Organizational vs. technical variables: impact on the collective - PowerPoint PPT Presentation

Organizational vs. technical variables: impact on the collective aspects of healthcare work situations Sylvia Pelayo, F. Anceaux, J. Rogalski & M.-C. Beuscart-Zéphir

Context of the study

Context Study 1 Study 2 Conclusion CPOE are inevitable for the quality and safety of the situations MIE 2009, Sarajevo, 31 August-2 September 3

Context Study 1 Study 2 Conclusion Difficulties with implementations Problems of usage CPOE are inevitable for the quality and safety of the situations MIE 2009, Sarajevo, 31 August-2 September 4

Context Study 1 Study 2 Conclusion Technical system is often pointed out: – ! Its poor design, – ! Its narrow and simplistic underlying model, – ! increasingly, its inefficiency to support the teamwork  The technical system weakens the doctors- nurses communications !!! MIE 2009, Sarajevo, 31 August-2 September 5

Context Study 1 Study 2 Conclusion What is the actual determinant of the quality of professionals’ cooperation ? The most important determinant ? The current determinant !! MIE 2009, Sarajevo, 31 August-2 September 6

Context Study 1 Study 2 Conclusion Objective of the study Identify the respective impact of the 2 variables on the doctors-nurses teamwork : the technical system vs. the organisation of work. How ? 1.Identification of the doctors-nurses face-to-face communications flows 2. Crossing of the 2 variables: • ! Impact on the communications’ duration? • ! Impact on the quality of the cooperation? MIE 2009, Sarajevo, 31 August-2 September 7

Methods (1)

Context Study 1 Study 2 Conclusion 1. ! Identify the doctors-nurses communications flows MIE 2009, Sarajevo, 31 August-2 September 9

Context Study 1 Study 2 Conclusion 1. ! Identify the doctors-nurses communications flows • ! Methods  ! Observations  ! Semi-structured interviews MIE 2009, Sarajevo, 31 August-2 September 10

Context Study 1 Study 2 Conclusion 1. ! Identify the doctors-nurses communications flows • ! Methods  ! Observations  ! Semi-structured interviews • ! Sites of the study  ! Paper-based » ! University Hospital of Lille (UHL) (Cardiology, Nephrology and Neurosurgery)  ! Computerized » ! Denain Public Hospital (DPH) (cardiology / gastroenterology and infectious disease) » ! HEGP (Nephrology and Immunology) MIE 2009, Sarajevo, 31 August-2 September 11

Results (1)

Context Study 1 Study 2 Conclusion 1. Identification of the communication flows Common Briefing Opportunistic Round Exchanges UHL/Neurosurgery 98% 0% 2% DPH/card.-Gastro. 92% 0% 8% UHL/Nephrology 0% 81% 19% DPH/Infectious disease 0% 89% 11% UHL/Cardiology 0% 0% 100% GPEH/Nephrology 0% 0% 100% GPEH/Immunology 0% 0% 100% Percentage of time the doctors and nurses spend on face-to-face communications MIE 2009, Sarajevo, 31 August-2 September 13

Context Study 1 Study 2 Conclusion 1. Identification of the communication flows Common Briefing Opportunistic Round Exchanges UHL/Neurosurgery 98% 0% 2% DPH/card.-Gastro. 92% 0% 8% UHL/Nephrology 0% 81% 19% DPH/Infectious disease 0% 89% 11% UHL/Cardiology 0% 0% 100% GPEH/Nephrology 0% 0% 100% GPEH/Immunology 0% 0% 100% Percentage of time the doctors and nurses spend on face-to-face communications A lot of information  partners can go MIE 2009, Sarajevo, 31 August-2 September 14 on with their own activities

Context Study 1 Study 2 Conclusion 1. Identification of the communication flows Common Briefing Opportunistic Round Exchanges UHL/Neurosurgery 98% 0% 2% DPH/card.-Gastro. 92% 0% 8% UHL/Nephrology 0% 81% 19% DPH/Infectious disease 0% 89% 11% UHL/Cardiology 0% 0% 100% GPEH/Nephrology 0% 0% 100% GPEH/Immunology 0% 0% 100% Percentage of time the doctors and nurses spend on face-to-face communications Notifications and specifications MIE 2009, Sarajevo, 31 August-2 September 15 needed outside Briefings

Context Study 1 Study 2 Conclusion 1. Identification of the communication flows Common Briefing Opportunistic Round Exchanges UHL/Neurosurgery 98% 0% 2% No time slot dedicated to verbal DPH/card.-Gastro. 92% 0% 8% exchanges  sometimes can no UHL/Nephrology 0% 81% 19% longer perform their own activities DPH/Infectious disease 0% 89% 11% UHL/Cardiology 0% 0% 100% GPEH/Nephrology 0% 0% 100% GPEH/Immunology 0% 0% 100% Percentage of time the doctors and nurses spend on face-to-face communications MIE 2009, Sarajevo, 31 August-2 September 16

Context Study 2 Conclusion 1. Identification of the communication flows Common Briefing Opportunistic Round Exchanges UHL/Neurosurgery 98% 0% 2% DPH/card.-Gastro. 92% 0% 8% UHL/Nephrology 0% 81% 19% DPH/Infectious disease 0% 89% 11% UHL/Cardiology 0% 0% 100% GPEH/Nephrology 0% 0% 100% GPEH/Immunology 0% 0% 100% Percentage of time the doctors and nurses spend on face-to-face communications MIE 2009, Sarajevo, 31 August-2 September 17

Methods (2)

Context Study 1 Study 2 Conclusion 2. ! Cross the two variables MIE 2009, Sarajevo, 31 August-2 September 19

Context Study 1 Study 2 Conclusion 2. ! Cross the two variables • ! Methods  ! Systematic observations (8/ ward)  ! Semi-structured interviews MIE 2009, Sarajevo, 31 August-2 September 20

Context Study 1 Study 2 Conclusion 2. ! Cross the two variables • ! Methods  ! Systematic observations (8/ ward)  ! Semi-structured interviews MIE 2009, Sarajevo, 31 August-2 September 21

Context Study 1 Study 2 Conclusion 2. ! Cross the two variables • ! Methods  ! Systematic observations (8/ ward)  ! Semi-structured interviews • ! Sites of the study  ! Paper-based » ! University Hospital of Lille (Cardiology, Nephrology and Neurosurgery)  ! Computerized » ! Denain Public Hospital (cardiology / gastroenterology and infectious disease) MIE 2009, Sarajevo, 31 August-2 September 22

Results (2)

Context Study 1 Study 2 Conclusion 2. Crossing of the two variables Common Briefings Opportunistic Rounds Exchanges CPOE 36h58 39h36 Paper-based 37h33 40h05 39h40 Number of hours of observation MIE 2009, Sarajevo, 31 August-2 September 24

Context Study 1 Study 2 Conclusion 2. Crossing of the two variables Communications Mean duration of organization dialogs Common Round 15h Briefing 2h16 Opportunistic 0h33 Exchanges MIE 2009, Sarajevo, 31 August-2 September 25

Context Study 1 Study 2 Conclusion 2. Crossing of the two variables Communications Mean duration of organization dialogs EXTENTED Common Round 15h KNOWLEDGE AND UNDERSTANDING Briefing 2h16 Opportunistic 0h33 Exchanges MIE 2009, Sarajevo, 31 August-2 September 26

Context Study 1 Study 2 Conclusion 2. Crossing of the two variables Communications Mean duration of organization dialogs Common Round 15h MORE LIMITED Briefing 2h16 UNDERSTANDING, OPERATIONAL Opportunistic KNOWLEDGE 0h33 Exchanges MIE 2009, Sarajevo, 31 August-2 September 27

Context Study 1 Study 2 Conclusion 2. Crossing of the two variables Duration of dialogs Communications Mean duration of Paper- CPOE organization dialogs based Common Round 15h 16h50 13h10 Briefing 2h16 2h18 2h15 Opportunistic 0h33 0h33 Exchanges MIE 2009, Sarajevo, 31 August-2 September 28

Conclusion

Context Study 1 Study 2 Conclusion • ! When introducing a new technology, it is important – ! to consider the entire work system • ! What are the current, and sometimes hidden, structuring variables? – ! To identify the organizational characterization of the various departments • ! Provide the hospitals with a framework supporting this characterization before the introduction of a CPOE system MIE 2009, Sarajevo, 31 August-2 September 30

Context Study 1 Study 2 Conclusion “ Implementing informatics applications is a socio-technical activity, which often depends more on the organizational context than on a specific technology ” (Ammenwerth, Talmon, Ash, Bates, Beuscart-Zéphir, Duhamel, Elkin, Gardner & Geissbuhler, 2006) MIE 2009, Sarajevo, 31 August-2 September 31

THANK YOU FOR YOUR ATTENTION MIE 2009, Sarajevo, 31 August-2 September 32