Repetita Iuvant: Exploring and Supporting Redundancy in Hospital Practices

Cabitza, Federico; Ellingsen, Gunnar; Locoro, Angela; Simone, Carla

doi:10.1007/s10606-017-9303-z

Cited by 7 publications

(4 citation statements)

References 54 publications

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“…Work practices that may appear routine, inefficient or superfluous often have an intrinsic value for cooperative teamwork. 44 While our quantitative findings reveal considerable potential for automation, our in-depth fieldwork demonstrated the need for a cautious approach given the complexity of social systems in healthcare delivery environments.…”

Section: Discussionmentioning

confidence: 83%

Qualitative and quantitative approach to assess the potential for automating administrative tasks in general practice

et al. 2020

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ObjectiveTo identify the extent to which administrative tasks carried out by primary care staff in general practice could be automated.DesignA mixed-method design including ethnographic case studies, focus groups, interviews and an online survey of automation experts.SettingThree urban and three rural general practice health centres in England selected for differences in list size and organisational characteristics.ParticipantsObservation and interviews with 65 primary care staff in the following job roles: administrator, manager, general practitioner, healthcare assistant, nurse practitioner, pharmacy technician, phlebotomist, practice nurse, pharmacist, prescription clerk, receptionist, scanning clerk, secretary and medical summariser; together with a survey of 156 experts in automation technologies.Methods330 hours of ethnographic observation and documentation of administrative tasks carried out by staff in each of the above job roles, followed by coding and classification; semistructured interviews with 10 general practitioners and 6 staff focus groups. The online survey of machine learning, artificial intelligence and robotics experts was analysed using an ordinal Gaussian process prediction model to estimate the automatability of the observed tasks.ResultsThe model predicted that roughly 44% of administrative tasks carried out by staff in general practice are ‘mostly’ or ‘completely’ automatable using currently available technology. Discussions with practice staff underlined the need for a cautious approach to implementation.ConclusionsThere is considerable potential to extend the use of automation in primary care, but this will require careful implementation and ongoing evaluation.

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Section: Discussionmentioning

confidence: 83%

Qualitative and quantitative approach to assess the potential for automating administrative tasks in general practice

et al. 2020

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“…The papers presented in this special issue, coupled with prior research, 1,3,4,42 show unequivocally that healthcare data are not simply passively available, even when sensors are installed or digital workflow systems capture data in the course of work. Data are produced through effortful, situated work carried out by people.…”

Section: Implications Of Healthcare Data Workmentioning

confidence: 97%

Data work in healthcare: An Introduction

Bossen

Pine

Cabitza

et al. 2019

Health Informatics J

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Healthcare organizations across the globe are currently grappling to implement tools and practices to transform data from "refuse to riches," a movement propelled by mass adoption of electronic health records (EHRs), sensors, and servers that can hold an ever-expanding volume of digital data. 1 Allegedly, "By digitizing, combining and effectively using big data, healthcare organizations ranging from single-physician offices and multi-provider groups to large hospital networks and accountable care organizations stand to realize significant benefits." 2 The potential is ".. . to improve care, save lives and lower costs." 2 As a consequence, organizations are struggling under massive institutional pressures to make healthcare "data-driven" against the messy reality of creating, managing, analyzing, and using data for management, decision-making, accountability, and medical research. 3 However, data do not sit in ready repository, fully formed, and easily harvestable. 4 Data must be created through various forms of situated work. Even when data is a byproduct-"exhaust data"from other processes, data has to be filtered, analyzed, and interpreted. 5 While scholars have acknowledged the situated and effortful nature of data production along with the inherent subjectivities of data, these practices have been little investigated.

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“…Due to “the difficulty in translating among specialties, stakeholders, clinicians, and implementers” (Kaplan & Harris-Salamone, 2009, p. 295) and the constant tension between standardization and flexibilization (Fitzpatrick & Ellingsen, 2013), users of HIS have been shown to require additional media, artefacts and (unofficial) procedures, e.g., workarounds, to make the HIS work for flexible collaboration. As one result, paper records tend to persist alongside HIS as a backup medium for documentation and coordination (Cabitza et al, 2019; Chen, 2010; Fitzpatrick, 2004), which facilitates backup but creates discontinuities between digital and analog modes of documentation (Hardstone et al, 2004). Similarly, studies on institution-wide information infrastructures have acknowledged the complexities arising from the need to integrate HIS with other systems used locally to establish a seamless flow of information (Ellingsen & Monteiro, 2003; Johannessen & Ellingsen, 2009).…”

Section: Related Workmentioning

confidence: 99%

Workarounds in the Shadow System: An Ethnographic Study of Requirements for Documentation and Cooperation in a Clinical Advisory Center

Mörike

Feufel

2022

Hum Factors

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Objective Hospital information systems (HIS) are meant to manage complex work processes across healthcare organizations. We describe limitations of HIS to address local information requirements and how they are circumvented at different organizational levels. Results can be used to better support collaboration in socio-technical systems. Background Workarounds describe a mismatch between a technology’s purpose and its actual use, whereas shadow systems are unofficial IT systems circumventing limitations of official systems to support workflows. Boundary infrastructures are conceptualized as the entirety of all (in)formal digital and analog systems connecting different communities of practice in a socio-technical system. Methods An ethnographic study with observations and semi-structured interviews was conducted and analyzed through categorization and iterative coding. Results Several digital-analog workarounds are employed for documentation and a shared server functions as a shadow system to support workflows in ways the HIS cannot. For collaborative documentation, all (official and informal) information sources were used simultaneously as part of an interconnected boundary infrastructure. Conclusion Formal and informal IT systems are interconnected across different organizational levels and provide insights into unmet information requirements, effective and problematic work practices, and how to address them to improve system functioning. An integrated perspective on boundary infrastructures, workarounds, and shadow systems may advance system analysis, providing a more comprehensive picture of IT requirements than any concept alone. Application Workarounds and shadow systems highlight that HIS should support systemic and local needs. Customized interfaces in HIS to support search, access, and exchange of relevant data might help to mitigate current shortcomings.

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Repetita Iuvant: Exploring and Supporting Redundancy in Hospital Practices

Cited by 7 publications

References 54 publications

Qualitative and quantitative approach to assess the potential for automating administrative tasks in general practice

Qualitative and quantitative approach to assess the potential for automating administrative tasks in general practice

Data work in healthcare: An Introduction

Workarounds in the Shadow System: An Ethnographic Study of Requirements for Documentation and Cooperation in a Clinical Advisory Center

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