderlies' work practices.

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“Drops Hollowing the Stone”: Workarounds as Resources for Better Task-Artifact Fit

Cited by 13 publications

References 39 publications

Workarounds Emerging From Electronic Health Record System Usage: Consequences for Patient Safety, Effectiveness of Care, and Efficiency of Care

Workarounds Emerging From Electronic Health Record System Usage: Consequences for Patient Safety, Effectiveness of Care, and Efficiency of Care

On a QUESt for a web-based tool promoting knowledge-sharing in medical communities

Accounting for the Invisible Work of Hospital Orderlies

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