Why the Plan Doesn’t Hold – a Study of Situated Planning, Articulation and Coordination Work in a Surgical Ward Jakob E. B...
Financial Disclosure <ul><li>Both authors are co-founders and shareholders in the company Cetrea A/S (Denmark) that produc...
Outline <ul><li>Background, Motivation, and Research Questions </li></ul><ul><li>Related Studies </li></ul><ul><li>Empiric...
Motivation 07-03-10 ·
Background : Motivation 07-03-10 ·  <ul><li>Plans, workflows, etc. are coordinative artifacts </li></ul><ul><li>Absolutely...
Background : Questions <ul><li>What is the nature of the changes to the plan, i.e. how many changes occur and how signific...
<ul><li>Suchman (1987)  </li></ul><ul><ul><li>“ plans become resources for work rather than they in any strong sense deter...
<ul><li>Studies of whiteboards in hospitals </li></ul><ul><ul><li>“ planning in hospitals is a continuous activity adjuste...
Empirical Background 07-03-10 ·
Empirical Background 07-03-10 ·  <ul><li>Operations are subject to extensive scheduling </li></ul><ul><ul><li>optimal use ...
<ul><li>OR Suite on a medium sized Danish hospital  </li></ul><ul><ul><li>Organ, orthopedic, and gynecological/obstetric s...
Empirical Background <ul><li>Integration between the two systems </li></ul>OP Schedule 07-03-10 ·  6 am PoCCS System Booki...
07-03-10 ·
07-03-10
07-03-10
07-03-10
<ul><li>Quantitative Methods </li></ul><ul><li>Log file analysis (PoCCS) </li></ul><ul><li>133 days, Oct. 2008 – February ...
Results 07-03-10 ·
Results 07-03-10 ·
Results 07-03-10 ·
Results 07-03-10 ·
Results 07-03-10 ·
Results 07-03-10 ·  <ul><li>Reasons – why are plans changed? </li></ul><ul><li>Consequences – what happens when plans are ...
Results <ul><li>Reasons for changing plans </li></ul>07-03-10 ·
Results <ul><li>Consequences of changing plans </li></ul>07-03-10 ·
Results <ul><li>Strategies for handling changes </li></ul>07-03-10 ·
<ul><li>56% of all operations are planned ahead.  </li></ul><ul><li>44% are acute and thus handled  ad-hoc . </li></ul><ul...
<ul><li>Reason? </li></ul><ul><li>Incoming acute patients, illness, delays, patient problems, ... </li></ul><ul><li>Contin...
Discussion & Implications for Design 07-03-10 ·
Continuous Planning <ul><li>Handling “What-if” scenarios –  creating, articulating, negotiating, realizing </li></ul>07-03...
Conclusion 07-03-10 ·  <ul><li>In OR Suite in Denmark... </li></ul><ul><li>56% of all operations are planned </li></ul><ul...
Please ask – or look at  www.itu.dk/~bardram Note! The IT University of Copenhagen has announced several  post doc and PhD...
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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

  1. 1. 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 ·
  2. 2. Financial Disclosure <ul><li>Both authors are co-founders and shareholders in the company Cetrea A/S (Denmark) that produce the technology being studied in this paper. </li></ul>07-03-10 ·
  3. 3. Outline <ul><li>Background, Motivation, and Research Questions </li></ul><ul><li>Related Studies </li></ul><ul><li>Empirical Background </li></ul><ul><li>Results </li></ul><ul><li>Discussion </li></ul><ul><li>Outline of Talk </li></ul>07-03-10 ·
  4. 4. Motivation 07-03-10 ·
  5. 5. Background : Motivation 07-03-10 · <ul><li>Plans, workflows, etc. are coordinative artifacts </li></ul><ul><li>Absolutely essential for “complex” work – like hospitals </li></ul><ul><li>However, work is contingent in nature – especially in hospitals </li></ul><ul><li>Several qualitative studies exists </li></ul><ul><li>... but no quantitative evidence exist! </li></ul><ul><li>Are all plans subject to change? 50%? 10%? 1%? </li></ul>What is the relationship between plans and actions?
  6. 6. Background : Questions <ul><li>What is the nature of the changes to the plan, i.e. how many changes occur and how significant are they? </li></ul><ul><li>What are the reasons for the changes, i.e. why are plans changed? </li></ul><ul><li>What are the consequences of these changes, i.e. how are changes experienced and what effect do they have? </li></ul><ul><li>What are the strategies used for coping with these changes, i.e. how do people handle and accommodate change? </li></ul><ul><li>How often, why, consequences, and coping strategies </li></ul>07-03-10 ·
  7. 7. <ul><li>Suchman (1987) </li></ul><ul><ul><li>“ plans become resources for work rather than they in any strong sense determine its course” </li></ul></ul><ul><li>Rönkkö, et al. (2005) </li></ul><ul><ul><li>“ support the articulation and coordination work necessary in situations where plans do not adequately work out.” </li></ul></ul><ul><li>Schmidt & Simone (1996) </li></ul><ul><ul><li>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 ...” </li></ul></ul>Related Studies <ul><li>Qualitative studies </li></ul>07-03-10 ·
  8. 8. <ul><li>Studies of whiteboards in hospitals </li></ul><ul><ul><li>“ planning in hospitals is a continuous activity adjusted to the conditions of the specific situation” </li></ul></ul><ul><li>Munkvold et al. </li></ul><ul><ul><li>“ [t]here is planning but not plans” </li></ul></ul><ul><ul><li>planning is “a collective, ongoing and heterogeneous achievement” </li></ul></ul><ul><li>Bardram & Bossen (2005) : stable coordination mechanisms are particularly useful </li></ul><ul><ul><li>safety-critical nature of the work, </li></ul></ul><ul><ul><li>distributed and mobile work </li></ul></ul><ul><ul><li>efficient use of scarce and costly resources </li></ul></ul>Related Studies <ul><li>Hospital studies </li></ul>07-03-10 ·
  9. 9. Empirical Background 07-03-10 ·
  10. 10. Empirical Background 07-03-10 · <ul><li>Operations are subject to extensive scheduling </li></ul><ul><ul><li>optimal use of resources </li></ul></ul><ul><ul><li>planning staff allocation </li></ul></ul><ul><ul><li>equipment allocation </li></ul></ul><ul><li>Operations are subject to extensive changes </li></ul><ul><ul><li>acute patients </li></ul></ul><ul><ul><li>adjustments during the day </li></ul></ul><ul><ul><li>contingencies of all sort </li></ul></ul>Scheduling and Execution of Operations in an OR Suite
  11. 11. <ul><li>OR Suite on a medium sized Danish hospital </li></ul><ul><ul><li>Organ, orthopedic, and gynecological/obstetric surgery </li></ul></ul><ul><ul><li>9 ORs, ca. 150 clinicians </li></ul></ul><ul><ul><li>Ca. 8,000 operations/year ≈ 22.4 operations / day, </li></ul></ul><ul><li>Using 2 IT systems </li></ul><ul><ul><li>Booking & Planning system </li></ul></ul><ul><ul><li>Peri-operative Coordination and Communication System (PoCCS) </li></ul></ul>Empirical Background <ul><li>Research Site </li></ul>07-03-10 ·
  12. 12. Empirical Background <ul><li>Integration between the two systems </li></ul>OP Schedule 07-03-10 · 6 am PoCCS System Booking & Scheduling System
  13. 13. 07-03-10 ·
  14. 14. 07-03-10
  15. 15. 07-03-10
  16. 16. 07-03-10
  17. 17. <ul><li>Quantitative Methods </li></ul><ul><li>Log file analysis (PoCCS) </li></ul><ul><li>133 days, Oct. 2008 – February 2009 </li></ul><ul><li># OPs, # Changes, # Cancelations, Reasons for cancelation </li></ul><ul><li>Qualitative Methods </li></ul><ul><li>Participant observations; 2 researchers 3 days (plus previous work) </li></ul><ul><li>Semi-structured group interview; 3 charge nurses, 30 min. </li></ul>Empirical Background <ul><li>Research Methods </li></ul>07-03-10 ·
  18. 18. Results 07-03-10 ·
  19. 19. Results 07-03-10 ·
  20. 20. Results 07-03-10 ·
  21. 21. Results 07-03-10 ·
  22. 22. Results 07-03-10 ·
  23. 23. Results 07-03-10 · <ul><li>Reasons – why are plans changed? </li></ul><ul><li>Consequences – what happens when plans are changed? </li></ul><ul><li>Coping strategy – how do you handle changes to the plan? </li></ul>Quantitative Questions
  24. 24. Results <ul><li>Reasons for changing plans </li></ul>07-03-10 ·
  25. 25. Results <ul><li>Consequences of changing plans </li></ul>07-03-10 ·
  26. 26. Results <ul><li>Strategies for handling changes </li></ul>07-03-10 ·
  27. 27. <ul><li>56% of all operations are planned ahead. </li></ul><ul><li>44% are acute and thus handled ad-hoc . </li></ul><ul><li>8 % of all operations are cancelled. </li></ul><ul><li>31% of all operations are shortened/prolonged > 30 min. </li></ul><ul><li>67% of all planned (“elective”) operations are substantially changed. </li></ul><ul><li>=> only 18% of the operation schedule is enacted as planned . </li></ul>Summary of Results <ul><li>Quantitative Results </li></ul>07-03-10 ·
  28. 28. <ul><li>Reason? </li></ul><ul><li>Incoming acute patients, illness, delays, patient problems, ... </li></ul><ul><li>Contingencies </li></ul><ul><li>Consequences? </li></ul><ul><li>Operations are moved, rescheduled, cancelled, ... </li></ul><ul><li>Plans are changed, adjusted, ... </li></ul><ul><li>Coping Strategies? </li></ul><ul><li>Continuous Planning </li></ul><ul><li>Articulating Continuous Planning </li></ul><ul><li>Negotiation Continuous Planning </li></ul>Summary of Results <ul><li>Qualitative Results </li></ul>07-03-10 ·
  29. 29. Discussion & Implications for Design 07-03-10 ·
  30. 30. Continuous Planning <ul><li>Handling “What-if” scenarios – creating, articulating, negotiating, realizing </li></ul>07-03-10 ·
  31. 31. Conclusion 07-03-10 · <ul><li>In OR Suite in Denmark... </li></ul><ul><li>56% of all operations are planned </li></ul><ul><li>18% of OPs are executed as planned </li></ul><ul><li>Execution is subject to “Continuous Planning” </li></ul><ul><li>... which has implications for design </li></ul><ul><li>... and for CSCW research </li></ul>What is the relationship between plans and (situated) action?
  32. 32. 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 ·

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