Safe Workflow Design Unit 7 1 Workflow Assessment

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Safe Workflow Design Unit 7. 1: Workflow Assessment Component 12/Unit #7 Health IT Workforce

Safe Workflow Design Unit 7. 1: Workflow Assessment Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 1

Objectives At the end of this segment, the student will be able to: •

Objectives At the end of this segment, the student will be able to: • Assess decision-making requirements in health or health care Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 2

Clinical Decision-Making • Systematic way to handle data and clinical algorithms to decide on

Clinical Decision-Making • Systematic way to handle data and clinical algorithms to decide on a best course of action • Algorithm = a step-by-step procedure for solving a problem. Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 3

Clinical Decision Making: Uncertainty Conceptual Technical • What should I do? Component 12/Unit #7

Clinical Decision Making: Uncertainty Conceptual Technical • What should I do? Component 12/Unit #7 Personal • What are the patients’ wishes? Health IT Workforce Curriculum Version 1. 0/Fall 2010 • How do I apply abstract concepts to concrete situations? 4

Clinical Decision Making: Uncertainty Indirect Direct • Knowing what we know • Knowing what

Clinical Decision Making: Uncertainty Indirect Direct • Knowing what we know • Knowing what is being researched • Knowing what works Component 12/Unit #7 • Establishing a communication infrastructure • Establishing evaluation of processes and outcomes of care Health IT Workforce Curriculum Version 1. 0/Fall 2010 5

Clinical Decision-Making: Expert Decision-Making Systems • Improve task • Depend on: performance – Analysis

Clinical Decision-Making: Expert Decision-Making Systems • Improve task • Depend on: performance – Analysis of clinical requirements and reduce cognitive processes errors within the workflow the clinical – Provide optimal workspace situation awareness through information visualization Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 6

Basic Elements of Decision-Making Situation Awareness Perception Comprehension Projection Decision-making Performance Component 12/Unit #7

Basic Elements of Decision-Making Situation Awareness Perception Comprehension Projection Decision-making Performance Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 7

Information Visualization • Real-time information needed for clinical task performance and decision-making • Should

Information Visualization • Real-time information needed for clinical task performance and decision-making • Should support 2 levels of complexity – Routine tasks – Complex (uncertain)tasks • Comprehensive, integrated across phases of care • Provide visual cues to avoid ambiguity Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 8

Human-Centered Design Cycle Specify Context of Use Evaluate Prototype Analyze Requirements Design Prototype Component

Human-Centered Design Cycle Specify Context of Use Evaluate Prototype Analyze Requirements Design Prototype Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 9

Human-Centered Design Cycle Specify Context of Use Evaluate Prototype Analyze Requirements Design Prototype Component

Human-Centered Design Cycle Specify Context of Use Evaluate Prototype Analyze Requirements Design Prototype Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 10

Analyze Requirements: Workflow Integration Matrix Current Workflow Component 12/Unit #7 Future Workflow Health IT

Analyze Requirements: Workflow Integration Matrix Current Workflow Component 12/Unit #7 Future Workflow Health IT Workforce Curriculum Version 1. 0/Fall 2010 11

Analyze Requirements: Workflow Integration Matrix Investigate and verify clinical milestone Analyze workflow Verify and

Analyze Requirements: Workflow Integration Matrix Investigate and verify clinical milestone Analyze workflow Verify and prioritize findings with clinicians Communicate with development team Conceptualize and evaluate design Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 12

Analyze Requirements: Workflow Integration Matrix Investigate and verify clinical milestone Analyze workflow Verify and

Analyze Requirements: Workflow Integration Matrix Investigate and verify clinical milestone Analyze workflow Verify and prioritize findings with clinicians Communicate with development team Conceptualize and evaluate design Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 13

Workflow Analysis Methods Qualitative Quantitative • Ethnographic observation • Shadowing of individual clinicians •

Workflow Analysis Methods Qualitative Quantitative • Ethnographic observation • Shadowing of individual clinicians • Surveys and questionnaires • Sensor technologies such as passive infrared sensors, radio identification tags and pressure sensors. • Video recordings Human-intensive; produce low-volume, high-quality data Component 12/Unit #7 Allow time stamping; produce high volume abstract data Health IT Workforce Curriculum Version 1. 0/Fall 2010 14

Clinical Workflow Cognitive Decision -Making Interaction & Communication Component 12/Unit #7 Movement Health IT

Clinical Workflow Cognitive Decision -Making Interaction & Communication Component 12/Unit #7 Movement Health IT Workforce Curriculum Version 1. 0/Fall 2010 15

Analyze Requirements: Workflow Integration Matrix Investigate and verify clinical milestone Analyze workflow Verify and

Analyze Requirements: Workflow Integration Matrix Investigate and verify clinical milestone Analyze workflow Verify and prioritize findings with clinicians Communicate with development team Conceptualize and evaluate design Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 16

Analyze Requirements: Workflow Integration Matrix Investigate and verify clinical milestone Analyze workflow Verify and

Analyze Requirements: Workflow Integration Matrix Investigate and verify clinical milestone Analyze workflow Verify and prioritize findings with clinicians Communicate with development team Conceptualize and evaluate design Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 17

Analyze Requirements: Workflow Integration Matrix Investigate and verify clinical milestone Analyze workflow Verify and

Analyze Requirements: Workflow Integration Matrix Investigate and verify clinical milestone Analyze workflow Verify and prioritize findings with clinicians Communicate with development team Conceptualize and evaluate design Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 18

Human-Centered Design Cycle Specify Context of Use Evaluate Prototype Analyze Requirements Design Prototype Component

Human-Centered Design Cycle Specify Context of Use Evaluate Prototype Analyze Requirements Design Prototype Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 19

Cognitive Task Analysis • Family of methods for understanding the cognitive processes that underlie

Cognitive Task Analysis • Family of methods for understanding the cognitive processes that underlie task performance and the cognitive skills needed to respond adeptly to complex situations. • Used to understand decision-making and communication processes • Has implications for workflow design Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 20

Cognitive Task Analysis Critical Care Environments Pattern recognition Uncertainty Management Team Coordination & Maintenance

Cognitive Task Analysis Critical Care Environments Pattern recognition Uncertainty Management Team Coordination & Maintenance of Common Ground Component 12/Unit #7 Strategic vs. Tactical Thinking Creation & Transfer of Meaning Through Stories Health IT Workforce Curriculum Version 1. 0/Fall 2010 21

Cognitive Task Analysis Critical Care Environments Pattern recognition Uncertainty Management Team Coordination & Maintenance

Cognitive Task Analysis Critical Care Environments Pattern recognition Uncertainty Management Team Coordination & Maintenance of Common Ground Component 12/Unit #7 Strategic vs. Tactical Thinking Creation & Transfer of Meaning Through Stories Health IT Workforce Curriculum Version 1. 0/Fall 2010 22

Cognitive Task Analysis Critical Care Environments Pattern recognition Uncertainty Management Team Coordination & Maintenance

Cognitive Task Analysis Critical Care Environments Pattern recognition Uncertainty Management Team Coordination & Maintenance of Common Ground Component 12/Unit #7 Strategic vs. Tactical Thinking Creation & Transfer of Meaning Through Stories Health IT Workforce Curriculum Version 1. 0/Fall 2010 23

Cognitive Task Analysis Critical Care Environments Pattern recognition Uncertainty Management Team Coordination & Maintenance

Cognitive Task Analysis Critical Care Environments Pattern recognition Uncertainty Management Team Coordination & Maintenance of Common Ground Component 12/Unit #7 Strategic vs. Tactical Thinking Creation & Transfer of Meaning Through Stories Health IT Workforce Curriculum Version 1. 0/Fall 2010 24

Cognitive Task Analysis Critical Care Environments Pattern recognition Uncertainty Management Team Coordination & Maintenance

Cognitive Task Analysis Critical Care Environments Pattern recognition Uncertainty Management Team Coordination & Maintenance of Common Ground Component 12/Unit #7 Strategic vs. Tactical Thinking Creation & Transfer of Meaning Through Stories Health IT Workforce Curriculum Version 1. 0/Fall 2010 25

Cognitive Task Analysis Critical Care Environments Pattern recognition Uncertainty Management Team Coordination & Maintenance

Cognitive Task Analysis Critical Care Environments Pattern recognition Uncertainty Management Team Coordination & Maintenance of Common Ground Component 12/Unit #7 Strategic vs. Tactical Thinking Creation & Transfer of Meaning Through Stories Health IT Workforce Curriculum Version 1. 0/Fall 2010 26

Summary • Clinical decision making is a systematic way of handling data and algorithms

Summary • Clinical decision making is a systematic way of handling data and algorithms to decide on the best course of action • Uncertainty (technical, personal, and conceptual) shapes clinical decisions • Workflow integration matrices are useful • Cognitive task analysis uncovers decisionmaking and communication processes and has implications for workflow analysis Component 12/Unit #7 Health IT Workforce Curriculum Version 1. 0/Fall 2010 27