Aligning Interdisciplinary Healthcare Team Behavior with Workflow Execution: An Example of a Radical Prostatectomy Workflow

Operationalizing care delivery through an interdisciplinary healthcare team (IHT) requires knowledge about the overall structure of an IHT and the behavioral rules that "control" the dynamics of this structure interpreted as team and clinical leadership maintenance and task allocation. While progress has been made in understanding IHT structure, there is less work on the behavioral aspects of an IHT associated with its dynamics. In this paper we fill this void by extending our Team and Workflow Management Framework (TWMF) with a set of rules to operationalize IHT behavior in terms of clinical leadership, coordination of workflow execution over multiple days as part of continuity of care, and management of tasks, including urgent ones that prevent planned workflow execution. We briefly describe a proof-of-concept implementation of extended TWMF in the form of a computer system for supporting cooperative execution of clinical workflows by an IHT. The system is built on top of an existing business workflow execution engine and employs behavioral rules to control the IHT behavior. We also illustrate the operations of TWMF in a case study where an IHT is executing a workflow for the management of post-operative inpatient recovery after radical prostatectomy

Dimensions of Nurse-Physician Communication

Hospital leaders set quality and safety as high priorities in their strategic goals. Improving the quality and safety of patient care requires improving internal processes that have direct implications for patient care. Hospital leaders need to improve health care providers\u27 communication as part of improving quality and safety. The problem addressed in this study was the lack of strategies health care administrators use to guide nurse-physician communication patterns in a university medical center in the Middle East. The purpose of this qualitative case study was to explore communication strategies that health care administrators use to guide nurse-physician communication. Relational coordination informed the conceptual framework of the study. The research question was designed to identify strategies health care administrators use to guide nurse-physician communication patterns. Data were collected and thematically analyzed through semistructured interviews with 5 administrators, 3 nurses, and 3 physicians, and the hospital policy manual. Analysis revealed 4 major themes: nurses\u27 empowerment, nurses and physicians\u27 accountability, multidisciplinary care delivery, and mutual respect. Strategies were identified through the exploration and analysis of the 4 themes. The key findings included that administrators considered holding nurses and physicians accountable for their work to be a key strategy that guides communication, and that effective communication is directly connected to mutual respect among different teams and individuals. The implications for social change include improved patient care and safety, and increased job satisfaction through health care leaders applying the identified strategies to enhance nurse-physician communication

Experiences of operating room staff about the role of theatre technicians in peri-operative nursing

Thesis (MCur)--Stellenbosch University, 2016.ENGLISH ABSTRACT: Background Unregulated theatre technicians allocated in scrub, circulating or anaesthetic assistant roles challenge traditional nursing roles in the operating room. No evidence could be found on the role of theatre technicians within the South African context, whilst such changes have an unknown effect on peri-operative patient care. Research question The study was guided by the question: “What are the experiences of operating room staff about the role of theatre technicians within peri-operative nursing?” Aim The aim of this study was to explore the experiences of operating room staff about the role of theatre technicians in peri-operative nursing. Objectives The objectives of this study were to gain an understanding of the experiences of operating room staff about the role of theatre technicians in peri-operative nursing with specific reference to: 1. Pre-operative nursing 2. Intra-operative nursing 3. Post-operative nursing 4. The supervision by professional nursing practitioners when theatre technicians are allocated to peri-operative nursing roles. Research process A descriptive qualitative research design was applied in this study. Ethics approval was obtained from the Health Research Ethics Committee of Stellenbosch University and three private healthcare organisations in the Cape Metropolitan area prior to the study. A pilot interview was conducted after which data was collected during semi-structured, audio recorded interviews with fourteen purposefully selected participants to whom pseudonyms were allocated to ensure anonymity. The interviews were transcribed, themes were induced and data was coded and elaborated upon whilst applying Lincoln and Guba’s criteria of credibility, transferability, dependability and conformability to enhance the trustworthiness of the study. Results The study found that theatre staff experienced overlapping roles between the roles of theatre technicians and that of operating room (OR) qualified professional nurses (PNs), as well as diverse views on comprehensive peri-operative care. Vague role boundaries were demonstrated through similar role expectations of staff in the scrub, circulator and anaesthetic assistant roles: “I don’t think there is a scope of practice for us… that says...this is what you do, this is what you don’t do” (Participant 12). However, within these roles, theatre technicians’ technical focus opposed the holistic patient care approach by OR qualified PNs. Holistic care, which necessitates an understanding of existing patient conditions, was associated with the anticipation and prevention of peri-operative risks. Surgical team composition seems undirected by standards and unguided by a required level of supervision. In the high risk OR environment, staff shortages and vague role expectations are linked to unclear responsibility. Coupled with limited information about team members’ credentials and their role boundaries, OR staff report conflict and leadership uncertainty, highlighted by theatre technicians’ educational backgrounds: “I (surgeon) think their training must be done differently to give them insight into what they do” (Participant 5). Conclusion The study emphasised unclear supervision requirements and questionable accountability of theatre technicians, although theatre staff experienced theatre technicians’ role as similar to that of OR qualified PNs. As voiced by participant 7: “If there is a real emergency…I (theatre technician) will be worried”. Thus, theatre technicians’ ambiguous role expectations require clarification as peri-operative risk prevention is fundamental to safe surgical care.AFRIKAANSE OPSOMMING: Agtergrond Die ongereguleerde aanwys van teatertegnici om te skrop, te sirkuleer of as narkose-assistent rolle te vervul, is ‘n uitdaging vir tradisionele verpleegrolle in die operasie-saal. Geen bewys kon gevind word oor die rol van teatertegnici binne die Suid-Afrikaanse konteks nie, terwyl sulke benaderinge ‘n ongekende effek op operatiewe pasiëntsorg het. Navorsingsvraag Hierdie studie is gelei deur die vraag: “Wat is die ervaringe van personeel in die operasie-saal oor die rol van teatertegnici binne peri-operatiewe verpleging?” Doel Die doel van hierdie studie is om die ervaringe van personeel in die operasie-saal oor die rol van teatertegnici in peri-operatiewe verpleging te ondersoek. Doelwitte Die doelwitte van hierdie studie is om ‘n begrip te verkry van die ervaringe van die personeel in die operasie-saal oor die rol van teatertegnici in peri-operatiewe verpleging met spesifieke verwysing na: 1. Pre-operatiewe verpleging 2. Intra-operatiewe verpleging 3. Post-operatiewe verpleging 4. Die toesighouding deur professionele verpleegkundiges wanneer peri-operatiewe verpleegrolle aan teatertegnici toegeken word. Navorsingsproses ’n Beskrywende kwalitatiewe navorsingsontwerp is in hierdie studie toegepas. Etiese goedkeuring is van die Gesondheidsnavorsingsetiekkomitee aan die Universiteit van Stellenbosch en drie private gesondheidsinstellings in die Kaapse Metropolitaanse area, voor die studie verkry. ’n Loodsprojek was na die insameling van data gedurende semi-gestruktureerde, oudioopnames met veertien doelbewus geselekteerde deelnemers aan wie skuilname toegeken is om anonimiteit te verseker, gedoen. Die onderhoude is getranskribeer, temas bepaal, data gekodeer en uitgebrei, terwyl Lincoln en Guba se kriteria van geloofwaardigheid, oordraagbaarheid, afhanklikheid en ooreenstemmigheid om die betroubaarheid van die studie te versterk, toegepas is. Resultate Die studie het getoon dat teaterpersoneel oorkoepelende rolle het wat die rol van teatertegnici, asook die van operasie-saal gekwalifiseerde professionele verpleegsters behels, met uiteenlopende sieninge oor komprehensiewe peri-operatiewesorg. Vae rolgrense is gedemonstreer deurdat personeel wat skrop, sirkuleer en narkose-assistent is, dieselfde rolverwagtinge het: “Ek dink nie dat daar ‘n bestek van praktyk vir ons in die praktyk is nie.. ....wat sê dis wat jy doen, dis wat jy nie doen nie” (Deelnemer 12). Nietemin, binne hierdie rolle is die teatertegnici met hul tegniese fokus in teenstelling met die holistiese benadering vir pasiëntsorg van operasie-saal professionele verpleegsters. Holistiesesorg waarvoor daar ‘n begrip van bestaande pasiënttoestande moet wees, word geassosieer met die antisipering en voorkoming van peri-operatiewe risiko’s. Die samestelling van chirurgiese spanne kom voor asof dit nie deur standaarde of ‘n vereiste vlak van toesighouding bepaal word nie. In die hoë risiko operasie-saal omgewing, word personeeltekorte en vae rolverwagtinge gekoppel aan onduidelike verantwoordelikhede. Gekoppel aan beperkte inligting oor spanwerkers se gekwalifiseerdhede en hulle rolgrense, rapporteer operasie-saal personeel konflik en leierskap onsekerhede, wat deur teatertegnici se opvoekundige agtergronde aan die lig gebring word: “Ek (chirurg) dink hulle opleiding moet verskillend wees om hulle die insig te gee oor wat hulle doen.” (Deelnemer 5) Gevolgtrekking Die studie beklemtoon onduidelike toesigvereistes en bevraagteken aanspreeklikheid van teatertegnici, alhoewel teaterpersoneel die rol van teatertegnici dieselfde as die van operasiesaal professionele verpleegkundiges ervaar. Soos aangehoor deur deelnemer 7: “As daar ‘n werklike noodgeval.... sal ek (teatertegnikus) bekommerd wees”. Dus, teatertegnici se onduidelike rolverwagtings noodsaak duidelikheid, omdat peri-operatiewe risiko-voorkoming fundamenteel vir veilige chirurgiese sorg is

Analysing supply chain operation dynamics through logic-based modelling and simulation

Supply Chain Management (SCM) is becoming increasingly important in the modern business world. In order to effectively manage and integrate a supply chain (SC), a deep understanding of overall SC operation dynamics is needed. This involves understanding how the decisions, actions and interactions between SC members affect each other, and how these relate to SC performance and SC disruptions. Achieving such an understanding is not an easy task, given the complex and dynamic nature of supply chains. Existing simulation approaches do not provide an explanation of simulation results, while related work on SC disruption analysis studies SC disruptions separately from SC operation and performance. This thesis presents a logic-based approach for modelling, simulating and explaining SC operation that fills these gaps. SC members are modelled as logicbased intelligent agents consisting of a reasoning layer, represented through business rules, a process layer, represented through business processes and a communication layer, represented through communicative actions. The SC operation model is declaratively formalised, and a rule-based specification is provided for the execution semantics of the formal model, thus driving the simulation of SC operation. The choice of a logic-based approach enables the automated generation of explanations about simulated behaviours. SC disruptions are included in the SC operation model, and a causal model is defined, capturing relationships between different types of SC disruptions and low SC performance. This way, explanations can be generated on causal relationships between occurred SC disruptions and low SC performance. This approach was analytically and empirically evaluated with the participation of SCM and business experts. The results indicate the following: Firstly, the approach is useful, as it allows for higher efficiency, correctness and certainty about explanations of SC operation compared to the case of no automated explanation support. Secondly, it improves the understanding of the domain for non-SCM experts with respect to their correctness and efficiency; the correctness improvement is significantly higher compared to the case of no prior explanation system use, without loss of efficiency. Thirdly, the logic-based approach allows for maintainability and reusability with respect to the specification of SC operation input models, the developed simulation system and the developed explanation system