Kathryn Momtahan

Using team cognitive work analysis to reveal healthcare team interactions in a birthing unit

Cognitive work analysis (CWA) as an analytical approach for examining complex sociotechnical systems has shown success in modelling the work of single operators. The CWA approach incorporates social and team interactions, but a more explicit analysis of team aspects can reveal more information for systems design. In this paper, Team CWA is explored to understand teamwork within a birthing unit at a hospital. Team CWA models are derived from theories and models of teamwork and leverage the existing CWA approaches to analyse team interactions. Team CWA is explained and contrasted with prior approaches to CWA. Team CWA does not replace CWA, but supplements traditional CWA to more easily reveal team information. As a result, Team CWA may be a useful approach to enhance CWA in complex environments where effective teamwork is required. Practitioner Summary: This paper looks at ways of analysing cognitive work in healthcare teams. Team Cognitive Work Analysis, when used to supplement traditional Cognitive Work Analysis, revealed more team information than traditional Cognitive Work Analysis. Team Cognitive Work Analysis should be considered when studying teams.

Supporting the Strategies of Cardiac Nurse Coordinators Using Cognitive Work Analysis

We conducted a cognitive work analysis to elicit the strategies of cardiac nurse coordinators (NCs). NCs field telephone calls from cardiology and cardiac surgery patients and make recommendations based on determinations of the severity of the patients condition. We used a semi-structured interview technique to elicit various strategies. We then developed a decision making tool that deliberately supports these strategies. In this paper we discuss the elicitation of strategies and the transfer of these strategies into a design artifact.

Control Task Analysis in Action: Collaboration in the Operating Room

Cognitive Work Analysis (CWA) is gaining momentum for analyzing complex socio-technical systems but it does not yet have the specific tools and techniques that allow it to address teamwork explicitly enough to provide good guidance on how to support teams. This paper focuses on expansion of control task analysis (ConTA), the second phase of CWA, to understand the collaborative decision making of a surgical team during Cesarean section surgery.

Challenges with applying FMEA to the process for reading labels on injectable drug containers

As a part of a study that aims to evaluate and improve the labelling of containers for injectable drugs, Failure Mode and Effects Analysis (FMEA) was applied to the label reading process. Implementing a FMEA on a small-scale cognitive process involved various challenges including difficulties in representing the process, defining the failure modes, causes and effects, developing the rating scales for criticality, and rating the criticality of the failure modes. The failure modes were rated via two focus groups of healthcare professionals. The results highlight complexities and potential pitfalls with applying FMEA to the label reading process.

Disconnects in design and infection prevention and control – how the design of products and the environment in neonatal intensive care may be undermining infection prevention practice

This study examined the role design plays in infection prevention and control within an existing neonatal intensive care unit. Methods from human-centred design such as planning, stakeholder meetings and naturalistic observation were used to obtain infection prevention information related to the existing unit design, interactions with products and the environment, and perspectives of front-line staff on design. Thematic analysis was used to categorize and structure the issues that were identified. The analysis revealed that the design of products and the environment may be undermining best practice in infection prevention. Health care workers experience a variety of difficulties in maintaining the recommended barriers to infection transmission, difficulties which stem from deficiencies in products and the environment. Various aspects of the neonatal care design lack the feedback or supports needed to help health care workers differentiate or work between infection transmission zones making the design challenging to use or maintain in a manner that supports best practice in infection prevention. Identifying issues in the design of products and the environment related to infection prevention practice led to the development of a ‘Design Exploration Guide’. The guide outlines issues and strategies for remediation based on feasibility within the project constraints.

Human factors considerations in designing for infection prevention and control in neonatal care – findings from a pre-design inquiry

Abstract Qualitative data collection methods drawn from the early stages of human-centred design frameworks combined with thematic analysis were used to develop an understanding of infection prevention practice within an existing neonatal intensive care unit. Findings were used to generate a framework of understanding which in turn helped inform a baseline approach for future research and design development. The study revealed that a lack of clarity between infection transmission zones and a lack of design attributes needed to uphold infection prevention measures may be undermining healthcare workers’ understanding and application of good practice. The issue may be further complicated by well-intentioned behavioural attitudes to meeting work objectives; undue influences from spatial constraints; the influence of inadvertent and excessive touch-based interactions; physical and/or cognitive exertion to maintain transmission barriers; and the impact of expanding job design and increased workload to supplement for lack of effective barriers. Practitioner Summary: Despite high hand hygiene compliance within a neonatal intensive care unit, healthcare workers expressed concerns about the unit design and infection prevention practice. Early inquiry methods from human-centred design and thematic analysis helped develop a framework to understand how design can be used to aid infection prevention.

Getting a Picture: A Grounded Theory of Nurses Knowing the Person in a Virtual Environment

Delivery of care by nurses in virtual environments is rapidly increasing with uptake of digitally mediated technologies, such as remote patient monitoring (RPM). Knowing the person is a phenomenon in nursing practice deemed requisite to building relationships and informing clinical decisions, but it has not been studied in virtual environments. Purpose of Study: The intent of this study was to explicate the processes of how nurses come to know the person using RPM, one form of telehealth technology used in a virtual environment. Study Design and Method: The study was informed by Charmaz’s constructivist grounded theory and included 33 interviews and 5 observational experiences of nurses using RPM in 7 different settings. Findings: Getting a Picture evolved as the core category to a theoretical conceptualization of nurses knowing the person through use of RPM and other technologies, such as telephone and electronic medical records. Getting a Picture reflected a dynamic flow and integration of seven processes, such as Connecting With the Person and Recording and Reflecting, to describe how nurses strove to attain a visualization of the person. Conclusions: While navigating disparate and disconnected information and communication technologies, Getting a Picture was important for providing safe, holistic, person-centered care.

Can teamwork and situational awareness (SA) in ED resuscitations be improved with a technological cognitive aid? Design and a pilot study of a team situation display

Effective teamwork in ED resuscitations, including information sharing and situational awareness, could be degraded. Technological cognitive aids can facilitate effective teamwork. OBJECTIVE This study focused on the design of an ED situation display and pilot test its influence on teamwork and situational awareness during simulated resuscitation scenarios. MATERIAL AND METHODS The display design consisted of a central area showing the critical dynamic parameters of the interventions with an events time-line below it. Static information was placed at the sides of the display. We pilot tested whether the situation display could lead to higher scores on the Clinical Teamwork Scale (CTS), improved scores on a context-specific Situational Awareness Global Assessment Technique (SAGAT) tool, and team communication patterns that reflect teamwork and situational awareness. RESULTS Resuscitation teamwork, as measured by the CTS, was overall better with the presence of the situation display as compared with no situation display. Team members discussed interventions more with the situation display compared with not having the situation display. Situational awareness was better with the situation display only in the trauma scenario. DISCUSSION The situation display could be more effective for certain ED team members and in certain cases. CONCLUSIONS Overall, this pilot study implies that a situation display could facilitate better teamwork and team communication in the resuscitation event.