Alessandro Jatobá

Designing for patient risk assessment in primary health care: a case study for ergonomic work analysis

In this paper, we study the importance of a consistent description of real work in patient risk assessment in the primary healthcare domain. Through a case study in the context of primary health care, we address the research problem of finding ways to build consistent real work descriptions of the patient risk assessment system in the primary healthcare domain, in order to foster the design of improved work situations and support devices. This is a qualitative field study based on ethnographic observation and semi-structured interviews carried out among professionals involved in the risk assessment process in a primary healthcare facility. The objects of ergonomic work analysis were work places and work situations with focus on human activity, as well as surrounding aspects. The analysis identified elements in the work domain with high cognitive demand and operations that could increase mental workload, providing elements for the earlier stages of the design of work situations and support devices to improve the risk assessment in primary health care. This paper shows the usefulness of real work descriptions in the design for complex situations like the risk assessment in health care, as well the impact of poor descriptions in generating harmful situations for both the patient and healthcare practitioners in the explored domain.

A method for work modeling at complex systems: towards applying information systems in family health care units

Work in organizations requires a minimum level of consensus on the understanding of the practices performed. To adopt technological devices to support the activities in environments where work is complex, characterized by the interdependence among a large number of variables, understanding about how work is done not only takes an even greater importance, but also becomes a more difficult task. Therefore, this study aims to present a method for modeling of work in complex systems, which allows improving the knowledge about the way activities are performed where these activities do not simply happen by performing procedures. Uniting techniques of Cognitive Task Analysis with the concept of Work Process, this work seeks to provide a method capable of providing a detailed and accurate vision of how people perform their tasks, in order to apply information systems for supporting work in organizations.

Reflections on work as done (WAD) and work as imagined (WAI) in an emergency response organization: A study on firefighters training exercises

Emergency response organizations need to be resilient to cope with escalating events resulting from dynamic, unexpected, or complex situations. In Brazil, the Firefighter Corps are military hierarchal organizations with a culture based on fixed structures, well defined norms and procedures. These push against innovations which are necessary to be resilient. This research describes how firefighter captains in the 30-35-year age range managed an emergency response escalation in light of standard operating procedures (SOPs) during a training exercise. The study used ethnographic methods to find and discuss gaps between the instructions and the activities carried out during the exercise, highlighting the differences between work as done (WAD) and work as imagined (WAI), as it was instantiated in the SOP prescriptions. The aim was to produce reflections on WAI and WAD as a way to raise awareness of the need for a cultural change toward resilience in firefighter organizations. This was achieved through firefighter engagement with a comprehensive visualization of the analysis results which afforded easy interaction between the experts, the data, and the researchers.

Patient visits in poorly developed territories: a case study with community health workers

In this paper, we study the effects of poor conditions of territories in patient visits performed by community health workers and the consequences to primary care policies. We carried a case study with community health workers in Rio de Janeiro, Brazil, including ethnographic observations in two primary healthcare clinics. Moreover, we present an analysis of the collected data with the support of the function resonance analysis method and we point out relations between the findings and the execution of the primary healthcare policy in a systemic approach. Thus, our study highlights the impacts of work situations in the health assistance of poorly developed communities, indicating how community health workers cope with adverse conditions, and how such situations affect the effectiveness of primary care policies.

Supporting decision-making in patient risk assessment using a hierarchical fuzzy model

In this paper, we present a hierarchical fuzzy model to support patient triage in primary health care. In developing countries like Brazil, public health must usually cover degraded territories; thus, allocating patients to health services is very hard due low availability, enormous demands, and the complexity of assessing patient conditions—which must account for more then physical aspects of patients, but their social conditions as well. This approach combines the fuzzy set theory under the AHP framework in order to illustrate the inherent imprecision in the evaluation of patient risk. Fieldwork was conducted in a primary healthcare facility in Brazil to demonstrate the applicability of the proposed approach. The proposed approach represents criterion in the formation of patients’ risk scores encompassing important aspects of primary care triage such as the structure of families, the conditions of residences, exposure to urban violence, and other aspects of patients’ lives, taking the risk assessment beyond the simple evaluation of symptoms and physiological conditions. Our approach focuses on enforcing decisions of public health workers by improving the awareness of patients’ conditions, which we believe will make the employment of triage criteria uniform and capable of showing tendencies on patients’ risks, as well as avoiding bias in patient triage.

The Role of Human Factors in Requirements Engineering in Health Care A Case Study in the Brazilian Health Care System

In this paper we propose an approach for the enhancement of software requirements specifications by combining human factors and requirements engineering concepts. The approach we propose uses cognitive engineering methods to increase understanding about how professionals perform complex work, taking into account the cognitive effort made by workers. We employed the suggested the approach in the context of a primary health care facility in Brazil to demonstrate that including human factors models improved the understanding of context, decision making and informal knowledge, enhancing software requirements specifications. Our results point out that a richer set of requirements was obtained, increasing the reliability of requirements specifications, enabling the design of better information technology to support work in the primary health care facility.