Factors influencing clinicians' perceptions of interruptions as disturbing or non-disturbing: A qualitative study

Berg, Lena; Källberg, Ann Sofie; Ehrenberg, Anna; Florin, Jan; Östergren, Jan; Djärv, Therese; Brixey, Juliana J.; Göransson, Katarina E.

doi:10.1016/j.ienj.2016.01.003

Cited by 22 publications

(48 citation statements)

References 28 publications

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“…Because the concept of interruption is a complex and dynamic phenomenon that includes multiple variables, studies have referred to environmental factors as possible contributors to the occurrence of interruptions Magrabi et al, 2010). However, specific details about how contextual factors influence ED clinicians perceptions of interruptions are elusive, except for those identified in a study conducted by the present research group (Berg et al, 2016). The current study suggests that the work environment in the ED itself is one factor that sustains the need to interrupt, which is related to the fact that clinicians are simultaneously involved in different flow and work processes in patient care but still frequently need to interact with one another.…”

Section: The Ed Working Environmentmentioning

confidence: 69%

“…Because clinicians are not fully aware of each other's ongoing tasks, interruptions may occur even during assignments that demand focus and concentration e.g., during preparation of medication or when discussing a patient's treatment plan with a colleague (Berg et al, 2013). Interruptions that occur during these kinds of assignments are often perceived as disturbing by the recipients (Berg et al, 2016). Despite viewing interruptions as disturbing elements, ED clinicians continue to interrupt one another at the workplace (Berg et al, 2013;Chisholm et al, 2000;Kosits and Jones, 2011 care context.…”

Section: (Pp 38)]mentioning

confidence: 99%

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Reasons for interrupting colleagues during emergency department work – A qualitative study

Berg

Florin

Ehrenberg

et al. 2016

International Emergency Nursing

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Section: The Ed Working Environmentmentioning

confidence: 69%

Section: (Pp 38)]mentioning

confidence: 99%

Reasons for interrupting colleagues during emergency department work – A qualitative study

Berg

Florin

Ehrenberg

et al. 2016

International Emergency Nursing

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“…The key purpose of CSE is to redesign the interaction amongst those agents for better operation of the joint cognitive system [91,92]. As noted, a key feature of CSE is its focus on the "joint cognitive system", but the papers reviewed still focused largely on the "interruption dyad" of interrupter and interruptee, with only occasional papers mentioning of the role of supporting artefacts and technologies [10,113] or of the interleaving of work amongst team members [9,108,115,116]. Only a subset of papers describe how agents cope with complexity [9,10,107,108,112,119].…”

Section: Cognitive Systems Engineeringmentioning

confidence: 99%

Traditions of research into interruptions in healthcare: A conceptual review

McCurdie

Sanderson

Aitken

2017

International Journal of Nursing Studies

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Objective. To identify research traditions that have motivated and guided interruptions research, and to note research questions posed, gaps in approach, and possible avenues for future research. Permanent repository link Methods.A critical review was conducted of research on interruptions in healthcare. Two researchers identified core research communities based on the community's motivations, philosophical outlook, and methods. Among the characteristics used to categorise papers into research communities were the predominant motivation for studying interruptions, the research questions posed, and key contributions to the body of knowledge on interruptions in healthcare. In cases where a paper approached an equal number of characteristics from two traditions, it was placed in a blended research community. Results.A total of 141 papers were identified and categorised; all papers identified were published from 1994 onwards. Four principal research communities emerged: epidemiology, quality improvement, cognitive systems engineering (CSE), and applied cognitive psychology. Blends and areas of mutual influence between the research communities were identified that combine the benefits of individual traditions, but there was a notable lack of blends incorporating quality

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“…However, there are several papers that embody a sufficient number of those features that we have categorised those papers under CSE rather than the other traditions. Almost all the papers categorised under CSE that report empirical findings have investigated interruptions in the naturalistic work environment [8,10,[107][108][109][110][111][112][113][114][115][116]; an exception is highfidelity simulator investigations by Prakash et al [117]. [122] is reflected in one paper from the CSE community by noting that interruptions contribute to organisational resilience [109].…”

Section: Cognitive Systems Engineeringmentioning

confidence: 99%

“…As noted, a key feature of CSE is its focus on the "joint cognitive system", but the papers reviewed still focused largely on the "interruption dyad" of interrupter and interruptee, with only occasional papers mentioning of the role of supporting artefacts and technologies [10,113] or of the interleaving of work amongst team members [9,108,115,116]. Only a subset of papers describe how agents cope with complexity [9,10,107,108,112,119].…”

Section: Cognitive Systems Engineeringmentioning

confidence: 99%

Interruptions in the healthcare workplace: a sociotechnical systems approach

McCurdie¹

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Interruptions to workflow have been a source of concern in the health services community.Interruptions have been associated with lost time, staff and patient frustration, and they may contribute to preventable medical error. Despite extensive efforts by researchers to mitigate the effects of interruptions, interventions are sometimes ineffective and do not fit the intended work system. In this thesis I investigate why interruptions occur in the first place, whether they are needed, and what, if anything, we should do about them.In a large-scale critical review of the healthcare interruptions literature I examined the research traditions that have motivated and guided interruptions research in order to impose some structure on the complex and conflicting body of literature. Among other insights, the review revealed that investigations into interruptions are often focused on a single clinical discipline, and that they fail to consider inter-disciplinary dependencies and other contributing sociotechnical system factors.Next I present two methodological innovations consistent with a systems approach. The first methodological innovation is the Dual Perspectives Method, an observational technique developed in order to collect multiple perspectives about interruptions that can be used to draw conclusions about their purpose in healthcare or the burden they impose. The Dual Perspectives Method was used to conduct observations of 46 participants at a 30-bed ICU at a large tertiary care hospital in Brisbane, Australia. In contrast to many other interruptions studies, participants were sampled from all operational levels and all work roles in the ICU work system, including medical staff, nurses in clinical and non-clinical roles, support staff, and allied health staff, in order to explore a full range of coordination needs and motivations for interrupting.The second methodological innovation is the application of social network analysis and modeling techniques to the observational data collected using the Dual Perspectives Method, making it possible to analyze patterns of interaction and interdependencies across all roles in a work system.Together the Dual Perspectives Method and social network analysis allowed me to identify targeted systems-based interventions that may reduce unnecessary interruptions while at the same time avoid unintended consequences that impose additional burden on ICU staff.Finally, I present a guide for identifying appropriate interventions, designed to help nurse unit managers improve the management of workflow interruptions in their respective units by guiding them towards system-based vs. person-based interventions, where appropriate. The concept behind the guide was based on the Institute for Safe Medication Practice's Hierarchy of Intervention Effectiveness. Semi-structured interviews were used to evaluate the guide and indicate improvements to future iterations.iii In contrast to a single-discipline approach, this program of research employed a systems approach to reveal vulnerabiliti...

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Factors influencing clinicians' perceptions of interruptions as disturbing or non-disturbing: A qualitative study

Cited by 22 publications

References 28 publications

Reasons for interrupting colleagues during emergency department work – A qualitative study

Reasons for interrupting colleagues during emergency department work – A qualitative study

Traditions of research into interruptions in healthcare: A conceptual review

Interruptions in the healthcare workplace: a sociotechnical systems approach

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