The site visit overview document outlines plans for McKesson analysts to observe clinical workflows at three Providence hospitals. The goal is to understand how information is gathered, stored, and transferred in the patient environment. Over three days, the analysts will observe activities like shift changes and patient admissions across units like ICU and medical/surgery. They will interview clinicians, take photos of the environment, and document tasks and interactions. The site visit aims to provide insights to help McKesson improve their clinical software applications.
A Patient's Guide to Knee Replacement Surgery: Waupun Memorial HospitalAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is evident in the care you receive. We trust that our associates and your surgeon provided you with the educational opportunity to prepare yourself adequately for your joint replacement surgery.
A Patient's Guide to Knee Replacement Surgery: Waupun Memorial HospitalAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is evident in the care you receive. We trust that our associates and your surgeon provided you with the educational opportunity to prepare yourself adequately for your joint replacement surgery.
A Patient's Guide to Knee Replacement Surgery: St. Agnes HospitalAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is evident in the care you receive. We trust that our associates and your surgeon provided you with the educational opportunity to prepare yourself adequately for your joint replacement surgery.
A Patient's Guide to Shoulder Surgery: St. Agnes HospitalAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your shoulder surgery. We hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is evident in the care you receive. We trust that our associates and your surgeon provided you with the educational opportunity to prepare yourself adequately for your surgery.
A Patient's Guide to Hip Replacement Surgery: St. Agnes HospitalAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We
hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is
evident in the care you receive. We trust that our associates and your surgeon provided you with the educational
opportunity to prepare yourself adequately for your joint replacement surgery.
A Patient's Guide to Hip Replacement Surgery: Ripon Medical CenterAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We
hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is
evident in the care you receive. We trust that our associates and your surgeon provided you with the educational
opportunity to prepare yourself adequately for your joint replacement surgery.
A Patient's Guide to Hip Replacement Surgery: Waupun Memorial HospitalAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We
hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is
evident in the care you receive. We trust that our associates and your surgeon provided you with the educational
opportunity to prepare yourself adequately for your joint replacement surgery.
A Patient's Guide to Knee Replacement Surgery: Ripon Medical CenterAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is evident in the care you receive. We trust that our associates and your surgeon provided you with the educational opportunity to prepare yourself adequately for your joint replacement surgery.
USC provides a series of resources for investigators to help them initiate and manage clinical studies and trials. Learn more at https://research.usc.edu/investigator-resources-for-clinical-trials/
Learn more about SC CTSI: http://sc-ctsi.org/
The patient handoff is a contemporaneous, interactive process of passing patient-specific information from one caregiver to another to ensure the continuity and safety of patient care. It is well recognized that the handoff is a point of vulnerability where valuable patient information can be distorted and omitted [1, 2]. A plethora of studies in the nursing literature have identified a variety of problems, including incomplete or inaccurate information [3-6], uneven quality [7], repeated interruptions and lack of anticipatory guidance [8]. Many reports have focused on characterizing the weaknesses with non-operative patient handovers, the use of handoff checklists and aviation safety models for specific groups of patients [1,5,9], and the pre- and post-implementation comparisons. [10-12] However, few studies have focused on prospective cohort studies validating and testing patient information management systems such as smart-templates in the setting of handover quality. [10]
Electronic templates containing patient information help to standardize the type of information conveyed during interactions, discourages ambiguous findings,[13] improves provider satisfaction and improves continuity of care.[14] Within the department, we developed the transfer template (T2) to address the issues in provider workflow and efficiency. With the press of a button, the T2 template automatically extracts live information from the anesthetic record, pertinent fields from the PAC note and laboratory values from IView, and provides a concise output of these relevant details.
MAN6501: Operations Management
1
MAN6501: Operations Management
Problem Set 1: Process Analysis and Improvement
Instructions:
1. The case contains all of the necessary data to complete the assignment. If you
believe critical data is missing, make an assumption. Any assumptions you make
should be reasonable and consistent with other case data.
2. As a general rule, if you have a question about the “correct” interpretation of
some aspect of the case or the assignment, you should just state your assumption
and continue to work. In fact, these statements of logic will be used in the
evaluation of your submission.
MedNOW Clinic case
The MedNOW clinic provides convenient healthcare services for a wide range of non-emergency
medical issues. The clinic is located in Cambridge in close vicinity to a large hospital and serving
a population with diverse ethnic backgrounds. Patients can walk-in or call in advance to schedule
an appointment. The clinic operates 7AM to 7 PM on weekdays, with extended opening hours
during the weekend. The clinic can do basic x-rays including chest x-ray and extremity x-rays
(such as ankle, foot, arm and leg) and also provides lab services. On average 20 patients arrive at
the clinic per hour, including walk-ins and appointments.
Registration – The registration desk is continuously staffed with one person. They call the
patient from the waiting room and create a patient record. The patient is then told to go back to
the waiting room. The registration process takes on average one minute.
Triage – The triage nurse calls the patients from the waiting room. They create a patient chart
and register the check-in time. During triage the nurse determines the priority of patients'
treatments based on the severity of their condition. The triage is staffed with one registered nurse
(RN) and the average time for triage is about 2 minutes. On average, 10% of the patients require
medical care that is not available at the clinic and need to be sent to a hospital in the vicinity of
the clinic. The other patients are told to go back to the waiting room and wait for the doctor call.
Examination – The clinic has four examination rooms and four MDs available at all time. An
assistant calls the patients into the examination rooms and help the patient prepare for the
examination. The examination time is highly dependent on the medical condition. Based on
historical records the clinic has determined the following distribution for examination time:
MAN6501: Operations Management
2
Probability 0.4 0.4 0.2
Time 2 minutes 8 minutes 10 minutes
In 50% of cases the MD completes the diagnosis, writes a prescription and the patient is ready to
discharge. The other 50% of patients require some form of diagnostic and are sent to the medical
diagnostic lab.
Medical Diagnostics – There are three areas of medical diagnostic testing each with its own staff.
Analysis ...
Banyan State University Medical ClinicBanyon State University .docxikirkton
Banyan State University Medical Clinic
Banyon State University (BSU) operates a walk-in medical clinic to meet the acute medical needs of its 13,000 students, 1,200 faculty and staff members, and covered relatives. The clinic is staffed by one doctor and one nurse and operates 8 hours a day, 5 days a week. The doctor and nurse do not take a lunch break, but rather use gaps between patient arrivals to eat lunch and take other short breaks. Because patients often do not arrive right when the clinic opens and because they must visit with a nurse before seeing the doctor, the doctor’s official start time is 45 minutes after the clinic opens. Patients arriving at the clinic are served on a first-come first-served basis.
As part of a new total quality management (TQM) initiative, BSU conducted an in-depth 40month study of its current operations. A key component of the study was a survey, distributed to all students, faculty, and staff. The purpose of the study was to identify and prioritize areas most in need of improvement. An impressive 44% of the surveys were returned and deemed usable. Follow-up analysis indicated that the respondents to the survey were representative of the population served by the clinic. After the results were tabulated, it was determined that the walk-in medical clinic was located at the bottom of the rankings, indicating a great deal of dissatisfaction with the clinic.
Preliminary analysis of the respondents’ comments indicated that people were reasonably satisfied with the treatment they received at the clinic but were very dissatisfied with the amount of time they had to wait to see a care giver. To gain additional insight into the problem, a team of students was asked to study the problem as part of a course project. In addition to determining the general issues, they were asked to determine the desirability of a new, computerized patient record system (CPRS) to aid in reducing waiting times. The student team initially collected data on the pattern of arrivals at the clinic and the various services times (discussed in more detail later). The team determined that on a typical day, inter-arrival times were uniformly distributed between 6 and 20 minutes. After arriving at the clinic, patients complete a form that requests background information and the reason for the visit. The staff collects these forms and retrieve the patients’ records from the basement. The team determined that the time to retrieve patient records follows a normal distribution with a mean of 4 minutes and a standard deviation of 0.75 minute. Retrieved patient records are placed in a pile from the clinic’s nurse in the order that the patients arrived at the clinic.
When the nurse finishes with the current patient, the file of the next patient is selected and the patient is directed to the nurse’s station. Here the nurse further documents the problem and takes some standard measurements such as temperature and blood pressure. ...
In the new healthcare industry, providers and patients will thrive by deploying intelligent technology to deliver care sooner and more effectively. New solutions include Kofax Smart Process Applications and Smart Mobile Apps, which enable healthcare organizations to automatically and accurately capture, validate, extract and classify information form anywhere inside or outside the organization.
A Patient's Guide to Knee Replacement Surgery: St. Agnes HospitalAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is evident in the care you receive. We trust that our associates and your surgeon provided you with the educational opportunity to prepare yourself adequately for your joint replacement surgery.
A Patient's Guide to Shoulder Surgery: St. Agnes HospitalAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your shoulder surgery. We hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is evident in the care you receive. We trust that our associates and your surgeon provided you with the educational opportunity to prepare yourself adequately for your surgery.
A Patient's Guide to Hip Replacement Surgery: St. Agnes HospitalAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We
hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is
evident in the care you receive. We trust that our associates and your surgeon provided you with the educational
opportunity to prepare yourself adequately for your joint replacement surgery.
A Patient's Guide to Hip Replacement Surgery: Ripon Medical CenterAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We
hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is
evident in the care you receive. We trust that our associates and your surgeon provided you with the educational
opportunity to prepare yourself adequately for your joint replacement surgery.
A Patient's Guide to Hip Replacement Surgery: Waupun Memorial HospitalAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We
hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is
evident in the care you receive. We trust that our associates and your surgeon provided you with the educational
opportunity to prepare yourself adequately for your joint replacement surgery.
A Patient's Guide to Knee Replacement Surgery: Ripon Medical CenterAgnesian HealthCare
Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is evident in the care you receive. We trust that our associates and your surgeon provided you with the educational opportunity to prepare yourself adequately for your joint replacement surgery.
USC provides a series of resources for investigators to help them initiate and manage clinical studies and trials. Learn more at https://research.usc.edu/investigator-resources-for-clinical-trials/
Learn more about SC CTSI: http://sc-ctsi.org/
The patient handoff is a contemporaneous, interactive process of passing patient-specific information from one caregiver to another to ensure the continuity and safety of patient care. It is well recognized that the handoff is a point of vulnerability where valuable patient information can be distorted and omitted [1, 2]. A plethora of studies in the nursing literature have identified a variety of problems, including incomplete or inaccurate information [3-6], uneven quality [7], repeated interruptions and lack of anticipatory guidance [8]. Many reports have focused on characterizing the weaknesses with non-operative patient handovers, the use of handoff checklists and aviation safety models for specific groups of patients [1,5,9], and the pre- and post-implementation comparisons. [10-12] However, few studies have focused on prospective cohort studies validating and testing patient information management systems such as smart-templates in the setting of handover quality. [10]
Electronic templates containing patient information help to standardize the type of information conveyed during interactions, discourages ambiguous findings,[13] improves provider satisfaction and improves continuity of care.[14] Within the department, we developed the transfer template (T2) to address the issues in provider workflow and efficiency. With the press of a button, the T2 template automatically extracts live information from the anesthetic record, pertinent fields from the PAC note and laboratory values from IView, and provides a concise output of these relevant details.
MAN6501: Operations Management
1
MAN6501: Operations Management
Problem Set 1: Process Analysis and Improvement
Instructions:
1. The case contains all of the necessary data to complete the assignment. If you
believe critical data is missing, make an assumption. Any assumptions you make
should be reasonable and consistent with other case data.
2. As a general rule, if you have a question about the “correct” interpretation of
some aspect of the case or the assignment, you should just state your assumption
and continue to work. In fact, these statements of logic will be used in the
evaluation of your submission.
MedNOW Clinic case
The MedNOW clinic provides convenient healthcare services for a wide range of non-emergency
medical issues. The clinic is located in Cambridge in close vicinity to a large hospital and serving
a population with diverse ethnic backgrounds. Patients can walk-in or call in advance to schedule
an appointment. The clinic operates 7AM to 7 PM on weekdays, with extended opening hours
during the weekend. The clinic can do basic x-rays including chest x-ray and extremity x-rays
(such as ankle, foot, arm and leg) and also provides lab services. On average 20 patients arrive at
the clinic per hour, including walk-ins and appointments.
Registration – The registration desk is continuously staffed with one person. They call the
patient from the waiting room and create a patient record. The patient is then told to go back to
the waiting room. The registration process takes on average one minute.
Triage – The triage nurse calls the patients from the waiting room. They create a patient chart
and register the check-in time. During triage the nurse determines the priority of patients'
treatments based on the severity of their condition. The triage is staffed with one registered nurse
(RN) and the average time for triage is about 2 minutes. On average, 10% of the patients require
medical care that is not available at the clinic and need to be sent to a hospital in the vicinity of
the clinic. The other patients are told to go back to the waiting room and wait for the doctor call.
Examination – The clinic has four examination rooms and four MDs available at all time. An
assistant calls the patients into the examination rooms and help the patient prepare for the
examination. The examination time is highly dependent on the medical condition. Based on
historical records the clinic has determined the following distribution for examination time:
MAN6501: Operations Management
2
Probability 0.4 0.4 0.2
Time 2 minutes 8 minutes 10 minutes
In 50% of cases the MD completes the diagnosis, writes a prescription and the patient is ready to
discharge. The other 50% of patients require some form of diagnostic and are sent to the medical
diagnostic lab.
Medical Diagnostics – There are three areas of medical diagnostic testing each with its own staff.
Analysis ...
Banyan State University Medical ClinicBanyon State University .docxikirkton
Banyan State University Medical Clinic
Banyon State University (BSU) operates a walk-in medical clinic to meet the acute medical needs of its 13,000 students, 1,200 faculty and staff members, and covered relatives. The clinic is staffed by one doctor and one nurse and operates 8 hours a day, 5 days a week. The doctor and nurse do not take a lunch break, but rather use gaps between patient arrivals to eat lunch and take other short breaks. Because patients often do not arrive right when the clinic opens and because they must visit with a nurse before seeing the doctor, the doctor’s official start time is 45 minutes after the clinic opens. Patients arriving at the clinic are served on a first-come first-served basis.
As part of a new total quality management (TQM) initiative, BSU conducted an in-depth 40month study of its current operations. A key component of the study was a survey, distributed to all students, faculty, and staff. The purpose of the study was to identify and prioritize areas most in need of improvement. An impressive 44% of the surveys were returned and deemed usable. Follow-up analysis indicated that the respondents to the survey were representative of the population served by the clinic. After the results were tabulated, it was determined that the walk-in medical clinic was located at the bottom of the rankings, indicating a great deal of dissatisfaction with the clinic.
Preliminary analysis of the respondents’ comments indicated that people were reasonably satisfied with the treatment they received at the clinic but were very dissatisfied with the amount of time they had to wait to see a care giver. To gain additional insight into the problem, a team of students was asked to study the problem as part of a course project. In addition to determining the general issues, they were asked to determine the desirability of a new, computerized patient record system (CPRS) to aid in reducing waiting times. The student team initially collected data on the pattern of arrivals at the clinic and the various services times (discussed in more detail later). The team determined that on a typical day, inter-arrival times were uniformly distributed between 6 and 20 minutes. After arriving at the clinic, patients complete a form that requests background information and the reason for the visit. The staff collects these forms and retrieve the patients’ records from the basement. The team determined that the time to retrieve patient records follows a normal distribution with a mean of 4 minutes and a standard deviation of 0.75 minute. Retrieved patient records are placed in a pile from the clinic’s nurse in the order that the patients arrived at the clinic.
When the nurse finishes with the current patient, the file of the next patient is selected and the patient is directed to the nurse’s station. Here the nurse further documents the problem and takes some standard measurements such as temperature and blood pressure. ...
In the new healthcare industry, providers and patients will thrive by deploying intelligent technology to deliver care sooner and more effectively. New solutions include Kofax Smart Process Applications and Smart Mobile Apps, which enable healthcare organizations to automatically and accurately capture, validate, extract and classify information form anywhere inside or outside the organization.
In the new healthcare industry, providers and
patients will thrive by deploying intelligent
technology to deliver care sooner and more
effectively. New solutions include Kofax Smart
Process Applications and Smart Mobile Apps, which
enable healthcare organizations to automatically
and accurately capture, validate, extract and classify
information from anywhere inside or outside the
organization — and then instantly drive business
processes and applications while saving critical
documentation in secure content repositories.
How to 'hack' the data world without having a computer expert on standby. Why the professionalization of paramedicine is important? When will we be professionals? How will professionalization affect the future of EMS?
Birmingham Heartlands Hospital in the U.K. has been using the Roche Digital Pathology portfolio to transform tissue diagnostics. They have streamlined collaboration, especially for their multi-disciplinary meetings and they have used digital technology in the education of new pathologists. Lab workflow has become more efficient and pathologists are now more seamlessly connected.
RTDPC-DP-0034b 6021A-3
Technoblade The Legacy of a Minecraft Legend.Techno Merch
Technoblade, born Alex on June 1, 1999, was a legendary Minecraft YouTuber known for his sharp wit and exceptional PvP skills. Starting his channel in 2013, he gained nearly 11 million subscribers. His private battle with metastatic sarcoma ended in June 2022, but his enduring legacy continues to inspire millions.
White wonder, Work developed by Eva TschoppMansi Shah
White Wonder by Eva Tschopp
A tale about our culture around the use of fertilizers and pesticides visiting small farms around Ahmedabad in Matar and Shilaj.
Maximize Your Content with Beautiful Assets : Content & Asset for Landing Page pmgdscunsri
Figma is a cloud-based design tool widely used by designers for prototyping, UI/UX design, and real-time collaboration. With features such as precision pen tools, grid system, and reusable components, Figma makes it easy for teams to work together on design projects. Its flexibility and accessibility make Figma a top choice in the digital age.
Storytelling For The Web: Integrate Storytelling in your Design ProcessChiara Aliotta
In this slides I explain how I have used storytelling techniques to elevate websites and brands and create memorable user experiences. You can discover practical tips as I showcase the elements of good storytelling and its applied to some examples of diverse brands/projects..
Connect Conference 2022: Passive House - Economic and Environmental Solution...TE Studio
Passive House: The Economic and Environmental Solution for Sustainable Real Estate. Lecture by Tim Eian of TE Studio Passive House Design in November 2022 in Minneapolis.
- The Built Environment
- Let's imagine the perfect building
- The Passive House standard
- Why Passive House targets
- Clean Energy Plans?!
- How does Passive House compare and fit in?
- The business case for Passive House real estate
- Tools to quantify the value of Passive House
- What can I do?
- Resources
Book Formatting: Quality Control Checks for DesignersConfidence Ago
This presentation was made to help designers who work in publishing houses or format books for printing ensure quality.
Quality control is vital to every industry. This is why every department in a company need create a method they use in ensuring quality. This, perhaps, will not only improve the quality of products and bring errors to the barest minimum, but take it to a near perfect finish.
It is beyond a moot point that a good book will somewhat be judged by its cover, but the content of the book remains king. No matter how beautiful the cover, if the quality of writing or presentation is off, that will be a reason for readers not to come back to the book or recommend it.
So, this presentation points designers to some important things that may be missed by an editor that they could eventually discover and call the attention of the editor.
Between Filth and Fortune- Urban Cattle Foraging Realities by Devi S Nair, An...Mansi Shah
This study examines cattle rearing in urban and rural settings, focusing on milk production and consumption. By exploring a case in Ahmedabad, it highlights the challenges and processes in dairy farming across different environments, emphasising the need for sustainable practices and the essential role of milk in daily consumption.
Between Filth and Fortune- Urban Cattle Foraging Realities by Devi S Nair, An...
Hospital site visit plan
1. Providence Site Visit
Site Visit Overview......................................................................................................................... 2
Goal............................................................................................................................................. 2
Objectives ................................................................................................................................... 2
Participants.................................................................................................................................. 3
Locations..................................................................................................................................... 3
Subjects....................................................................................................................................... 4
Schedule...................................................................................................................................... 4
Before visit (questions/tasks):..................................................................................................... 5
Materials ..................................................................................................................................... 6
Notes ........................................................................................................................................... 6
Letter of Introduction.................................................................................................................. 7
Photography Release Form......................................................................................................... 8
Observation Notebook .................................................................................................................... 9
Clinician Questionnaire ............................................................................................................ 10
Clinician Interview Outline....................................................................................................... 12
Physical Inventory of the Unit (AEIOU).................................................................................. 14
2. Site Visit Overview
Goal
How is information gathered, stored, and transferred in the patient environment?
Objectives
• Gather data needed to construct common clinical personas and scenarios, specifically
Assistant Head Nurse, Nurse Specialist, Nurse Manager, RN, Respiratory Therapist, and
Physician
• Document workflow for common clinical tasks, specifically shift changes/reports and
patient admission, transfer, and discharge
• Give analysts insights into current hospital operations
We will seek a broad understanding of the clinicians and their day-to-day activities. Major
activities that will be observed will include:
- Shift change
- Patient admission
- Patient transfer into unit
- Patient transfer out of unit
- Patient discharge
- Task management
- Plan-of-care method
- Communication methods
- New orders
- Pre-op
- Post-op
If time allows, we will also observe:
- Covering for another clinician
- Patient education
- Charting vitals
3. Participants
Client
(names removed)
Name, title, location, phone, email, availability
McKesson
Team 1:
(name removed), Clinical Analyst
(name removed), System Administrator
Team 2:
John Milanski, User Research Expert
(name removed), Product Manager (Wed-Fri)
Team 3 (Floaters):
(name removed), Clinical Analyst
(name removed), Clinical Analyst (Tue-Fri)
Locations
We intend to visit three sites in the Providence Medical Center (pmc, cust #5165) network:
- Providence Portland
(483 beds, 262 avg daily census, 985 clinical staff, 21K admissions/yr)
- Providence St. Vincent
(451 beds, 370 avg daily census, 1647 clinical staff, 31K admissions/yr)
- Providence Milwaukie
(77 acute beds, 29 avg daily census, 445 clinical staff, 3K admissions/yr)
These sites were chosen because of the different facility sizes, specializations, and computerized
systems installed. At each site will observe activities in two (2) high-turnover units:
- Med/Surgery
- ICU
- NICU (if time allows)
- Pediatrics (if time allows)
4. Subjects
At each of these 3 sites, we will observe and interview:
- Nurse Manager
- Assistant Head Nurse
- Nurse Specialist
- RN
- Respiratory Therapist
If time allows, we will also interview:
- PT
- OT
- RN Case manager
- Nutritionist
- Physician
- Hospitalist
Schedule
Monday: 1p: Meet with (name removed) @ Providence-St Vincent, orient to facility,
get department assignments
2p-6p: Observations (including 3p shift change)
Tuesday: 6:30a: Meet at Providence-St Vincent
6:30a-12p: Observations (including 7a shift change and when? physician
rounds)
1p: Meet with (name removed) @ Providence-Portland, orient to facility, get
department assignments,
2p-6p: Observations (including 3p shift change)
Wednesday: 6:30a: Meet at Providence-Portland
6:30a-3:30p: Observations (including 7a shift change, 10a physician rounds,
and 3p shift change)
Thursday: 8:30a: Meet with (name removed) @ Providence-Milwaukie, orient to
facility, get department assignments
9a-4p: Observations (including 9a physician rounds and 3p shift change).
Friday: 8a-10a: Debrief Meeting, Providence-Portland
5. Before visit (questions/tasks):
- Collect existing clinical forms and staff evaluation forms
- Collect documentation on existing workflow
- List of installed SW applications
- Site demographics, market segmentation
- Find Mark A.’s SharePoint Folder
- What is the shift schedule at the facilities we will be visiting?
- About when does activity on the night shift usually stop?
- What is the difference in activity between shifts and between units?
- To whom can we send clinician questionnaires in advance of our visit?
- Copy of materials from those who attended Cooper Persona training.
Before the site visit, the McKesson team will be briefed on the sites. This site review will include
details about the facility (history, size, specialties, units, location, staff, competition, community,
issues facility is facing), the software applications currently installed and planned for installation,
and any current logged software issues (although fixing them is not the purpose of the visit).
Also in advance of the site visits, likely subjects will be asked to fill out a clinician
questionnaire. The questionnaire was developed using former clinicians working for McKesson.
The information will help us focus on the most interesting locations, units, and subjects.
At each facility, a team of two will observe one unit over an entire 8-hr shift, beginning 30
minutes before the shift change. Team 1 will observe the ICU, Team 2 will observe the
Med/Surgery unit, and Team 3 (‘floaters’) will follow particular clinicians between units, likely
an Acute Care Manager, a Respiratory Therapist, or a Physical Therapist. Each team member
will perform three tasks during their visit: document whatever tasks are happening on the unit,
interview clinicians, and record environment data in five major categories (AEIOU: activities,
environment, interactions, objects, users). Each team will debrief at regular intervals during the
shift. At the end of each observation session, the teams will leave the units to debrief. After one
shift has been observed, the teams will move to a new facility, covering three facilities over three
days (Tue, Wed, Thu).
On the last day (Fri), the teams will have a debrief session with some of the clinicians and
informatics staff. The analysts will display their sketches and pictures of the units, their
understanding of the tasks, and their understanding of the clinical roles. The clinicians and staff
will then have a chance to correct and flesh out these understandings.
6. Materials
6- Field Notebooks (1 per person)
3- Digital cameras (1 per team) + charger, USB cord, memory cards
3- Audio tape recorders (1 per team) + blank tapes, extra batteries
Notes
Providence currently has the following CRs:
31% 08/23/2006 168983 New HED: A result is not available in Add Selection when it
appears in two class cfgs with different security on the
same CRv
46% 08/16/2006 162427 New Keep changes to result names synchronized between
FS_RES and FS_RES_CFG
48% 08/09/2006 161643 New HED ER 9176 SP2: When refresh is clicked in chart
mode the first label in the first class disappears from
the CRV
70% 07/27/2006 160732 Pending HED AdminRX: Need a way to require clinical users
enter a valid override reason.
27% 07/21/2006 160291 Assigned Support Esc: Webforms is prompting login screen at
humility
The addresses for the hospitals are:
Providence Portland Medical Center
4805 NE Glisan Street
Portland, OR 97213
Providence St. Vincent Medical Center
9205 SW Barnes Road
Portland, OR 97225
Providence Milwaukie Hospital
10150 SE 32nd Avenue
Milwaukie, OR 97222
7. Letter of Introduction
To the clinicians at Providence-Portland, Milwaukie, and St. Vincent,
Six analysts from McKesson Provider Technologies will be visiting the Medical/Surgical and
ICU units during the week of Monday, September 18. Our goal is to understand you and the jobs
you do better so that we can improve the plan of care, patient record, and charting software that
you use.
We hope to spend one shift (7a-3p) in each unit at each facility with no more than three people in
any one unit. While there, we hope to observe these tasks:
- shift changes
- patient admissions
- patient transfers into/out of the unit
- patient discharges
- task management
- plan-of-care method
While on unit, we will be observing the tasks being done, asking occasional questions, and
conducting 15-minute interviews with clinicians to learn more who you are and what you care
about. We may take pictures of things and staff in the unit, but the images will only be used for
research and not for any promotional purposes. No patients or patient data will be recorded. We
will bring release forms for anyone who is photographed.
It is especially important that we meet with Assistant Head Nurses, Nurse Specialists, and Nurse
Managers to understand how tasks are expected to be done and how they are done. We would
also like to meet with a Respiratory Therapist and an Acute Care Manager/Social Worker to
understand tasks across units. We will bring a small token gift for every unit we visit.
Thank you so much for your help. Please feel free to call me at 303-926-2464 or Terri Barylak-
Roge at 303-926-2459 if you have any other questions.
Sincerely,
McKesson Provider Technologies, Site visit team
8. Photography Release Form
If permitted, analysts from McKesson Provider Technologies will photograph your work area.
The photographs will help us analyze your work environment and make recommendations for
improving your McKesson Horizon Clinical software applications.
McKesson will use these photographs for internal research and internal presenta purposes only;
the images will not be used for any external purpose such as advertising. Internally, McKesson
will not disclose the names of participants seen in any photographs.
Please read the following statements and ask the analysts any questions you may have. Indicate
that you understand and agree to the conditions stated in this form by checking the boxes and
signing and dating below.
I give McKesson Provider Technologies permission to photograph me and my workspace
during the site visit. I understand that the photographs will be used in McKesson’s analysis
and recommendations and that my name will not be associated with my comments or
discussion of company affairs.
At the completion of the site visit, all photographs will remain in McKesson’s possession.
McKesson may use the photographs for future analysis with no obligation to me. The
photographs will not be used for commercial advertising.
I have been given the opportunity to ask questions and have had my questions answered to
my satisfaction.
Participant’s Signature
Participant’s Printed Name
McKesson Representative
Date
9. Observation Notebook
Observer Name
Facility (circle) Providence-Portland Providence-St. Vincent Providence-Milwaukie
Unit in Facility
Date/Time am / pm
Check off these tasks as you do them:
Overview (fill out observation form):
Begin by asking for a tour of the unit.
- record in observation notebook (e.g. # beds, # and type of staff, hours, location of
computers, SW apps installed)
Interview (fill out Clinician Interview form):
Required: If time allows:
Department Manager PT
RN OT
Respiratory Therapist RN Case manager
Nutritionist
Physician
Observe tasks (fill out observation form):
Required: If time allows:
Shift change (including shift report) Covering for another clinician
Shift change Med administration
Patient admission Med not on floor
Patient transfer into unit Med late
Patient transfer out of unit New orders
Patient discharge Patient education
Task management Pre-op
Plan-of-care method Post-op
Charting vitals
After each observation, review your notes and fill in anything else you remember.
10. Clinician Questionnaire
Thanks for your help with this survey. There are no ‘right’ or ‘wrong’ answers, and your
responses will be kept confidential.
Demographics
Name
Age
Email (to be used only if we need to clarify)
Gender Female Male
Education High school Bachelor’s Graduate degree Post grad
Degrees
Certifications
Current occupation
Specialties
Current employer Location # of beds
How many hours per week do you work (on average)? hours/week
How long have you been with this employer? years
What are your job responsibilities?
How many years have you been in this occupation? years
Other occupations and clinical roles you’ve had:
Circle any devices that you use regularly:
- PDA (e.g. Palm, iPaq) - Cell phone
- Music/MP3 player - Video games
How many hours per week do you use a computer: At work: hours/week
At home: hours/week
11. Circle what do you use your computer for?
Work: Charting Home: Personal financial management
Clinical data review Internet
Accessing on line resources Office type applications
Internet access Other
Office type applications (word processing, etc)
Other
What computer training has been given at work? Mouse/keyboard Standard Windows
Specific Application training Other
How many hours of training? _________________
How do you rate your computer skills? (1 = beginner and 10 = expert) 1 2 3 4 5 6 7 8 9 10
How often do you use the internet? Never Daily Weekly Monthly
Do you wear glasses or contacts? Yes No
What is your corrected eyesight (e.g. 20/30)?
Do you have any trouble seeing colors? Yes No
If ‘yes’, describe
Tasks
List some of the tasks you do at work and how often:
Care planning : Never Weekly Once/Shift Multiple times/shift
Shift report : Never Weekly Once/Shift Multiple times/shift
Direct patient care : Never Weekly Once/Shift Multiple times/shift
Discharge planning : Never Weekly Once/Shift Multiple times/shift
Bed control : Never Weekly Once/Shift Multiple times/shift
Admission : Never Weekly Once/Shift Multiple times/shift
Discharge : Never Weekly Once/Shift Multiple times/shift
Assigning Tasks : Never Weekly Once/Shift Multiple times/shift
Coordinate Patient Care: Never Weekly Once/Shift Multiple times/shift
: Never Weekly Once/Shift Multiple times/shift
: Never Weekly Once/Shift Multiple times/shift
: Never Weekly Once/Shift Multiple times/shift
Thank you so much for your help!
12. Clinician Interview Outline
(perform the interview ‘on the unit’ in a semi-private place)
Goals
- To understand a day-in-your-life as a clinician on this unit
- To understand you as a person outside of your clinical role (what you like t do, what your
goals are)
1) Could you please fill out this Clinical Questionnaire (if you haven’t already done it)?
2) Do you mind if I record this so I don’t forget anything you tell me? I’d like to transcribe it
later.
3) Can I ask you a few questions about your Questionnaire? (fill in anything they left blank or
that you don’t understand)
4) May I take a nice picture of you for the file?
5) Now I’d like to ask you a few general questions about you and your job, ok?
List of questions:
(This is a conversation – not a survey. Use the questions as a guide, but let the clinician guide
the discussion.)
(background questions)
Where are you from?
Do you have any children? Are you married?
How did you get started doing this?
(their history)
(their job)
What’s a normal day / week?
How are patient charges handled? (esp. ask Respiratory and PT)
How do you receive orders and requisitions?
Where do you do your documentation?
How do you communicate cor status, scheduling of patients (esp. for off unit things)?
Differences between shifts, days, units
What activities do you do away from work (for fun)?
What words might others use to describe you?
13. What are the most common activities on the unit?
What are your goals at work? At home?
What things motivate you at work? At home?
What things scare you or frustrate you at work? At home?
What things do you look forward to?
(wrap-up)
Let me make sure I understand:
here is what I think your job is…
here is what problems you have
Thank you so very much for your help.
14. Observer _____________________ Hospital _____________________ Unit_________ Date__________ Time________ am/pm
Physical Inventory of the Unit (AEIOU)
• Take pictures of all information sources, esp. informal ones (binders, whiteboards, sticky notes, notebooks, PDAs, books).
• Get copies of all paper forms in use.
• Examine computer station in detail. Look for physical signs of workarounds: sticky notes, worn keys, fingerprints, hardware modifications.
• Sketch the unit. Include location of information sources, pics of areas, places where time is spent, frequently traveled routes.
Activities (tasks people are doing) Sketch of unit
Environments
Interactions (people-people, people-objects)
Objects (and how they relate to activities)
Users (people, roles, relationships)
15. Person observed ____________________ Page
Observer _____________________ Hospital _____________________ Unit_________ Date__________ Time________ am/pm
GOAL: How is information gathered, stored, and transferred in the patient environment?
Time Task or Observation
(what you saw or “quotes”)
Pic # Comments
(why it was interesting – workaround, idea, sketch)
:
:
:
:
:
:
:
Hints: Take pics of all paper (notes, binders, etc) • Ask person to ‘think aloud’ during tasks • Look for workarounds • Let them talk