Work Coordination, Workflow, &Workarounds in a Medical Context Marina Kobayashi, Susan R. Fussell Human Computer Interacti...
Motivation                 Time People                 TaskResources
Workarounds: medical contextContext: Urban HospitalTrauma Operating Room (OR)   –  High-reliability: required to be      d...
Workarounds: current studyData Collection: Field study – 120 hours of observations,  interviews, focus groups – Personnel ...
Workarounds: current study Workarounds—informal temporary practices for handling exceptions to normal workflow. How do wor...
Workarounds                  Blood not sent                  for testing                         Lab                      ...
Workflow
Findings: Workaround patterns Differ as a function of actor’s role    – “As the charge nurse I think about things in one ...
Workaround support tools  Training    –  Provide a library of previously used workarounds and       outcomes  Memory    ...
Future research  Implement and evaluate workaround support tools  Further study of workarounds in ORs    –  Triggers    ...
Thanks!Sara Kiesler, Yuqing Ren, Peter Scupelli,Scott Davidoff, Lui Min Oh, and other membersof our research group on Larg...
Questions? Contact us…        Marina   marinak@andrew.cmu.edu        Susan    sfussell@andrew.cmu.edu        Yan      yxia...
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Work Coordination, Workflow, and Workarounds in a Medical Context

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Presented at CHI 2005.
We report on an ethnographic study of workarounds—informal temporary practices for handling exceptions to normal workflow—in a hospital environment. Workarounds are a common technique for dealing with the inherent uncertainty of dynamic work environments. Workarounds can help coordinate work, especially under conditions of high time pressure, but they may result in information or work protocols that are unstable, unavailable, or unreliable. We investigated workarounds and their effects through observation and interviews in a major teaching medical center. Our results suggest 4 key features of workarounds that technologies might help address: (a) workarounds differ as a function of people’s role; (b) workarounds draw on tacit knowledge of others’ abilities and willingness to help; (c) workarounds can have a cascading effect, causing other workarounds down the line; (d) workarounds often rely on principles of fairness and who owes whom a favor. We provide recommendations for designing systems to better support workarounds in dynamic environments.

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Work Coordination, Workflow, and Workarounds in a Medical Context

  1. 1. Work Coordination, Workflow, &Workarounds in a Medical Context Marina Kobayashi, Susan R. Fussell Human Computer Interaction Institute Carnegie Mellon University Yan Xiao, F. Jacob Seagull School of Medicine - Human Factors Research Program University of Maryland, Baltimore April 6, 2005
  2. 2. Motivation Time People TaskResources
  3. 3. Workarounds: medical contextContext: Urban HospitalTrauma Operating Room (OR) –  High-reliability: required to be dependable with minimal errors –  Fast-response: limitations to amount of time to attend to tasks –  Critical task environment: high urgency and emergent
  4. 4. Workarounds: current studyData Collection: Field study – 120 hours of observations, interviews, focus groups – Personnel in targeted roles: charge nurse, charge anesthesia, surgeon – Critical incident reports
  5. 5. Workarounds: current study Workarounds—informal temporary practices for handling exceptions to normal workflow. How do workarounds influence work coordination and workflow in the medical context?
  6. 6. Workarounds Blood not sent for testing Lab Use universally accepted typePatient bloodtype unknown Nurse Charge Nurse
  7. 7. Workflow
  8. 8. Findings: Workaround patterns Differ as a function of actor’s role – “As the charge nurse I think about things in one way and there’s things that I’m concerned about, but [she] is a clerk, so even though she’s helping me with the same task she’s thinking about other things…” Draw on tacit knowledge of other’s abilities and willingness tohelp – "[You] just kind of know from experience who your stronger people are, who your weaker people are, whos flexible…" Have a cascading effect Often rely on principles of fairness and who owes whom favors – “[In any OR management situation] what you really want when you’re running the OR is you want everybody to owe you a favor at all…It helps if they can remember last week when you helped them….”
  9. 9. Workaround support tools  Training –  Provide a library of previously used workarounds and outcomes  Memory –  Remind workaround initiators of who they should call on for a favor, or where to find a person with specific skills/ experience  Decision-making –  Simulate and predict the short and long-term effects of different workarounds, and suggest strategies to best handle repercussions  Awareness –  Provide knowledge of availability or current status of resources and personnel
  10. 10. Future research  Implement and evaluate workaround support tools  Further study of workarounds in ORs –  Triggers –  Execution –  Outcome (short & long)  Workarounds in other critical contexts
  11. 11. Thanks!Sara Kiesler, Yuqing Ren, Peter Scupelli,Scott Davidoff, Lui Min Oh, and other membersof our research group on Large-Scale CollaborationOur collaborators at theUniversity of Maryland Medical CenterThis project is supported byNational Science Foundation grant #0325087
  12. 12. Questions? Contact us… Marina marinak@andrew.cmu.edu Susan sfussell@andrew.cmu.edu Yan yxiao@umaryland.edu Jake jseag001@umaryland.edu

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