Presentation
Systems Thinking and Configuration Diagramming: Is This Picture Worth a Thousand Words?
SessionDH8: Connected Care Systems: Integrating Digital Health, Clinical Workflows, and Patient Safety
DescriptionBackground: Across health care institutions various implementations of new policies or health information technologies have been prone to unintentional negative consequences. These consequences have impacted patient, clinician, and organizational outcomes. For example, new organizational policies related to cross institutional referrals were associated with communication breakdowns. In another study, the introduction of new mobile computing to clinical workflows increased the nurses’ workload. Existing studies have reported increases in patient safety risks, clinician burnout, and healthcare costs related to implementations of similar interventions. Although human factors engineering is important in the implementation of health care interventions, more evidence is needed to demonstrate the benefits of human factors methods.
The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) framework introduced the concept of configuration. System configurations pertain to the subset of components (e.g., person, tools and technology, organization, environment, and task) and their interactions that are relevant to a particular workflow or process. Configuration diagramming illustrates these subsets and changes throughout a process. This presentation’s objective is to demonstrate the benefits and limitations of configuration analysis and diagramming in health services research.
Participants, Settings, and Recruitment: Across two studies, we recruited clinicians from primary care clinics and specialized consulting clinics at academic medical centers, primarily from two healthcare networks in the Midwest with different electronic health record systems. We sought to recruit at least 30 clinicians, 10 primary care physicians, 10 specialty physicians, and 10 primary care nurses to reach data saturation, which is typically reached with approximately 10-15 participants. We used convenience sampling. Eligible clinicians were contacted via email and phone calls.
Methods: We conducted semi-structured interviews with clinicians. Based on the SEIPS 2.0 framework, we conducted rapid qualitative analyses, determining perceived barriers and related implications. After the rapid analysis, two human factors experts independently identified key characteristics that interviewees perceived as important workflow aspects, facilitators, or barriers. A consensus meeting was held to resolve differences and finalize the list. Together, they assigned one SEIPS factor to each characteristic, based on factor descriptions from SEIPS 2.0 and the SEIPS 101 supplement. To illustrate the persistence of characteristics across referral steps and their designation as facilitators and barriers, the human factors experts drew configural diagrams of the overall process and selected steps.
Results: Configuration diagrams were generated for each study, illustrating barriers and facilitators for related workflows. We were able to enhance initial diagrams by adding new aspects of diagramming elements, including size and color variations. The visualizations highlighted the dynamic and interconnectedness of the work system and how experiences were shaped at each step of clinical processes and workflows.
Conclusion: The configuration diagrams were beneficial. With these seemingly temporal depicts, the evolution and ripple effects of facilitators and barriers in the work system were apparent. Across studies, reported barriers often included two or more persistent system factors. Configuration analysis and diagramming can provide evidence or methods needed to support the system thinking and the integration of human factors and implementation science.
Keywords: SEIPS 2.0, Systems thinking, Socio-technical interventions, Implementation science
The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) framework introduced the concept of configuration. System configurations pertain to the subset of components (e.g., person, tools and technology, organization, environment, and task) and their interactions that are relevant to a particular workflow or process. Configuration diagramming illustrates these subsets and changes throughout a process. This presentation’s objective is to demonstrate the benefits and limitations of configuration analysis and diagramming in health services research.
Participants, Settings, and Recruitment: Across two studies, we recruited clinicians from primary care clinics and specialized consulting clinics at academic medical centers, primarily from two healthcare networks in the Midwest with different electronic health record systems. We sought to recruit at least 30 clinicians, 10 primary care physicians, 10 specialty physicians, and 10 primary care nurses to reach data saturation, which is typically reached with approximately 10-15 participants. We used convenience sampling. Eligible clinicians were contacted via email and phone calls.
Methods: We conducted semi-structured interviews with clinicians. Based on the SEIPS 2.0 framework, we conducted rapid qualitative analyses, determining perceived barriers and related implications. After the rapid analysis, two human factors experts independently identified key characteristics that interviewees perceived as important workflow aspects, facilitators, or barriers. A consensus meeting was held to resolve differences and finalize the list. Together, they assigned one SEIPS factor to each characteristic, based on factor descriptions from SEIPS 2.0 and the SEIPS 101 supplement. To illustrate the persistence of characteristics across referral steps and their designation as facilitators and barriers, the human factors experts drew configural diagrams of the overall process and selected steps.
Results: Configuration diagrams were generated for each study, illustrating barriers and facilitators for related workflows. We were able to enhance initial diagrams by adding new aspects of diagramming elements, including size and color variations. The visualizations highlighted the dynamic and interconnectedness of the work system and how experiences were shaped at each step of clinical processes and workflows.
Conclusion: The configuration diagrams were beneficial. With these seemingly temporal depicts, the evolution and ripple effects of facilitators and barriers in the work system were apparent. Across studies, reported barriers often included two or more persistent system factors. Configuration analysis and diagramming can provide evidence or methods needed to support the system thinking and the integration of human factors and implementation science.
Keywords: SEIPS 2.0, Systems thinking, Socio-technical interventions, Implementation science
Event Type
Oral Presentations
TimeWednesday, March 258:30am - 8:52am EDT
LocationNassau
Digital Health