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

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

Dec 28, 2022 344 likes •685 views

Organizational vs. technical variables: impact on the collective aspects of healthcare work situations Sylvia Pelayo, F. Anceaux, J. Rogalski & M.-C. Beuscart-Zphir Context of the study Context Study 1 Study 2 Conclusion CPOE are

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Organizational vs. technical variables: impact on the collective aspects of healthcare work situations

Sylvia Pelayo, F. Anceaux, J. Rogalski & M.-C. Beuscart-Zéphir

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Context of the study

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MIE 2009, Sarajevo, 31 August-2 September 3

CPOE are inevitable for the quality and safety

  • f the situations

Context Conclusion Study 2 Study 1

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MIE 2009, Sarajevo, 31 August-2 September 4

CPOE are inevitable for the quality and safety

  • f the situations

Difficulties with implementations Problems of usage

Context Conclusion Study 2 Study 1

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MIE 2009, Sarajevo, 31 August-2 September 5

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 !!!

Context Conclusion Study 2 Study 1

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MIE 2009, Sarajevo, 31 August-2 September 6

Context Conclusion Study 2 Study 1 What is the actual determinant of the quality of professionals’ cooperation ?

The most important determinant ? The current determinant !!

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MIE 2009, Sarajevo, 31 August-2 September 7

Context Conclusion Study 2 Study 1

Objective of the study

Identify the respective impact of the 2 variables on the doctors-nurses teamwork : the technical system vs. the

  • rganisation of work.

How ?

1.Identification

  • f

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?
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Methods (1)

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MIE 2009, Sarajevo, 31 August-2 September 9

1.! Identify the doctors-nurses communications flows

Context Conclusion Study 2 Study 1

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MIE 2009, Sarajevo, 31 August-2 September 10

1.! Identify the doctors-nurses communications flows

  • !

Methods

! Observations ! Semi-structured interviews

Context Conclusion Study 2 Study 1

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MIE 2009, Sarajevo, 31 August-2 September 11

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)

Context Conclusion Study 2 Study 1

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Results (1)

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MIE 2009, Sarajevo, 31 August-2 September 13

Context Conclusion Study 2 Study 1

Common Round Briefing Opportunistic 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%

  • 1. Identification of the communication flows

Percentage of time the doctors and nurses spend on face-to-face communications

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MIE 2009, Sarajevo, 31 August-2 September 14

Context Conclusion Study 2 Study 1

Common Round Briefing Opportunistic 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%

  • 1. Identification of the communication flows

Percentage of time the doctors and nurses spend on face-to-face communications

A lot of information  partners can go

  • n with their own activities
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MIE 2009, Sarajevo, 31 August-2 September 15

Context Conclusion Study 2 Study 1

Common Round Briefing Opportunistic 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%

  • 1. Identification of the communication flows

Percentage of time the doctors and nurses spend on face-to-face communications

Notifications and specifications needed outside Briefings

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MIE 2009, Sarajevo, 31 August-2 September 16

Context Conclusion Study 2 Study 1

Common Round Briefing Opportunistic 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%

  • 1. Identification of the communication flows

Percentage of time the doctors and nurses spend on face-to-face communications

No time slot dedicated to verbal exchanges  sometimes can no longer perform their own activities

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MIE 2009, Sarajevo, 31 August-2 September 17

Context Conclusion Study 2

Common Round Briefing Opportunistic 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%

  • 1. Identification of the communication flows

Percentage of time the doctors and nurses spend on face-to-face communications

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Methods (2)

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MIE 2009, Sarajevo, 31 August-2 September 19

2.! Cross the two variables

Context Conclusion Study 2 Study 1

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MIE 2009, Sarajevo, 31 August-2 September 20

2.! Cross the two variables

  • !

Methods

! Systematic observations (8/ ward) ! Semi-structured interviews

Context Conclusion Study 2 Study 1

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MIE 2009, Sarajevo, 31 August-2 September 21

2.! Cross the two variables

  • !

Methods

! Systematic observations (8/ ward) ! Semi-structured interviews

Context Conclusion Study 2 Study 1

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MIE 2009, Sarajevo, 31 August-2 September 22

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)

Context Conclusion Study 2 Study 1

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Results (2)

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MIE 2009, Sarajevo, 31 August-2 September 24

Context Conclusion Study 2 Study 1

  • 2. Crossing of the two variables

Common Rounds Briefings Opportunistic Exchanges CPOE 36h58 39h36 Paper-based 37h33 40h05 39h40 Number of hours of observation

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MIE 2009, Sarajevo, 31 August-2 September 25

Context Conclusion Study 2 Study 1

  • 2. Crossing of the two variables

Communications

  • rganization

Mean duration of dialogs Common Round 15h Briefing 2h16 Opportunistic Exchanges 0h33

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MIE 2009, Sarajevo, 31 August-2 September 26

Context Conclusion Study 2 Study 1

  • 2. Crossing of the two variables

Communications

  • rganization

Mean duration of dialogs Common Round 15h Briefing 2h16 Opportunistic Exchanges 0h33

EXTENTED KNOWLEDGE AND UNDERSTANDING

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MIE 2009, Sarajevo, 31 August-2 September 27

Context Conclusion Study 2 Study 1

  • 2. Crossing of the two variables

Communications

  • rganization

Mean duration of dialogs Common Round 15h Briefing 2h16 Opportunistic Exchanges 0h33

MORE LIMITED UNDERSTANDING, OPERATIONAL KNOWLEDGE

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MIE 2009, Sarajevo, 31 August-2 September 28

Context Conclusion Study 2 Study 1

  • 2. Crossing of the two variables

Communications

  • rganization

Mean duration of dialogs CPOE Paper- based Common Round 15h 16h50 13h10 Briefing 2h16 2h18 2h15 Opportunistic Exchanges 0h33 0h33 Duration of dialogs

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Conclusion

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MIE 2009, Sarajevo, 31 August-2 September 30

Context Conclusion Study 2 Study 1

  • ! 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

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MIE 2009, Sarajevo, 31 August-2 September 31

Context Conclusion Study 2 Study 1

“Implementing informatics applications is a socio-technical activity, which

  • ften

depends more on the organizational context than on a specific technology”

(Ammenwerth, Talmon, Ash, Bates, Beuscart-Zéphir, Duhamel, Elkin, Gardner & Geissbuhler, 2006)

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MIE 2009, Sarajevo, 31 August-2 September 32

THANK YOU FOR YOUR ATTENTION