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Why the Plan Doesn’t Hold: A Study of Situated Planning, Articulation and Coordination Work in a Surgical Ward
 

Why the Plan Doesn’t Hold: A Study of Situated Planning, Articulation and Coordination Work in a Surgical Ward

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  • Jakob: thanks for sharing your slides!

    In case any other viewers are interested, here's a link to the CSCW 2010 paper upon which these slides are based:
    http://research.microsoft.com/en-us/um/redmond/groups/connect/cscw_10/docs/p331.pdf
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    Why the Plan Doesn’t Hold: A Study of Situated Planning, Articulation and Coordination Work in a Surgical Ward Why the Plan Doesn’t Hold: A Study of Situated Planning, Articulation and Coordination Work in a Surgical Ward Presentation Transcript

    • Why the Plan Doesn’t Hold – a Study of Situated Planning, Articulation and Coordination Work in a Surgical Ward Jakob E. Bardram & Thomas R. Hansen IT University of Copenhagen & Cetrea A/S, Denmark CSCW 2010 – Everyday Healthcare 07-03-10 ·
    • Financial Disclosure
      • Both authors are co-founders and shareholders in the company Cetrea A/S (Denmark) that produce the technology being studied in this paper.
      07-03-10 ·
    • Outline
      • Background, Motivation, and Research Questions
      • Related Studies
      • Empirical Background
      • Results
      • Discussion
      • Outline of Talk
      07-03-10 ·
    • Motivation 07-03-10 ·
    • Background : Motivation 07-03-10 ·
      • Plans, workflows, etc. are coordinative artifacts
      • Absolutely essential for “complex” work – like hospitals
      • However, work is contingent in nature – especially in hospitals
      • Several qualitative studies exists
      • ... but no quantitative evidence exist!
      • Are all plans subject to change? 50%? 10%? 1%?
      What is the relationship between plans and actions?
    • Background : Questions
      • What is the nature of the changes to the plan, i.e. how many changes occur and how significant are they?
      • What are the reasons for the changes, i.e. why are plans changed?
      • What are the consequences of these changes, i.e. how are changes experienced and what effect do they have?
      • What are the strategies used for coping with these changes, i.e. how do people handle and accommodate change?
      • How often, why, consequences, and coping strategies
      07-03-10 ·
      • Suchman (1987)
        • “ plans become resources for work rather than they in any strong sense determine its course”
      • Rönkkö, et al. (2005)
        • “ support the articulation and coordination work necessary in situations where plans do not adequately work out.”
      • Schmidt & Simone (1996)
        • there is a need for artifacts designed to help “cooperative ensembles [to] articulate their distributed activities more effectively and with a higher degree of flexibility ...”
      Related Studies
      • Qualitative studies
      07-03-10 ·
      • Studies of whiteboards in hospitals
        • “ planning in hospitals is a continuous activity adjusted to the conditions of the specific situation”
      • Munkvold et al.
        • “ [t]here is planning but not plans”
        • planning is “a collective, ongoing and heterogeneous achievement”
      • Bardram & Bossen (2005) : stable coordination mechanisms are particularly useful
        • safety-critical nature of the work,
        • distributed and mobile work
        • efficient use of scarce and costly resources
      Related Studies
      • Hospital studies
      07-03-10 ·
    • Empirical Background 07-03-10 ·
    • Empirical Background 07-03-10 ·
      • Operations are subject to extensive scheduling
        • optimal use of resources
        • planning staff allocation
        • equipment allocation
      • Operations are subject to extensive changes
        • acute patients
        • adjustments during the day
        • contingencies of all sort
      Scheduling and Execution of Operations in an OR Suite
      • OR Suite on a medium sized Danish hospital
        • Organ, orthopedic, and gynecological/obstetric surgery
        • 9 ORs, ca. 150 clinicians
        • Ca. 8,000 operations/year ≈ 22.4 operations / day,
      • Using 2 IT systems
        • Booking & Planning system
        • Peri-operative Coordination and Communication System (PoCCS)
      Empirical Background
      • Research Site
      07-03-10 ·
    • Empirical Background
      • Integration between the two systems
      OP Schedule 07-03-10 · 6 am PoCCS System Booking & Scheduling System
    • 07-03-10 ·
    • 07-03-10
    • 07-03-10
    • 07-03-10
      • Quantitative Methods
      • Log file analysis (PoCCS)
      • 133 days, Oct. 2008 – February 2009
      • # OPs, # Changes, # Cancelations, Reasons for cancelation
      • Qualitative Methods
      • Participant observations; 2 researchers 3 days (plus previous work)
      • Semi-structured group interview; 3 charge nurses, 30 min.
      Empirical Background
      • Research Methods
      07-03-10 ·
    • Results 07-03-10 ·
    • Results 07-03-10 ·
    • Results 07-03-10 ·
    • Results 07-03-10 ·
    • Results 07-03-10 ·
    • Results 07-03-10 ·
      • Reasons – why are plans changed?
      • Consequences – what happens when plans are changed?
      • Coping strategy – how do you handle changes to the plan?
      Quantitative Questions
    • Results
      • Reasons for changing plans
      07-03-10 ·
    • Results
      • Consequences of changing plans
      07-03-10 ·
    • Results
      • Strategies for handling changes
      07-03-10 ·
      • 56% of all operations are planned ahead.
      • 44% are acute and thus handled ad-hoc .
      • 8 % of all operations are cancelled.
      • 31% of all operations are shortened/prolonged > 30 min.
      • 67% of all planned (“elective”) operations are substantially changed.
      • => only 18% of the operation schedule is enacted as planned .
      Summary of Results
      • Quantitative Results
      07-03-10 ·
      • Reason?
      • Incoming acute patients, illness, delays, patient problems, ...
      • Contingencies
      • Consequences?
      • Operations are moved, rescheduled, cancelled, ...
      • Plans are changed, adjusted, ...
      • Coping Strategies?
      • Continuous Planning
      • Articulating Continuous Planning
      • Negotiation Continuous Planning
      Summary of Results
      • Qualitative Results
      07-03-10 ·
    • Discussion & Implications for Design 07-03-10 ·
    • Continuous Planning
      • Handling “What-if” scenarios – creating, articulating, negotiating, realizing
      07-03-10 ·
    • Conclusion 07-03-10 ·
      • In OR Suite in Denmark...
      • 56% of all operations are planned
      • 18% of OPs are executed as planned
      • Execution is subject to “Continuous Planning”
      • ... which has implications for design
      • ... and for CSCW research
      What is the relationship between plans and (situated) action?
    • Please ask – or look at www.itu.dk/~bardram Note! The IT University of Copenhagen has announced several post doc and PhD positions – also within healthcare. Come talk to us or see www.itu.dk Questions? 07-03-10 ·