Towards a hybrid method to categorize interruptions and activities in healthcare

Abstract

SummaryObjective-Interruptions are known to have a negative impact on activity performance. Understanding how an interruption contributes to human error is limited because there is not a standard method for analyzing and classifying interruptions. Qualitative data are typically analyzed by either a deductive or an inductive method. Both methods have limitations. In this paper a hybrid method was developed that integrates deductive and inductive methods for the categorization of activities and interruptions recorded during an ethnographic study of physicians and registered nurses in a Level One Trauma Center. Understanding the effects of interruptions is important for designing and evaluating informatics tools in particular and for improving healthcare quality and patient safety in general.Method-The hybrid method was developed using a deductive a priori classification framework with the provision of adding new categories discovered inductively in the data. The inductive process utilized line-by-line coding and constant comparison as stated in Grounded Theory.Results-The categories of activities and interruptions were organized into a three-tiered hierarchy of activity. Validity and reliability of the categories were tested by categorizing a medical error case external to the study. No new categories of interruptions were identified during analysis of the medical error case.Conclusions-Findings from this study provide evidence that the hybrid model of categorization is more complete than either a deductive or an inductive method alone. The hybrid method developed in this study provides the methodical support for understanding, analyzing, and managing interruptions and workflow.

Interruptions in a level one trauma center: A case study

“…The field notes were analyzed using the Hybrid Method to Categorize Interruptions and Activities (HyMCIA) [15]. HyMCIA was developed through the hybridization of a deductive a priori classification framework with the provision of adding new categories discovered inductively in the data using grounded theory [12].…”

Behavior observation of major noise sources in critical care wards

“…Behavioural modification and improvement of major noise sources is considered to be an effective noise reduction strategy in the context of hospital acoustic environments [1]. However, very little observational data regarding noise sources in the healthcare environment exists, though there are some studies investigating the human activities related to interruptions on activity performance and communication in hospitals [7,8]. Similar to the field measurement and simulation works presented in previous papers [9][10][11][12] , researchers have measured the noise levels or studied the sound field of various healthcare environments.…”

The nature and occurrence of registration errors in the emergency department

“…It constitutes a complex and dynamic environment in which a team, consisting of attending and resident physicians, nurses, students, technicians and support staff, as well as subspecialty consultants, is charged with managing a varying, often overwhelming volume of patients with a wide range of clinical illnesses [2]. Such environments, where decisions are made under pressure and with incomplete information, have been considered more conducive to error [3].…”