Adapting structuration theory to understand the role of reflexivity: Problematization, clinical audit and information systems

This paper is an exploratory account of the further development and application of a hybrid framework, StructurANTion, that is based on Structuration Theory and Actor Network Theory (ANT). The use of social theories in general and their use in information systems (IS) research in particular is explored leading to the use of the framework to examine the concept of what are termed humanchine networks in the context of clinical audit, within a healthcare Primary Care Trust (PCT). A particular focus is on the manner in which information systems-based reflexivity contributes to both entrenching a networks’ structurated order as well as contributing to its emancipatory change. The case study compares clinic-centric and patientcentric audit and seeks to further extend the understanding of the role of information and information systems within structurated humanchine activity systems. Conclusions indicate that the use of more socially informed IS methods and approaches can incorporate more emancipatory ideals and lead to greater adoption and usage of more relevant and useful clinical information systems and practices

Bar-Code Technology and Nursing Adaptations

Background: Medication administration errors (MAEs) have long been a prevalent problem and endanger patient safety. Bar-code medication administration (BCMA) systems were developed for the purpose of preventing the occurrence of MAEs. However, it has been demonstrated that the implementation of BCMA has brought about unanticipated consequences on nursing work and new, potential predictable paths to MAEs. More recently, investigators have introduced a new approach to describe the impact of BCMA on nursing work, which reflects nurses’ adaptations to the operational problems of BCMA under difficult circumstances. A more complete understanding of the process of nurses’ adaptations to technology will better inform intervention program for performance and safety improvement. Specific Aims: The specific aims of this study were to: 1) conduct an integrative literature review about operational problems of BCMA, 2) validate a typology of operational problems of BCMA yielded in the literature review, and 3) assess nurses’ adaptations to BCMA operational problems and describe their perceptions about the adaptations. Conceptual Framework: The conceptual framework guided this study was an integration of the work system from the Systems Engineering Initiative for Patient Safety (SEIPS) model and the frames perspective. When there is a collision between the frames (system frame and practice frame), the operational problems occur, and then nurses make adaptations to the operational problems. In this study, it is considered that the “system frame” is functionalized as the “work system”, which is the core of the SEIPS model. Methods: A prospective, exploratory design was conducted to meet the study aims. This descriptive study included two convenience samples of registered nurses working on identified medical and surgical adult acute care units. An observation of BCMA use and a semi-structured interview was conducted with each participant of one group of sample (N=22) to collect data about the operational problems of BCMA. Another group of sample (N=21) conducted scenario interviews and follow-up interviews to describe their adaptations to the operational problems of BCMA. Results: This study found that 1) the triggers of operational problems of BCMA can be categorized according to the elements of the work system of the SEIPS model, which are technology and tools, tasks, person, environment, and organization; 2) the five elements of the SEIPS work system were validated for use as a typology of the triggers of operational problems of BCMA; 3) nurses conducted different adaptations with various strategies to accommodate to the operational problems of medication administration using BCMA; and 4) the perceptions of nurses about the adaptations to the operational problems of BCMA can be addressed by the sequential steps, implying nurses think in a logic and objective way during adaptations. Conclusions: This study provides a new way to approach the impact of BCMA on nursing work – adaptations. This is one of the first studies that attempts to understand nurses’ adaptations to the operational problems of BCMA, and also one of the first studies that investigates nurses’ perceptions about adaptations. Future research should more rigorously study nurses’ adaptive behaviors to operational problems.PHDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/146043/1/liujia_1.pd

Improving communication in intensive care unit to ward transitions: Protocol for multisite national implementation of the ICU-PAUSE handoff tool

BACKGROUND: The intensive care unit (ICU)-ward transfer poses a particularly high-risk period for patients. The period after transfer has been associated with adverse events and additional work for care teams related to miscommunication or omission of information. Standardized handoff processes have been found to reduce communication errors and adverse patient events in other clinical environments but are understudied at the ICU-ward interface. We previously developed an electronic ICU-ward transfer tool, ICU-PAUSE, which embeds the key elements and diagnostic reasoning to facilitate a safe transfer of care at ICU discharge. OBJECTIVE: The aim of this study is to evaluate the implementation process of the ICU-PAUSE handoff tool across 10 academic medical centers, including the rate of adoption and acceptability, as perceived by clinical care teams. METHODS: ICU-PAUSE will be implemented in the medical ICU across 10 academic hospitals, with each site customizing the tool to their institution\u27s needs. Our mixed methods study will include a combination of a chart review, quantitative surveys, and qualitative interviews. After a 90-day implementation period, we will conduct a retrospective chart review to evaluate the rate of uptake of ICU-PAUSE. We will also conduct postimplementation surveys of providers to assess perceptions of the tool and its impact on the frequency of communication errors and adverse events during ICU-ward transfers. Lastly, we will conduct semistructured interviews of faculty stakeholders with subsequent thematic analysis with the goal of identifying benefits and barriers in implementing and using ICU-PAUSE. RESULTS: ICU-PAUSE was piloted in the medical ICU at Barnes-Jewish Hospital, the teaching hospital of Washington University School of Medicine in St. Louis, in 2019. As of July 2022, implementation of ICU-PAUSE is ongoing at 6 of 10 participating sites. Our results will be published in 2023. CONCLUSIONS: Our process of ICU-PAUSE implementation embeds each step of template design, uptake, and customization in the needs of users and key stakeholders. Here, we introduce our approach to evaluate its acceptability, usability, and impact on communication errors according to the tenets of sociotechnical theory. We anticipate that ICU-PAUSE will offer an effective handoff tool for the ICU-ward transition that can be generalized to other institutions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40918

A web-based information system for a regional public mental healthcare service network in Brazil

Acknowledgements We would like to thank all the participating representatives of public mental health services for their invaluable contribution to this system development and implementation and the XIII Regional Health Department of Sao Paulo state for their support. Funding: This study was funded by the ‘Conselho Nacional de Desenvolvimento Científico e Tecnológico’ (CNPq) and ‘Coordenação de Aperfeiçoamento de Pessoal de Nível Superior’ (CAPES)—Science Without Borders Programme.Peer reviewedPublisher PD

Pick-n-mix approaches to technology supply : XML as a standard “glue” linking universalised locals

We report on our experiences in a participatory design project to develop ICTs in a hospital ward working with deliberate self-harm patients. This project involves the creation and constant re-creation of sociotechnical ensembles in which XML-related technologies may come to play vital roles. The importance of these technologies arises from the aim underlying the project of creating systems that are shaped in locally meaningful ways but reach beyond their immediate context to gain wider importance. We argue that XML is well placed to play the role of "glue" that binds multiple such systems together. We analyse the implications of localised systems development for technology supply and argue that inscriptions that are evident in XML-related standards are and will be very important for the uptake of XML technologies

Human Performance Contributions to Safety in Commercial Aviation

In the commercial aviation domain, large volumes of data are collected and analyzed on the failures and errors that result in infrequent incidents and accidents, but in the absence of data on behaviors that contribute to routine successful outcomes, safety management and system design decisions are based on a small sample of non- representative safety data. Analysis of aviation accident data suggests that human error is implicated in up to 80% of accidents, which has been used to justify future visions for aviation in which the roles of human operators are greatly diminished or eliminated in the interest of creating a safer aviation system. However, failure to fully consider the human contributions to successful system performance in civil aviation represents a significant and largely unrecognized risk when making policy decisions about human roles and responsibilities. Opportunities exist to leverage the vast amount of data that has already been collected, or could be easily obtained, to increase our understanding of human contributions to things going right in commercial aviation. The principal focus of this assessment was to identify current gaps and explore methods for identifying human success data generated by the aviation system, from personnel and within the supporting infrastructure

BEYOND CRISIS RESPONSE: LEVERAGING SOCIOTECH-NICAL TRANSFORMABILITY

We investigate the organizational capacities required to leverage digital infrastructures both (1) in re-sponse to crisis and external threats, and (2) in realizing the transformative potential associated with the digital infrastructures. Thus, our research question is: What is required for organizations to be able to transform in the face of disruptions and breakdowns? We report from an empirical study of a digital infrastructure innovation process in the context of the COVID-19 pandemic, which involved extensions and novel development of both the technology and the former service model. While the literature on organizational resilience offers us a conceptual framework to identify organizational capabilities, we lean on literature that foregrounds transformability as a crucial aspect of resilience. We discuss organ-izational capacities which are considered vital in realizing the potential for transformative crisis learn-ing in sociotechnical systems that builds adaptive capacity and influences the enactment of future or-ganisational routines

A Proposed Theoretical Foundation for the Information Systems Discipline (version 1. 1)

“Rethink the theoretical foundations of the IS discipline” is one of the grand challenges for IS research identified in a Delphi study in Business Information Systems Engineering (Becker et al., 2015). This draft addresses that challenge directly through an integrated approach to the operation and evolution of systems. Almost any attempt to articulate a theoretical foundation for IS (a TFIS) would need to cover that topic although other attempts might emphasize other topics and other viewpoints. The proposed Theoretical Foundation for IS (TFIS) has three main goals: 1) Integration. Build outward from an integrated core. Do not accept the excuse that the IS field is not ready for a serious attempt at integration. 2) Usefulness. Contribute to describing, analyzing, designing, and evaluating systems, developing new tools and methods, and supporting empirical IS research. 3) Near-symmetry. Treat sociotechnical systems (with human participants) and totally automated systems as similarly as possible. Trends toward digitalization, automation, AI, and robotics imply benefits from that type of near-symmetry for understanding changes in the “division of labor.