Workflow interruptions and mental workload in hospital pediatricians: an observational study

Background: Pediatricians' workload is increasingly thought to affect pediatricians' quality of work life and patient safety. Workflow interruptions are a frequent stressor in clinical work, impeding clinicians' attention and contributing to clinical malpractice. We aimed to investigate prospective associations of workflow interruptions with multiple dimensions of mental workload in pediatricians during clinical day shifts. Methods: In an Academic Children's Hospital a prospective study of 28 full shift observations was conducted among pediatricians providing ward coverage. The prevalence of workflow interruptions was based on expert observation using a validated observation instrument. Concurrently, Pediatricians' workload ratings were assessed with three workload dimensions of the well-validated NASA-Task Load Index: mental demands, effort, and frustration. Results: Observed pediatricians were, on average, disrupted 4.7 times per hour. Most frequent were interruptions by colleagues (30.2%), nursing staff (29.7%), and by telephone/beeper calls (16.3%). Interruption measures were correlated with two workload outcomes of interest: frequent workflow interruptions were related to less cognitive demands, but frequent interruptions were associated with increased frustration. With regard to single sources, interruptions by colleagues showed the strongest associations to workload. Conclusions: The findings provide insights into specific pathways between different types of interruptions and pediatricians' mental workload. These findings suggest further research and yield a number of work and organization re-design suggestions for pediatric care

The effects of improving hospital physicians working conditions on patient care: a prospective, controlled intervention study

Background: Physicians, particularly in hospitals, suffer from adverse working conditions. There is a close link between physicians' psychosocial work environment and the quality of the work they deliver. Our study aimed to explore whether a participatory work-design intervention involving hospital physicians is effective in improving working conditions and quality of patient care. Methods: A prospective, controlled intervention study was conducted in two surgical and two internal departments. Participants were 57 hospital physicians and 1581 inpatients. The intervention was a structured, participatory intervention based on continuous group meetings. Physicians actively analyzed problematic working conditions, developed solutions, and initiated their implementation. Physicians' working conditions and patients' perceived quality of care were outcome criteria. These variables were assessed by standardized questionnaires. Additional data on implementation status were gathered through interviews. Results: Over the course of ten months, several work-related problems were identified, categorized, and ten solutions were implemented. Post-intervention, physicians in the intervention departments reported substantially less conflicting demands and enhanced quality of cooperation with patients' relatives, compared to control group physicians. Moreover, positive changes in enhanced colleague support could be attributed to the intervention. Regarding patient reports of care quality of care, patient ratings of physicians organization of care improved for physicians in the intervention group. Five interviews with involved physicians confirm the plausibility of obtained results, provide information on implementation status and sustainability of the solutions, and highlight process-related factors for re-design interventions to improve hospital physicians work. Conclusions: This study demonstrates that participatory work design for hospital physicians is a promising intervention for improving working conditions and promoting patient quality of care

The effects of improving hospital physicians working conditions on patient care: a prospective, controlled intervention study

Background: Physicians, particularly in hospitals, suffer from adverse working conditions. There is a close link between physicians' psychosocial work environment and the quality of the work they deliver. Our study aimed to explore whether a participatory work-design intervention involving hospital physicians is effective in improving working conditions and quality of patient care. Methods: A prospective, controlled intervention study was conducted in two surgical and two internal departments. Participants were 57 hospital physicians and 1581 inpatients. The intervention was a structured, participatory intervention based on continuous group meetings. Physicians actively analyzed problematic working conditions, developed solutions, and initiated their implementation. Physicians' working conditions and patients' perceived quality of care were outcome criteria. These variables were assessed by standardized questionnaires. Additional data on implementation status were gathered through interviews. Results: Over the course of ten months, several work-related problems were identified, categorized, and ten solutions were implemented. Post-intervention, physicians in the intervention departments reported substantially less conflicting demands and enhanced quality of cooperation with patients' relatives, compared to control group physicians. Moreover, positive changes in enhanced colleague support could be attributed to the intervention. Regarding patient reports of care quality of care, patient ratings of physicians organization of care improved for physicians in the intervention group. Five interviews with involved physicians confirm the plausibility of obtained results, provide information on implementation status and sustainability of the solutions, and highlight process-related factors for re-design interventions to improve hospital physicians work. Conclusions: This study demonstrates that participatory work design for hospital physicians is a promising intervention for improving working conditions and promoting patient quality of care

Dipole-dipole correlations and the Debye process in the dielectric response of non-associating glass forming liquids

The non-exponential shape of the $\alpha$-process observed in supercooled liquids is considered as one of the hallmarks of glassy dynamics and has thus been under study for decades, but is still poorly understood. For a polar van der Waals liquid, we show here - in line with a recent theory - that dipole-dipole correlations give rise to an additional process in the dielectric spectrum slightly slower than the $\alpha$-relaxation, which renders the resulting combined peak narrower than observed by other experimental techniques. This is reminiscent of the Debye process found in monohydroxy alcohols. The additional peak can be suppressed by weakening the dipole-dipole interaction via dilution with a nonpolar solvent

Hospital doctors' workflow interruptions and activities: an observation study

BACKGROUND Interruptions of hospital doctors' workflow are a frequent stressor, eventually jeopardising quality of clinical performance. To enhance the safety of hospital doctors' work, it is necessary to analyse frequency and circumstances of workflow interruptions. AIM To quantify workflow interruptions among hospital doctors, identify frequent sources and relate sources to doctors' concurrent activities. METHODS Within a typical hospital, 32 participant observations of doctors' full work shifts were carried out. Time-motion information was collected on types of workflow interruption and doctors' activities and analysed with logit-linear analyses. RESULTS The frequency of workflow interruptions was high, especially on the intensive care unit and emergency ward. Telephones and bleepers were the most frequently recorded type of work interruption. The combined analysis of doctors' activities and concurrent workflow interruptions revealed that the likelihood of the occurrence of certain types of interruption depended on the tasks being carried out by the doctor. CONCLUSION The present method may be useful for quantifying and distinguishing sources of hospital doctors' workflow interruptions and useful in raising awareness of organisational circumstances

Is resistance to ischaemia of motor axons in diabetic subjects due to membrane depolarization?

The reasons for the resistance to ischaemia of peripheral nerves in diabetics are not well understood. We have now explored whether axonal depolarization underlies this phenomenon, as has previously been proposed. Resistance to ischaemia was determined by the new method of “threshold tracking”. This method revealed an increase in excitability of the peroneal nerve at the popliteal fossa during ischaemia, and a decrease in excitability in the post-ischaemic period. The extent of these alterations in 28 type 1 diabetics without peripheral neuropathy showed a strong correlation with the mean blood glucose concentrations during the last 24 h before examination. To test whether the ischaemic resistance was related to membrane potential, we also measured axonal superexcitability in 11 selected diabetics, since it has been shown that post-spike changes in excitability depend on membrane potential. Changes in excitability of the peroneal nerve were measured in the period between 10 and 30 msec following a conditioning supramaximal compound action potential. Under resting conditions, no differences in the post-spike superexcitability were found between controls and diabetics, despite striking differences in their responses to a 10-min pressure cuff. These observations indicate that membrane depolarization is not involved in the resistance to ischaemia of motor axons in diabetic subjects

Local dielectric response in 1-propanol: α\alpha-relaxation versus relaxation of mesoscale structures

The dielectric Debye relaxation in monohydroxy alcohols has been subject of long-standing scientific interest and is presently believed to arise from the relaxation of transiently H-bonded supramolecular structures. Therefore, its manifestation might be expected to differ from a local dielectric probe as compared to the standard macroscopic dielectric experiment. In this work we present such local dielectric measurements obtained by triplet state solvation dynamics (TSD) and compare the results with macroscopic dielectric and light scattering data. In particular, with data from an improved TSD setup, a detailed quantitative comparison reveals that the Debye process does not significantly contribute to the local Stokes shift response function, while $\alpha$- and $\beta$-relaxations are clearly resolved. Furthermore, this comparison reveals that the structural relaxation has almost identical time constants and shape parameters in all three measurement techniques. Altogether our findings support the notion that the transiently bound chain structures lead to a strong cross-correlation contribution in macroscopic dielectric experiments, to which both light scattering and TSD are insensitive, the latter due to its local character and the former due to the molecular optical anisotropy being largely independent of the OH bonded suprastructures.Comment: 8 pages, 9 figure

Modelling learning for a better safety culture within an organization using a virtual safety coach:Reducing the risk of postpartum depression via improved communication with parents

This paper describes an extension of a safety culture within hospital organizations providing more transparency and acknowledgement of all actors, and in particular the parents. It contributes a model architecture to support a hospital to develop such an extended safety culture. It is illustrated for prevention of postpartum depression. Postpartum depression is a commonly known consequence of childbirth for both mothers and fathers. In this research, we computationally analyze the risk factors and lack of support received by fathers. Therefore, we use shared mental models to model the effects of poor and additional communication by healthcare practitioners to mitigate the development of postpartum depression in both the mother and the father. Both individual mental models and shared mental models are considered in the design of the computational model. The paper illustrates the benefits of simple support in terms of communication during childbirth, which has lasting effects, even outside the hospital. For the impact of additional communication, a Virtual Safety Coach is designed that intervenes when necessary to provide support, i.e., when a health care practitioner doesn't. Moreover, organizational learning is also modelled to improve the mental models of both the Safety Coach and the Health Care Practitioner.Safety and Security Scienc