Interruptions in the wild: Development of a sociotechnical systems model of interruptions in the emergency department through a systematic review

Werner, Nicole E.; Holden, Richard J.

doi:10.1016/j.apergo.2015.05.010

Cited by 65 publications

(67 citation statements)

References 58 publications

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“…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]. Further key features of CSE emerging in the interruptions papers are its focus on redesign [9,10,108,111,114,[118][119][120] and its preference for systems-based changes to avoid the need for interruptions over person-based changes that prevent interruptions at the point where they occur [10,13,108,116,118].…”

Section: Cognitive Systems Engineeringmentioning

confidence: 99%

“…Only a subset of papers describe how agents cope with complexity [9,10,107,108,112,119]. Further key features of CSE emerging in the interruptions papers are its focus on redesign [9,10,108,111,114,[118][119][120] and its preference for systems-based changes to avoid the need for interruptions over person-based changes that prevent interruptions at the point where they occur [10,13,108,116,118]. In summary, CSE brings to interruptions research a broad systems approach that focuses on the functions of interruptions and on the potential for design to provide solutions where needed.…”

Section: Cognitive Systems Engineeringmentioning

confidence: 99%

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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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Section: Cognitive Systems Engineeringmentioning

confidence: 99%

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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“…One of these domains is healthcare environments, in which the practical problems of interruption lately have been receiving a great amount of attention (e.g. Janssen et al 2015;Sanderson and Grundgeiger 2015;Weigl et al 2014;Werner and Holden 2015).…”

Section: Upcoming Trends In Interruption Researchmentioning

confidence: 99%

“…Grundgeiger and Sanderson 2009;Werner and Holden 2015), and a descriptive attempt to portray interruptions as they occur in an additional natural setting is therefore of major importance (e.g. Janssen et al 2015;Werner and Holden 2015).…”

Section: Introductionmentioning

confidence: 99%

Interruptions in the wild: portraying the handling of interruptions in manufacturing from a distributed cognition lens

2016

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This paper presents a study examining interruptions in the wild by portraying the handling of interruptions in manufacturing from a distributed cognition lens. By studying how interruptions occur and are handled in the daily activities of a work team at a large foundry for casting heavy diesel engines, we highlight situations when the propagation, transformation, and representation of information are not supported by prescribed work processes and propose recommendations for how this can be amended. The study was conducted by several visits to the aforementioned factory with cognitive ethnography as the basis for the data collection. The focus was on identifying interruptions and analysing these through a distributed cognition framework as an initial step towards studying interruptions in a manufacturing environment. The key findings include the identification of three, previously undefined, types of interruptions and the conclusion that interruptions do indeed affect the distributed workload of the socio-technical system and thus the overall production performance at the casting line.

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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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Interruptions in the wild: Development of a sociotechnical systems model of interruptions in the emergency department through a systematic review

Cited by 65 publications

References 58 publications

Traditions of research into interruptions in healthcare: A conceptual review

Traditions of research into interruptions in healthcare: A conceptual review

Interruptions in the wild: portraying the handling of interruptions in manufacturing from a distributed cognition lens

Interruptions in the healthcare workplace: a sociotechnical systems approach

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