Towards a Hybrid Method to Categorize Interruptions and Activities in Healthcare

Objective Interruptions are known to have a negative impact on activity performance. Understanding how an interruption contributes to human error is limited because there is not a standard method for analyzing and classifying interruptions. Qualitative data are typically analyzed by either a deductive or an inductive method. Both methods have limitations. In this paper a hybrid method was developed that integrates deductive and inductive methods for the categorization of activities and interruptions recorded during an ethnographic study of physicians and registered nurses in a Level One Trauma Center. Understanding the effects of interruptions is important for designing and evaluating informatics tools in particular and for improving healthcare quality and patient safety in general. Method The hybrid method was developed using a deductive a priori classification framework with the provision of adding new categories discovered inductively in the data. The inductive process utilized line-by-line coding and constant comparison as stated in Grounded Theory. Results The categories of activities and interruptions were organized into a three-tiered hierarchy of activity. Validity and reliability of the categories were tested by categorizing a medical error case external to the study. No new categories of interruptions were identified during analysis of the medical error case. Conclusions Findings from this study provide evidence that the hybrid model of categorization is more complete than either a deductive or an inductive method alone. The hybrid method developed in this study provides the methodical support for understanding, analyzing, and managing interruptions and workflow.

Towards a hybrid method to categorize interruptions and activities in healthcare.

OBJECTIVE: Interruptions are known to have a negative impact on activity performance. Understanding how an interruption contributes to human error is limited because there is not a standard method for analyzing and classifying interruptions. Qualitative data are typically analyzed by either a deductive or an inductive method. Both methods have limitations. In this paper, a hybrid method was developed that integrates deductive and inductive methods for the categorization of activities and interruptions recorded during an ethnographic study of physicians and registered nurses in a Level One Trauma Center. Understanding the effects of interruptions is important for designing and evaluating informatics tools in particular as well as improving healthcare quality and patient safety in general. METHOD: The hybrid method was developed using a deductive a priori classification framework with the provision of adding new categories discovered inductively in the data. The inductive process utilized line-by-line coding and constant comparison as stated in Grounded Theory. RESULTS: The categories of activities and interruptions were organized into a three-tiered hierarchy of activity. Validity and reliability of the categories were tested by categorizing a medical error case external to the study. No new categories of interruptions were identified during analysis of the medical error case. CONCLUSIONS: Findings from this study provide evidence that the hybrid model of categorization is more complete than either a deductive or an inductive method alone. The hybrid method developed in this study provides the methodical support for understanding, analyzing, and managing interruptions and workflow.

Effets de l’utilisation d’un chien d’assistance sur les efforts aux membres supérieurs lors de la montée d’une pente en fauteuil roulant chez les individus ayant une lésion médullaire

Problématique. L'utilisation d'un chien d'assistance à la mobilité (CAM) représente une option novatrice pour préserver l’intégrité des membres supérieurs (MSs) chez les utilisateurs de fauteuil roulant manuel (FRM). Aucune étude biomécanique n’a quantifié les effets du CAM sur les efforts aux MSs lors de la montée d’un plan incliné. Objectif. Cette étude quasi-expérimentale vise à comparer les efforts aux MSs lors de la montée d’un plan incliné avec et sans l’assistance d’un CAM. Méthodologie. Dix participants avec une lésion de la moelle épinière (LME) qui utilisent un FRM et possèdent un CAM ont monté un plan incliné à trois reprises avec et sans l’assistance du CAM. Les forces appliquées sur les cerceaux, mesurées avec des roues instrumentées, et les mouvements du FRM et des MSs, enregistrés avec un système d'analyse du mouvement, ont permis de mesurer les efforts mécaniques aux MSs. Simultanément, l'activité électromyographique (EMG) des muscles grand pectoral, deltoïde antérieur, biceps et triceps a été enregistrée et normalisée avec sa valeur maximale pour mesurer les efforts musculaires aux MSs. Résultats. En général, le CAM réduit significativement les valeurs moyennes et maximales de la force totale appliquée aux cerceaux et de sa composante tangentielle, des moments nets de flexion, de rotation interne et d’adduction aux épaules et des taux d’utilisation musculaire du deltoïde antérieur, du biceps et du triceps. Conclusion. L’assistance d’un CAM réduit les efforts aux MSs lors de la montée d’un plan incliné chez les utilisateurs d’un FRM ayant une LME.

Preditores espaço-temporais do andar para testes de capacidade funcional em pacientes com doença de Parkinson

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Treino prévio reduz o tempo de execução de tarefas visuo-espaciais em ambiente virtual

Objective. To evaluate the influence of previous adaptation to different computational environments in visuo-spacial tasks performance of healthy individuals. Method. Healthy volunteers (n = 30), 15 male, mean age 25.3 ± 3.3 years, were divided in three groups: the first group, considered control, was not adapted to the proposed environments; the second group was adapted to a closed environment (stable and expected), and the third group was adapted to an open environment A (unexpected). The proposed task was to go through two open environments B and C (maze). The dependent variables Time and Error were considered for the analysis. Results. It was observed that during the adaptation phase, in the Time variable, the groups presented a progressive improvement in the performance to each task (p = 0.0036). The group adapted in the A open environment, showed a tendency to be faster in the execution of B and C open environments tasks, than the group adapted in the closed environment (p = 0.068). Conclusion. The study suggests that subjects adapted to visuo-spacial tasks execution involving unknown and no guided situations, present a tendency to a better time performance in these tasks when compared to subjects adapted in fixed and guided situations.

Stroke phases responses around maximal lactate steady state in front crawl

The objective of this study was to analyze changes in stroke rate (SR), stroke length (SL) and stroke phases (entry and catch, pull, push and recovery) when swimming at (MLSS) and above (102.5% MLSS) the maximal lactate steady state. Twelve endurance swimmers (21±8 year, 1.77±0.10m and 71.6±7.7kg) performed in different days the following tests: (1) 200- and 400-m all-out tests, to determine critical speed (CS), and; (2) 2-4 30-min sub-maximal constant-speed tests, to determine the MLSS and 102.5% MLSS. There was significant difference among MLSS (1.22±0.05ms-1), 102.5% MLSS (1.25±0.04ms-1) and CS (1.30±0.08ms-1). SR and SL were maintained between the 10th and 30th minute of the test swum at MLSS and have modified significantly at 102.5% MLSS (SR - 30.9±3.4 and 32.2±3.5cyclesmin-1 and SL - 2.47±0.2 and 2.38±0.2mcycle-1, respectively). All stroke phases were maintained at 10th and 30th minute at MLSS. However, the relative duration of propulsive phase B (pull) increased significantly at 102.5% MLSS (21.7±3.4% and 22.9±3.9%, respectively). Therefore, the metabolic condition may influence the stroke parameters (SR and SL) and stroke strategy to maintain the speed during swim tests lasting 30min. © 2010 Sports Medicine Australia.

Instrução verbal: solicitar foco de atenção não garante sua adoção e melhor desempenho

The purposes of this study were to investigate a) the effect of redundant and non-redundant instruction on external focus of attention adoption, b) the effect of adopting an external focus of attention on performance in a front crawl swimming task, and c) the effect of redundancy in the wording of a verbal instruction on the above variables. 43 college students (m/f) aged 17 to 46 swam 25 m crawl at maximum speed, once under each of three conditions: without focus instruction (SF), following a focus instruction (CF) and a redundant focus instruction (CFR), in counterbalanced order. For focus adoption control, after completing the task participants were asked about what they had focused on while swimming. As a measure of performance, time and number of strokes were taken and the stroke index was calculated. The results showed that under redundant focus instruction (CFR) condition, 42 % failed to adopt the attentional focus as asked, and following focus (CF) instruction, 23 %. Under CF condition, the frequency of participants that adopted the focus was higher than of those who did not. Performance did not differ significantly among the three conditions (p>0,05). These findings stress the need of manipulation checks in attentional focus research, regarding both performance and motor learning efficiency, as well as the need for further investigation into the relation between instruction extension and performance.

Interruptions in Workflow for RNs in a Level One Trauma Center

An understanding of interruptions in healthcare is important for the design, implementation, and evaluation of health information systems and for the management of clinical workflow and medical errors. The purpose of this study is to identify and classify the types of interruptions experienced by Emergency Department(ED) nurses working in a Level One Trauma Center. This was an observational field study of Registered Nurses (RNs) employed in a Level One Trauma Center using the shadowing method. Results of the study indicate that nurses were both recipients and initiators of interruptions. Telephones, pagers, and face-to-face conversations were the most common sources of interruptions. Unlike other industries, the healthcare community has not systematically studied interruptions in clinical settings to determine and weigh the necessity of the interruption against their sometimes negative results such as medical errors, decreased efficiency, and increased costs. Our study presented here is an initial step to understand the nature, causes, and effects of interruptions, thereby improving both the quality of healthcare and patient safety. We developed an ethnographic data collection technique and a data coding method for the capturing and analysis of interruptions. The interruption data we collected are systematic, comprehensive, and close to exhaustive. They confirmed the findings from earlier studies by other researchers that interruptions are frequent events in critical care and other healthcare settings. We are currently using these data to analyze the workflow dynamics of ED clinicians, to identify the bottlenecks of information flow, and to develop interventions to improve the efficiency of emergency care through the management of interruptions.

Interruptions in workflow for RNs in a Level One Trauma Center.

An understanding of interruptions in healthcare is important for the design, implementation, and evaluation of health information systems and for the management of clinical workflow and medical errors. The purpose of this study is to identify and classify the types of interruptions experienced by ED nurses working in a Level One Trauma Center. This was an observational field study of Registered Nurses employed in a Level One Trauma Center using the shadowing method. Results of the study indicate that nurses were both recipients and initiators of interruptions. Telephone, pagers, and face-to-face conversations were the most common sources of interruptions. Unlike other industries, the outcomes caused by interruptions resulting in medical errors, decreased efficiency and increased cost have not been systematically studied in healthcare. Our study presented here is an initial step to understand the nature, causes, and effects of interruptions, and to develop interventions to manage interruptions to improve healthcare quality and patient safety. We developed an ethnographic data collection technique and a data coding method for the capturing and analysis of interruptions. The interruption data we collected are systematic, comprehensive, and close to exhaustive. They confirmed the findings from early studies by other researchers that interruptions are frequent events in critical care and other healthcare settings. We are currently using these data to analyze the workflow dynamics of ED clinicians, identify the bottlenecks of information flow, and develop interventions to improve the efficiency of emergency care through the management of interruptions.

Self-efficacy and task performance: An investigation from two levels of analysis and specificity

This research adopts a resource allocation theoretical framework to generate predictions regarding the relationship between self-efficacy and task performance from two levels of analysis and specificity. Participants were given multiple trials of practice on an air traffic control task. Measures of task-specific self-efficacy and performance were taken at repeated intervals. The authors used multilevel analysis to demonstrate dynamic main effects, dynamic mediation and dynamic moderation. As predicted, the positive effects of overall task specific self-efficacy and general self-efficacy on task performance strengthened throughout practice. In line with these dynamic main effects, the effect of general self-efficacy was mediated by overall task specific self-efficacy; however this pattern emerged over time. Finally, changes in task specific self-efficacy were negatively associated with changes in performance at the within-person level; however this effect only emerged towards the end of practice for individuals with high levels of overall task specific self-efficacy. These novel findings emphasise the importance of conceptualising self-efficacy within a multi-level and multi-specificity framework and make a significant contribution to understanding the way this construct relates to task performance.

Goal orientation, ability and task performance: A moderated analysis

Achievement goal orientation represents an individual's general approach to an achievement situation, and has important implications for how individuals react to novel, challenging tasks. However, theorists such as Yeo and Neal (2004) have suggested that the effects of goal orientation may emerge over time. Bell and Kozlowski (2002) have further argued that these effects may be moderated by individual ability. The current study tested the dynamic effects of a new 2x2 model of goal orientation (mastery/performance x approach/avoidance) on performance on a simulated air traffic control (ATC) task, as moderated by dynamic spatial ability. One hundred and one first-year participants completed a self-report goal orientation measure and computerbased dynamic spatial ability test and performed 30 trials of an ATC task. Hypotheses were tested using a two-level hierarchical linear model. Mastery-approach orientation was positively related to task performance, although no interaction with ability was observed. Performance-avoidance orientation was negatively related to task performance; this association was weaker at high levels of ability. Theoretical and practical implications will be discussed.

The relationship between cognitive ability, the big five, task and contextual performance: a meta-analysis

For years, researchers and human resources specialists have been searching for predictors of performance as well as for relevant performance dimensions (Barrick & Mount, 1991; Borman & Motowidlo, 1993; Campbell, 1990; Viswesvaran et al., 1996). In 1993, Borman and Motowidlo provided a framework by which traditional predictors such as cognitive ability and the Big Five personality factors predicted two different facets of performance: 1) task performance and 2) contextual performance. A meta-analysis was conducted to assess the validity of this model as well as that of other modified models. The relationships between predictors such as cognitive ability and personality variables and the two outcome variables were assessed. It was determined that even though the two facets of performance may be conceptually different, empirically they overlapped substantially (p= .75). Finally, results show that there is some evidence for cognitive ability as a predictor of both task and contextual performance and conscientiousness as a predictor of both task and contextual performance. The possible mediation of predictor-- criterion relationships was also assessed. The relationship between cognitive ability and contextual performance vanished when task performance was controlled.

Effect of group formation on performance, task management and social loafing

Engineering graduates of today are required to adapt to a rapidly changing work environment. In particular, they are expected to demonstrate enhanced capabilities in both mono-disciplinary and multi-disciplinary teamwork environments. Engineering education needs, as a result, to further focus on developing group work capabilities amongst engineering graduates. Over the last two years, the authors trialed various group work strategies across two engineering disciplines. In particular, the effect of group formation on students' performance, task management, and social loafing was analyzed. A recently developed online teamwork management tool, Teamworker, was used to collect students' experience of the group work. Analysis showed that students who were allowed to freely allocate to any group were less likely to report loafing from other team members, than students who were pre-allocated to a group. It also showed that performance was more affected by the presence or absence of a leader in pre-allocated rather than free-allocated groups.