Two sides to every story: The Dual Perspectives Method for examining interruptions in healthcare

Abstract

Interruptions are widely considered a problem in healthcare. Results from observation and experimental studies have guided extensive mitigation efforts, but the effectiveness of interventions remains mixed. We have built on current theories and methods for studying interruptions to develop a novel observational approach - the Dual Perspectives Method - for examining interruptions from the perspectives of the different work functions in an Intensive Care Unit (ICU). We detail the method and provide representative examples of the insights it offers, such as why interruptions happen, the role they play, and the consequences of preserving them or eliminating them. We anticipate that the Dual Perspectives Method will help us to arrive at a better basis on which to draw conclusions about interruptions, and will lead to the development of appropriate and sustainable interventions to ensure the effective and safe functioning of the work system under examination.

Traditions of research into interruptions in healthcare: A conceptual review

“…The key purpose of CSE is to redesign the interaction amongst those agents for better operation of the joint cognitive system [91,92]. As noted, a key feature of CSE is its focus on the "joint cognitive system", but the papers reviewed still focused largely on the "interruption dyad" of interrupter and interruptee, with only occasional papers mentioning of the role of supporting artefacts and technologies [10,113] or of the interleaving of work amongst team members [9,108,115,116]. Only a subset of papers describe how agents cope with complexity [9,10,107,108,112,119].…”

“…Only a subset of papers describe how agents cope with complexity [9,10,107,108,112,119]. Further key features of CSE emerging in the interruptions papers are its focus on redesign [9,10,108,111,114,[118][119][120] and its preference for systems-based changes to avoid the need for interruptions over person-based changes that prevent interruptions at the point where they occur [10,13,108,116,118]. In summary, CSE brings to interruptions research a broad systems approach that focuses on the functions of interruptions and on the potential for design to provide solutions where needed.…”

Interruptions in the healthcare workplace: a sociotechnical systems approach

“…However, there are several papers that embody a sufficient number of those features that we have categorised those papers under CSE rather than the other traditions. Almost all the papers categorised under CSE that report empirical findings have investigated interruptions in the naturalistic work environment [8,10,[107][108][109][110][111][112][113][114][115][116]; an exception is highfidelity simulator investigations by Prakash et al [117]. [122] is reflected in one paper from the CSE community by noting that interruptions contribute to organisational resilience [109].…”

“…As noted, a key feature of CSE is its focus on the "joint cognitive system", but the papers reviewed still focused largely on the "interruption dyad" of interrupter and interruptee, with only occasional papers mentioning of the role of supporting artefacts and technologies [10,113] or of the interleaving of work amongst team members [9,108,115,116]. Only a subset of papers describe how agents cope with complexity [9,10,107,108,112,119].…”

“…Only a subset of papers describe how agents cope with complexity [9,10,107,108,112,119]. Further key features of CSE emerging in the interruptions papers are its focus on redesign [9,10,108,111,114,[118][119][120] and its preference for systems-based changes to avoid the need for interruptions over person-based changes that prevent interruptions at the point where they occur [10,13,108,116,118]. In summary, CSE brings to interruptions research a broad systems approach that focuses on the functions of interruptions and on the potential for design to provide solutions where needed.…”