Safe Workflow Design Unit 7 a Workflow Assessment

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Safe Workflow Design Unit 7 a: Workflow Assessment This material was developed by Johns

Safe Workflow Design Unit 7 a: Workflow Assessment This material was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU 24 OC 000013.

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 2. 0/Spring 2011 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 2. 0/Spring 2011 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 2. 0/Spring 2011 • 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 2. 0/Spring 2011 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 2. 0/Spring 2011 6

Basic Elements of Decision-Making Situation Awareness Perception Comprehension Projection Decision-making Performance Jalote-Parmar A. ,

Basic Elements of Decision-Making Situation Awareness Perception Comprehension Projection Decision-making Performance Jalote-Parmar A. , et al, (2010) Component 12/Unit 7 Health IT Workforce Curriculum Version 2. 0/Spring 2011 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 2. 0/Spring 2011 8

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

Human-Centered Design Cycle Specify Context of Use Evaluate Prototype Analyze Requirements Design Prototype Jalote-Parmar A. , et al, (2010) Component 12/Unit 7 Health IT Workforce Curriculum Version 2. 0/Spring 2011 9

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

Human-Centered Design Cycle Specify Context of Use Evaluate Prototype Analyze Requirements Design Prototype Jalote-Parmar A. , et al, (2010) Component 12/Unit 7 Health IT Workforce Curriculum Version 2. 0/Spring 2011 10

Analyze Requirements: Workflow Integration Matrix Current Workflow Future Workflow Jalote-Parmar A. , et al,

Analyze Requirements: Workflow Integration Matrix Current Workflow Future Workflow Jalote-Parmar A. , et al, (2010) Component 12/Unit 7 Health IT Workforce Curriculum Version 2. 0/Spring 2011 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 2. 0/Spring 2011 Jalote-Parmar A. , et al, (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 2. 0/Spring 2011 Jalote-Parmar A. , et al, (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 2. 0/Spring 2011 14

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

Clinical Workflow Cognitive Decision -Making Interaction & Communication Component 12/Unit 7 Health IT Workforce Curriculum Version 2. 0/Spring 2011 Movement 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 2. 0/Spring 2011 Jalote-Parmar A. , et al, (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 2. 0/Spring 2011 Jalote-Parmar A. , et al, (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 2. 0/Spring 2011 Jalote-Parmar A. , et al, (2010) 18

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

Human-Centered Design Cycle Specify Context of Use Evaluate Prototype Analyze Requirements Design Prototype Jalote-Parmar A. , et al, (2010) Component 12/Unit 7 Health IT Workforce Curriculum Version 2. 0/Spring 2011 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 2. 0/Spring 2011 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 Strategic vs. Tactical Thinking Creation & Transfer of Meaning Through Stories Fackler, et al. , (2009) Component 12/Unit 7 Health IT Workforce Curriculum Version 2. 0/Spring 2011 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 Strategic vs. Tactical Thinking Creation & Transfer of Meaning Through Stories Fackler, et al. , (2009) Component 12/Unit 7 Health IT Workforce Curriculum Version 2. 0/Spring 2011 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 Strategic vs. Tactical Thinking Creation & Transfer of Meaning Through Stories Fackler, et al. , (2009) Component 12/Unit 7 Health IT Workforce Curriculum Version 2. 0/Spring 2011 23

Critical Care Environments Pattern Recognition Uncertainty Management Team Coordination & Maintenance of Common Ground

Critical Care Environments Pattern Recognition Uncertainty Management Team Coordination & Maintenance of Common Ground Strategic vs. Tactical Thinking Creation & Transfer of Meaning Through Stories Fackler, et al. , (2009) Component 12/Unit 7 Health IT Workforce Curriculum Version 2. 0/Spring 2011 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 Strategic vs. Tactical Thinking Creation & Transfer of Meaning Through Stories Fackler, et al. , (2009) Component 12/Unit 7 Health IT Workforce Curriculum Version 2. 0/Spring 2011 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 Strategic vs. Tactical Thinking Creation & Transfer of Meaning Through Stories Fackler, et al. , (2009) Component 12/Unit 7 Health IT Workforce Curriculum Version 2. 0/Spring 2011 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 2. 0/Spring 2011 27