Different roles with different goals: Designing to support shared situational awareness between patients and clinicians in the hospital

Abstract

Objective Team situational awareness helps to ensure high-quality care and prevent errors in the complex hospital environment. Although extensive work has examined factors that contribute to breakdowns in situational awareness among clinicians, patients’ and caregivers’ roles have been neglected. To address this gap, we studied team-based situational awareness from the perspective of patients and their caregivers. Materials and Methods We utilized a mixed-methods approach, including card sorting and semi-structured interviews with hospitalized patients and their caregivers at a pediatric hospital and an adult hospital. We analyzed the results utilizing the situational awareness (SA) theoretical framework, which identifies 3 distinct stages: (1) perception of a signal, (2) comprehension of what the signal means, and (3) projection of what will happen as a result of the signal. Results A total of 28 patients and 19 caregivers across the 2 sites participated in the study. Our analysis uncovered how team SA helps patients and caregivers ensure that their values are heard, their autonomy is supported, and their clinical outcomes are the best possible. In addition, our participants described both barriers—such as challenges with communication—and enablers to facilitating shared SA in the hospital. Discussion Patients and caregivers possess critical knowledge, expertise, and values required to ensure successful and accurate team SA. Therefore, hospitals need to incorporate tools that facilitate patients and caregivers as key team members for effective SA. Conclusions Elevating patients and caregivers from passive recipients to equal contributors and members of the healthcare team will improve SA and ensure the best possible outcomes.

Using stakeholder intervention refinement teams to develop approaches for real-time integration of patient-reported safety information during older adults’ hospital-to-home-health care transitions

“…The IRT process led to findings supported by previous research in the area of care transitions indicating health systems need centralized and shareable sources of information tailored to support situation awareness among healthcare providers and patients in real-time. 24 Previous research regarding situation awareness has focused on inpatient settings and shown improved outcomes for patients with the implementation of periodic information checkpoints and regular information sharing between providers. 25,26 Since hospital-to-HH care transitions are challenging periods for information transfer, increasing situation awareness can support HH clinicians to deliver informed care, identify high-risk transitions, and improve discharge planning.…”

“…While clinicians have specific expertise to identify healthcare-related safety concerns, incorporating patient voices into quality reporting supports communication with those who have the most to gain from successful situational awareness – patients themselves. 24 Additionally, since the onset of the COVID-19 pandemic, there has been a coordinated effort within the HH industry to continue to provide quality care safely to people in their homes despite the risks associated with close contact between patients and HH clinicians. 27 Care coordination challenges presented by the pandemic highlight the importance of a tool for HH agencies to identify potential threats to patient safety in real-time.…”

Using Natural Language Processing to Extract Intelligence for Public Health Crises

“…The concept of SSA is no stranger to medical settings or public health. It was applied to analyzing the impact of dialogues in surgery rooms on clinical decision-making (Gillespie et al, 2013), and informing the design of health information technologies to improve patients' hospital experiences (Pollack et al, 2021).…”

“…It refers to the degree to which the actors in the system have the same understanding (Endsley, 1995;Endsley & Jones, 1997). It has three levels: 1) "the perception of elements in the environment within a volume of time and space" (Endsley, 1988); 2) "the comprehension of their meaning" (Endsley, 1988); and, 3) projection of their status and the prediction of their actions on the shared goals in the future (Endsley, 1988;Pollack et al, 2021). The concept of SSA is no stranger to medical settings or public health.…”

“…The concept of SSA is no stranger to medical settings or public health. It was applied to analyzing the impact of dialogues in surgery rooms on clinical decision-making (Gillespie et al, 2013), and informing the design of health information technologies to improve patients' hospital experiences (Pollack et al, 2021).The COVID-19 pandemic is an awakening call to public health agencies to assess and re-assess SSA. The degree to which the public health agencies and the public possess the same SSA is critical to the effectiveness and e ciency of crisis responses (Bunker, 2021).…”