Toward a process-level view of distributed healthcare tasks: Medication management as a case study

Abstract

We aim to highlight the importance of using a process-level view in analyzing distributed healthcare tasks through a case study analysis of medication management (MM). MM during older adults' hospital-to-skilled-home-healthcare (SHHC) transitions is a healthcare process with tasks distributed across people, organizations, and time. MM has typically been studied at the task level, but a process-level is needed to fully understand and improve MM during transitions. A process-level view allows for a broader investigation of how tasks are distributed throughout the work system through an investigation of interactions and the resultant emergent properties. We studied MM during older adults' hospital-to-SHHC transitions through interviews and observations with 60 older adults, their 33 caregivers, and 79 SHHC providers at 5 sites associated with 3 SHHC agencies. Study findings identified key cross-system characteristics not observable at the task-level: (1) identification of emergent properties (e.g., role ambiguity, loosely-coupled teams performing MM) and associated barriers; and (2) examination of barrier propagation across system boundaries. Findings highlight the importance of a process-level view of healthcare delivery occurring across system boundaries.

It’s Complicated: Patient and Informal Caregiver Performance of Outpatient Parenteral Antimicrobial Therapy-Related Tasks

“…Patients and their informal caregivers developed strategies to mitigate hazards. Although a few task analyses have shown how patients self-manage their medical conditions, 5,[9][10][11][12]26 task analysis has not been used to understand patient-performed tasks as complex and requiring as high a level of competency as in OPAT.…”

“…[2][3][4] To understand how to decrease OPAT complications, one needs to characterize the tasks patients and informal caregivers ("caregivers") perform in OPAT. Task analysis is a human factors engineering method that has been used to describe the complex work of professional care providers [5][6][7][8] and more recently patient self-management. 5,[9][10][11][12] Patient self-management task analysis has focused on tasks such as management of oral medications at the hospital-to-home transition, 5 on performance of activities of daily living while managing a chronic condition, 10,11 or on shared caregiver-nurse tasks.…”

Household medication safety practices during the COVID-19 pandemic: a descriptive qualitative study protocol

“…5 Optimal medication use requires input from multiple stakeholders, including consumers, patients and carers, operating within complex adaptive systems. 6 Evidence suggests that contribution by patients, informal carers and family members ('lay involvement') is a potentially important modifiable factor in optimising medication outcomes and providing system resilience. [7][8][9][10] Examples of lay involvement…”

Identifying roles in older adults’ emergency department transitions

“…Members of the care team need to understand their role and responsibilities in the process as well as how their role relates to others on the team (Schultz, Carayon, Hundt, & Springman, 2007); this provides the foundation for communication and coordination. When roles are not clearly defined, confusion in care transitions may occur and affect communication and coordination (Schoenborn et al, 2013;Werner et al, 2017). Previous research has identified role ambiguity as a barrier in older adult transitions from hospital to skilled home healthcare (Werner et al, 2017), finding fragmented and conflicting information throughout the transition process (Arbaje et al, 2019).…”