Operational Failures and Problem Solving: An Empirical Study of Incident Reporting

Operational failures occur in all industries with consequences that range from minor inconveniences to major catastrophes. Many organizations have implemented incident reporting systems to highlight actual and potential operational failures in order to encourage problem solving and prevent subsequent failures. Our study is among the first to develop and empirically test theory regarding which reported operational failures are likely to spur problem solving. We hypothesize that problem solving activities are especially likely to follow reported operational failures that provoke financial and legal liability risks. We also hypothesize that management commitment to problem solving, enacted through managers' communication and engagement practices, can encourage frontline workers to conduct problem solving. We test our hypotheses in the health care context, in which the use of incident reporting systems to highlight operational failures is widespread. Using data on nearly 7,500 reported incidents from a single hospital, we find support for our hypotheses. Our findings suggest that frontline workers' participation in problem solving is motivated by some inherent characteristics of the problems as well as by particular management practices.

Managerial practices that promote voice and taking charge among frontline workers

Process-improvement ideas often come from frontline workers who speak up by voicing concerns about problems and by taking charge to resolve them. We hypothesize that organization-wide process-improvement campaigns encourage both forms of speaking up, especially voicing concern. We also hypothesize that the effectiveness of such campaigns depends on the prior responsiveness of line managers. We test our hypotheses in the healthcare setting, in which problems are frequent. We use data on nearly 7,500 reported incidents extracted from an incident-reporting system that is similar to those used by many organizations to encourage employees to communicate about operational problems. We find that process-improvement campaigns prompt employees to speak up and that campaigns increase the frequency of voicing concern to a greater extent than they increase taking charge. We also find that campaigns are particularly effective in eliciting taking charge among employees whose managers have been relatively unresponsive to previous instances of speaking up. Our results therefore indicate that organization-wide campaigns can encourage voicing concerns and taking charge, two important forms of speaking up. These results can enable managers to solicit ideas from frontline workers that lead to performance improvement.

Object-guided Spatial Attention in Touch: Holding the Same Object with Both Hands Delays Attentional Selection

Abstract Previous research has shown that attention to a specific location on a uniform visual object spreads throughout the entire object. Here we demonstrate that, similar to the visual system, spatial attention in touch can be object guided. We measured event-related brain potentials to tactile stimuli arising from objects held by observers' hands, when the hands were placed either near each other or far apart, holding two separate objects, or when they were far apart but holding a common object. Observers covertly oriented their attention to the left, to the right, or to both hands, following bilaterally presented tactile cues indicating likely tactile target location(s). Attentional modulations for tactile stimuli at attended compared to unattended locations were present in the time range of early somatosensory components only when the hands were far apart, but not when they were near. This was found to reflect enhanced somatosensory processing at attended locations rather than suppressed processing at unattended locations. Crucially, holding a common object with both hands delayed attentional selection, similar to when the hands were near. This shows that the proprioceptive distance effect on tactile attentional selection arises when distant event locations can be treated as separate and unconnected sources of tactile stimulation, but not when they form part of the same object. These findings suggest that, similar to visual attention, both space- and object-based attentional mechanisms can operate when we select between tactile events on our body surface.</jats:p

Patient characteristics associated with objective measures of digital health tool use in the United States: A literature review.

The study sought to determine which patient characteristics are associated with the use of patient-facing digital health tools in the United States.We conducted a literature review of studies of patient-facing digital health tools that objectively evaluated use (eg, system/platform data representing frequency of use) by patient characteristics (eg, age, race or ethnicity, income, digital literacy). We included any type of patient-facing digital health tool except patient portals. We reran results using the subset of studies identified as having robust methodology to detect differences in patient characteristics.We included 29 studies; 13 had robust methodology. Most studies examined smartphone apps and text messaging programs for chronic disease management and evaluated only 1-3 patient characteristics, primarily age and gender. Overall, the majority of studies found no association between patient characteristics and use. Among the subset with robust methodology, white race and poor health status appeared to be associated with higher use.Given the substantial investment in digital health tools, it is surprising how little is known about the types of patients who use them. Strategies that engage diverse populations in digital health tool use appear to be needed.Few studies evaluate objective measures of digital health tool use by patient characteristics, and those that do include a narrow range of characteristics. Evidence suggests that resources and need drive use

Comparing methods of grouping hospitals

ObjectiveTo compare the performance of widely used approaches for defining groups of hospitals and a new approach based on network analysis of shared patient volume.Study SettingNonâ federal acute care hospitals in the United States.Study DesignWe assessed the measurement properties of four methods of grouping hospitals: hospital referral regions (HRRs), metropolitan statistical areas (MSAs), coreâ based statistical areas (CBSAs), and community detection algorithms (CDAs).Data Extraction MethodsWe combined data from the 2014 American Hospital Association Annual Survey, the Census Bureau, the Dartmouth Atlas, and Medicare data on interhospital patient travel patterns. We then evaluated the distinctiveness of each grouping, reliability over time, and generalizability across populations.Principle FindingsHospital groups defined by CDAs were the most distinctive (modularity = 0.86 compared to 0.75 for HRRs and 0.83 for MSAs; 0.72 for CBSA), were reliable to alternative specifications, and had greater generalizability than HRRs, MSAs, or CBSAs. CDAs had lower reliability over time than MSAs or CBSAs (normalized mutual information between 2012 and 2014 CDAs = 0.93).ConclusionsCommunity detection algorithmâ defined hospital groups offer high validity, reliability to different specifications, and generalizability to many uses when compared to approaches in widespread use today. They may, therefore, offer a better choice for efforts seeking to analyze the behaviors and dynamics of groups of hospitals. Measures of modularity, shared information, inclusivity, and shared behavior can be used to evaluate different approaches to grouping providers.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151847/1/hesr13188-sup-0001-AuthorMatrix.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151847/2/hesr13188_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151847/3/hesr13188.pd

Preparing healthcare delivery organizations for managing computable knowledge

IntroductionThe growth of data science has led to an explosion in new knowledge alongside various approaches to representing and sharing biomedical knowledge in computable form. These changes have not been matched by an understanding of what healthcare delivery organizations need to do to adapt and continuously deploy computable knowledge. It is therefore important to begin to conceptualize such changes in order to facilitate routine and systematic application of knowledge that improves the health of individuals and populations.MethodsAn AHRQâ funded conference convened a group of experts from a range of fields to analyze the current state of knowledge management in healthcare delivery organizations and describe how it needs to evolve to enable computable knowledge management. Presentations and discussions were recorded and analyzed by the author team to identify foundational concepts and new domains of healthcare delivery organization knowledge management capabilities.ResultsThree foundational concepts include 1) the current state of knowledge management in healthcare delivery organizations relies on an outdated biomedical library model, and only a small number of organizations have developed enterpriseâ scale knowledge management approaches that â pushâ knowledge in computable form to frontline decisions, 2) the concept of Learning Health Systems creates an imperative for scalable computable knowledge management approaches, and 3) the ability to represent data science discoveries in computable form that is FAIR (findable, accessible, interoperable, reusable) is fundamental to spread knowledge at scale. For healthcare delivery organizations to engage with computable knowledge management at scale, they will need new organizational capabilities across three domains: policies and processes, technology, and people. Examples of specific capabilities were developed.ConclusionsHealthcare delivery organizations need to substantially scale up and retool their knowledge management approaches in order to benefit from computable biomedical knowledge.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149202/1/lrh210070.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149202/2/lrh210070_am.pd

Object-Guided Spatial Selection in Touch Without Concurrent Changes in the Perceived Location of the Hands

In an endogenous cueing paradigm with central visual cues, observers made speeded responses to tactile targets at the hands, which were either close together or far apart, and holding either two separate objects or one common object between them. When the hands were far apart, the response time costs associated with attending to the wrong hand were reduced when attention had to be shifted along one object jointly held by both hands compared to when it was shifted over the same distance but across separate objects. Similar reductions in attentional costs were observed when the hands were placed closer together, suggesting that processing at one hand is less prioritized over that at another when the hands can be “grouped” by virtue of arising from the same spatial location or from the same object. Probes of perceived hand locations throughout the task showed that holding a common object decreased attentional separability without decreasing the perceived separation between the hands. Our findings suggest that tactile events at the hands may be represented in a spatial framework that flexibly adapts to (object-guided) attentional demands, while their relative coordinates are simultaneously preserved. </jats:p

Barriers to Hospital Electronic Public Health Reporting and Implications for the COVID-19 Pandemic

We sought to identify barriers to hospital reporting of electronic surveillance data to local, state, and federal public health agencies and the impact on areas projected to be overwhelmed by the COVID-19 pandemic. Using 2018 American Hospital Association data, we identified barriers to surveillance data reporting and combined this with data on the projected impact of the COVID-19 pandemic on hospital capacity at the hospital referral region level. Our results find the most common barrier was public health agencies lacked the capacity to electronically receive data, with 41.2% of all hospitals reporting it. We also identified 31 hospital referral regions in the top quartile of projected bed capacity needed for COVID-19 patients in which over half of hospitals in the area reported that the relevant public health agency was unable to receive electronic data. Public health agencies’ inability to receive electronic data is the most prominent hospital-reported barrier to effective syndromic surveillance. This reflects the policy commitment of investing in information technology for hospitals without a concomitant investment in IT infrastructure for state and local public health agencies