Impact of a large-scale robotics adoption on the hospital pharmacy workforce

The National Health Service (NHS) regularly adopts new technologies which often result in the redesign of services, where large numbers of staff undergo organisational change. The NHS is made up of teams of people, all of whom continue to work interdependently providing safe and effective care throughout these times of change. Automation in pharmacy is becoming popular, with recent advancements involving the automation of the medicines supply chain. Previous ventures involving Automated Dispensing Systems (ADS) have been small-scale. Maximising efficiencies through automation relies on the effective introduction of technologies as well as the alignment of technical and social change, and there has been little exploration of how automation impacts on the staff experience and team effectiveness. In the literature there are numerous models available against which to compare and analyse the success of teams more generally. Underpinning many of these models is the Hackman model which proposes that team effectiveness is influenced by: the effort team members exhibit; the knowledge and skills team members possess; and the appropriateness of the performance strategies implemented. There is a gap in the literature on the impacts large-scale automation has on teams (and their success) in healthcare, specifically in pharmacy. Approved in August 2008, NHS Greater Glasgow & Clyde (GG&C) initiated a large-scale redesign (the PPSU Acute Pharmacy Redesign Programme). The Programme aimed to; provide a single procurement department for Glasgow pharmacy; have a centralised Pharmacy Distribution Centre (PDC); introduce ward-level ordering; and improve the current staff skill-mix while promoting the use of patients’ own medicines in hospital (Making the Most of Your Medicines or MMyM). Since opening in September 2010, the PDC (comprising 9 robots in total) is now the single facility responsible for the procurement and distribution of medicines to approximately 4000 destinations, and affected approximately 530 hospital pharmacy staff. This scale of pharmacy redesign has not been seen in any other automated schemes in the UK. The aim of the first study was to describe and evaluate NHS GG&C pharmacy staff experiences over the programme duration by different job roles/locations. Interviews were conducted with 36 pharmacy staff members from 4 hospital sites and the PDC, and 9 stakeholders, identified by members of the project Steering Group. Staff were interviewed about their experiences before, during and after the redesign. An inductive content analysis was performed, which produced two main themes: “The Work I Do” and “The Context of My Work”. The first theme allowed the exploration of the changes in staff job role, with a focus on tasks, work pace/control, morale, training/progression opportunities and voice/relationships. The second theme focused on social impacts of the redesign, including support, leadership, praise, reliability and trust of co-workers. Results showed that there was a lack of training available and morale was low in part due to this. There was no cohesive vision among participants as to why the redesign was happening. Hospital staff training was in theory available, yet completing training, and progressing into higher pay bands was not always feasible. Management were concerned with PDC technicians losing their clinical-skills as a result of a change in job location. PDC support workers experienced a gradual depletion of medicines knowledge due to this transition. The pharmacist role was seen as more social. Experiences between MMyM and non-MMyM staff were different in terms of how challenging, varied and social the work was. All roles within the PDC appeared to be less social compared with hospital roles. The aims of the second study were to apply Hackman’s model of team effectiveness in the context of the pharmacy team dynamics and performance and (based on this model) discuss the extent to which these teams were successful in the adoption of the automation. Hackman’s characteristics were applied to the pharmacy staff interviews (n=36). The results indicated that PDC and hospital teams exhibited 8 of the 23 characteristics: members have a variety of high-level skills; members contribute and are motivated equally; members are equally committed; members have personal and professional skills; relevant education and training is present; learning should be collective; members self-regulate; and there is clarity about task requirements, constraints, resources available and who the service user is. The “minimising of performance slippages” characteristic could be observed in one hospital team but not in the PDC. The teams did not exhibit 5 of the characteristics, indicating less success in these areas: autonomy is available; adequate feedback is available; excellent performance is rewarded; team size is appropriate; and relevant education and training is actually available. Nine of Hackman’s characteristics could not be commented on due to a lack of illustrative data. This thesis adds to the limited literature on the exploration of automation in healthcare, specifically pharmacy. Three main lessons can be concluded: staff consultation and engagement is critical to the successful redesign of services driven by technology; ensuring job role components are appropriate for job tasks is essential- technology adoption may require new skill sets and also cause other pre-existing skill sets to become lost; team effectiveness is an important focus within any organisational change programme, but less up-to-date models of team effectiveness may not be ideally applicable to teams utilising technology. These lessons align with current Scottish Government policy on pharmacy innovation and provide valuable key points for change implementers to support the continued adoption of automation locally, nationally and internationally.The National Health Service (NHS) regularly adopts new technologies which often result in the redesign of services, where large numbers of staff undergo organisational change. The NHS is made up of teams of people, all of whom continue to work interdependently providing safe and effective care throughout these times of change. Automation in pharmacy is becoming popular, with recent advancements involving the automation of the medicines supply chain. Previous ventures involving Automated Dispensing Systems (ADS) have been small-scale. Maximising efficiencies through automation relies on the effective introduction of technologies as well as the alignment of technical and social change, and there has been little exploration of how automation impacts on the staff experience and team effectiveness. In the literature there are numerous models available against which to compare and analyse the success of teams more generally. Underpinning many of these models is the Hackman model which proposes that team effectiveness is influenced by: the effort team members exhibit; the knowledge and skills team members possess; and the appropriateness of the performance strategies implemented. There is a gap in the literature on the impacts large-scale automation has on teams (and their success) in healthcare, specifically in pharmacy. Approved in August 2008, NHS Greater Glasgow & Clyde (GG&C) initiated a large-scale redesign (the PPSU Acute Pharmacy Redesign Programme). The Programme aimed to; provide a single procurement department for Glasgow pharmacy; have a centralised Pharmacy Distribution Centre (PDC); introduce ward-level ordering; and improve the current staff skill-mix while promoting the use of patients’ own medicines in hospital (Making the Most of Your Medicines or MMyM). Since opening in September 2010, the PDC (comprising 9 robots in total) is now the single facility responsible for the procurement and distribution of medicines to approximately 4000 destinations, and affected approximately 530 hospital pharmacy staff. This scale of pharmacy redesign has not been seen in any other automated schemes in the UK. The aim of the first study was to describe and evaluate NHS GG&C pharmacy staff experiences over the programme duration by different job roles/locations. Interviews were conducted with 36 pharmacy staff members from 4 hospital sites and the PDC, and 9 stakeholders, identified by members of the project Steering Group. Staff were interviewed about their experiences before, during and after the redesign. An inductive content analysis was performed, which produced two main themes: “The Work I Do” and “The Context of My Work”. The first theme allowed the exploration of the changes in staff job role, with a focus on tasks, work pace/control, morale, training/progression opportunities and voice/relationships. The second theme focused on social impacts of the redesign, including support, leadership, praise, reliability and trust of co-workers. Results showed that there was a lack of training available and morale was low in part due to this. There was no cohesive vision among participants as to why the redesign was happening. Hospital staff training was in theory available, yet completing training, and progressing into higher pay bands was not always feasible. Management were concerned with PDC technicians losing their clinical-skills as a result of a change in job location. PDC support workers experienced a gradual depletion of medicines knowledge due to this transition. The pharmacist role was seen as more social. Experiences between MMyM and non-MMyM staff were different in terms of how challenging, varied and social the work was. All roles within the PDC appeared to be less social compared with hospital roles. The aims of the second study were to apply Hackman’s model of team effectiveness in the context of the pharmacy team dynamics and performance and (based on this model) discuss the extent to which these teams were successful in the adoption of the automation. Hackman’s characteristics were applied to the pharmacy staff interviews (n=36). The results indicated that PDC and hospital teams exhibited 8 of the 23 characteristics: members have a variety of high-level skills; members contribute and are motivated equally; members are equally committed; members have personal and professional skills; relevant education and training is present; learning should be collective; members self-regulate; and there is clarity about task requirements, constraints, resources available and who the service user is. The “minimising of performance slippages” characteristic could be observed in one hospital team but not in the PDC. The teams did not exhibit 5 of the characteristics, indicating less success in these areas: autonomy is available; adequate feedback is available; excellent performance is rewarded; team size is appropriate; and relevant education and training is actually available. Nine of Hackman’s characteristics could not be commented on due to a lack of illustrative data. This thesis adds to the limited literature on the exploration of automation in healthcare, specifically pharmacy. Three main lessons can be concluded: staff consultation and engagement is critical to the successful redesign of services driven by technology; ensuring job role components are appropriate for job tasks is essential- technology adoption may require new skill sets and also cause other pre-existing skill sets to become lost; team effectiveness is an important focus within any organisational change programme, but less up-to-date models of team effectiveness may not be ideally applicable to teams utilising technology. These lessons align with current Scottish Government policy on pharmacy innovation and provide valuable key points for change implementers to support the continued adoption of automation locally, nationally and internationally

Investigating error injection to enhance the effectiveness of mobile text entry studies of error behaviour

During lab studies of text entry methods it is typical to observer very few errors in participants' typing - users tend to type very carefully in labs. This is a problem when investigating methods to support error awareness or correction as support mechanisms are not tested. We designed a novel evaluation method based around injection of errors into the users' typing stream and report two user studies on the effectiveness of this technique. Injection allowed us to observe a larger number of instances and more diverse types of error correction behaviour than would normally be possible in a single study, without having a significant impact on key input behaviour characteristics. Qualitative feedback from both studies suggests that our injection algorithm was successful in creating errors that appeared realistic to participants. The use of error injection shows promise for the investigation of error correction behaviour in text entry studies

A participatory design and formal study investigation into mobile text entry for older adults

Text entry remains key to many tasks on touchscreen smartphones and is an important factor in the usability of such devices. The known problems of text entry can be particularly acute for older adults due to physical and cognitive issues associated with ageing. In a study of mobile text entry the authors employed a variety of participatory design and formal comparative study techniques in order to explore the requirements of this group of users and to discover the key differences in texting activity between them and younger users of mobile devices. They report on the findings of a lab study of texting behaviour of older adults. The authors’ findings indicate differences in attitudes to texting styles and tasks between older and younger adults. They also identify some differences in typing behaviour and reflect on methods

Designed with older adults to support better error correction in smartphone text entry : the MaxieKeyboard

Through our participatory design with older adults a need for improved error support for texting on smartphones emerged. Here we present the MaxieKeyboard based on the outcomes from this process. The keyboard highlights errors, auto-corrections and suggestion bar usage in the composition area and gives feedback on the keyboard on typing correctness. Our older adult groups have shown strong support for the keyboard

Special issue on reimagining interfaces for older adults

According to the Population Reference Bureau: "The world's population is growing and aging. Very low birth rates in developed countries, coupled with birth rate declines in most developing countries, are projected to increase the population ages 65 and over to the point in 2050 when it will be 2.5 times that of the population ages 0-4. This is an exact reversal of the situation in 1950.". In parallel, recent years have seen mobile technologies having a massive impact on work and social life, for example in May 2014 ComScore estimated that 60% of total digital media time was spent on mobile platforms. Older adults should not be disadvantaged in using mobile technologies for professional, social and lifestyle usage as, increasingly, these are central to supporting work, domestic administration, community involvement and personal independence. Unfortunately, natural ageing processes can interfere with mobile technology usage. The normal ageing process typically involves a decline in visual and auditory abilities together with a decline in working memory, selective attention, and motor control. For example, many people in their 40s start to have vision changes that affect their near focus while movement can be both slower and less accurate from the mid-60s onwards. Many of the physical features of mobile devices are not accommodating of these changing physical characteristics. It has also been highlighted that many older adults will experience problems with small buttons that have poor feedback, complex menu structures, overall device size and difficulty in reading small on-screen text – all common features of the most widely available mobile devices. Where input is concerned, older people have been shown to be slower in text entry studies and studies with older adults have shown concerns about "fat fingers" since the early days of personal digital assistants (PDAs)

Through their eyes: A Samoan perspective on child wellbeing

Child wellbeing is the subject of a considerable body of research and policy making globally, and in New Zealand today. Despite its extensive use, the concept of child wellbeing is used differently across disciplines and across diverse social and cultural contexts. Little of the extant literature recognises the influence of ‘other’ worldviews, cultural beliefs, values, and ways of knowing. Further, the voices of children are largely missing in the child wellbeing debates, despite the fact that children are able to offer authoritative knowledge of their world and of their experiences. A review of the literature on Pasifika, children and childhoods, and wellbeing, highlights that there is currently no literature in New Zealand that connects these three areas together. This is the gap where this research contributes new knowledge to understanding - from the standpoint of Samoan children and their parents living in Wellington - how they conceptualise child wellbeing. The Samoan diaspora is the focus of this research given the diversity that exists within Pasifika. Guided by the Talanoa ile i’a (Faleolo, 2009), this exploratory research positions children as ‘experts’ on their wellbeing and creates the space for them to share their knowledge. The Samoan children do so through combining Samoan (talanoaga) and Western (photovoice) research methods. The Samoan children took 10 photos of what made them feel ‘happy, safe, and loved’, which they used to guide their talanoa. The views of their parents were elicited through talanoaga. From the talanoaga, the Samoan children defined their wellbeing as “a bunch of stuff that has good bits and bad bits”. This definition picks up the relational aspect of wellbeing as well as resilience. Four factors are important to their wellbeing, which are: social connections, not having to worry, feeling valued and included, and being a good person. Connecting with people, particularly their family, stands out as being of overwhelming importance to their wellbeing. The Samoan children bring these ideas together conceptually as a seesaw in a playground. Parents conceptualise the wellbeing of their children as ola manaia or the beautiful life. They see their main role as laying the foundations on which their children could have a beautiful life. For many parents, they are drawing on the fa’asamoa and the way in which they have been raised, but ‘tweaking’ this to account for shifts in the broader context. Of note, parents view wellbeing in terms of their children being happy and emotionally stable, being good people, having values, and that they do something meaningful with their lives that they were passionate about. The talanoa from the parents are woven together as the Ola Manaia model that captures the importance of resilience and the relational aspect of wellbeing. This research has significance in terms of adding to the community, national and global body of knowledge on child wellbeing. This is the first New Zealand study of the wellbeing of Samoan children that gives priority to the voices of children. In doing so, it adds the child’s voice as well as the ‘other’ to the child wellbeing literature, and does this in a holistic way that takes account of the multi-dimensional aspect of child wellbeing. Further, this research reinforces that, when given the opportunity, children are able to make an incredible contribution to issues that affect them

When you ask the fish: Child wellbeing through the eyes of Samoan children

Child wellbeing is the subject of substantial academic and policy interest globally and in New Zealand. Notably however, the voices of children are largely missing in much of the extended literature. In addition, and largely due to an assumption that wellbeing is a universally held construct, the influence of cultural values and beliefs on the perceptions and experiences of wellbeing of children, such as the Samoan children in this study, have not warranted in-depth attention. This study explores the influence of culture on how 8-year old Samoan children living in Wellington, NZ, conceptualise their wellbeing (Dunlop-Bennett, 2019). Part I of this article details the research approach developed for this study. Guided by Talanoa ile i’a (Faleolo, 2009) or ‘Talking to the Fish’, this study positioned children as experts on their wellbeing and through the use of talanoa and photos successfully created the reflective discussion space for 11 Samoan children to share their knowledge. The findings, outlined in Part II, show that when given the opportunity, these Samoan children offered critical and realistic insights into their experiences and aspirations. One model of wellbeing shared by these children used the analogy of a seesaw, where wellbeing was achieved when the “good bits and the bad bits” are balanced. The influence of context of wellbeing was a second key finding. These Samoan children’s experiences of wellbeing indicated a subtle interplay and balancing of their fa’asamoa (the Samoan way) and New Zealand life experiences. While this ethnic-specific study does not purport to represent the diversity of the Samoan diaspora, it presents a model that can be adapted by the Samoan diaspora living in other parts of New Zealand as well as other Pasifika and minority groups, as appropriate

Mobile text entry behaviour in lab and in-the-wild studies : is it different?

Text entry in smartphones remains a critical element of mobile HCI. It has been widely studied in lab settings, using primarily transcription tasks, and to a far lesser extent through in-the-wild (field) experiments. So far it remains unknown how well user behaviour during lab transcription tasks approximates real use. In this paper, we present a study that provides evidence that lab text entry behaviour is clearly distinguishable from real world use. Using machine learning techniques, we show that it is possible to accurately identify the type of study in which text entry sessions took place. The implications of our findings relate to the design of future studies in text entry, aiming to support input with virtual smartphone keyboards

Impact of robotics-led organisational change on the pharmacy workforce - preliminary findings : report for the pharmacy & prescribing support unit, NHS Greater Glasgow & Clyde

This report looks at the preliminary findings on the impact of robotics-led organisational change on the pharmacy workforc

Rethinking mobile interfaces for older adults

This SIG advances the study of mobile user interfaces for the aging population. The topic is timely, as the mobile device has become the most widely used computer terminal and at the same time the number of older people will soon exceed the number of children worldwide. However, most HCI research addresses younger adults and has had little impact on older adults. Some design trends, like the mantra “smaller is smarter”, contradict the needs of older users. Developments like this may diminish their ability to access information and participate in society. This can lead to further isolation (social and physical) of older adults and increased widening of the digital divide. This SIG aims to discuss mobile interfaces for older adults. The SIG has three goals: (i) to map the state-of-art, (ii) to build a community gathering experts from related areas, and (iii) to raise awareness within the SIGCHI community. The SIG will be open to all at CHI