Toward a process-level view of distributed healthcare tasks: Medication management as a case study

Nicole E Werner; Seema Malkana; Ayse P Gurses; Bruce Leff; Alicia I Arbaje

doi:10.1016/j.apergo.2017.06.020

Toward a process-level view of distributed healthcare tasks: Medication management as a case study

Appl Ergon. 2017 Nov:65:255-268. doi: 10.1016/j.apergo.2017.06.020. Epub 2017 Jul 13.

Authors

Nicole E Werner¹, Seema Malkana², Ayse P Gurses³, Bruce Leff⁴, Alicia I Arbaje⁵

Affiliations

¹ Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States; Center for Quality and Productivity Improvement, College of Engineering, University of Wisconsin-Madison, Madison, WI, United States; Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, United States. Electronic address: nwerner3@wisc.edu.
² Department of Medicine, Temple University Hospital, Philadelphia, PA, United States.
³ Armstrong Institute for Patient Safety and Quality, Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Department of Civil Engineering and Systems Institute, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, United States.
⁴ Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, MD, United States.
⁵ Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Clinical Investigation, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.

Abstract

We aim to highlight the importance of using a process-level view in analyzing distributed healthcare tasks through a case study analysis of medication management (MM). MM during older adults' hospital-to-skilled-home-healthcare (SHHC) transitions is a healthcare process with tasks distributed across people, organizations, and time. MM has typically been studied at the task level, but a process-level is needed to fully understand and improve MM during transitions. A process-level view allows for a broader investigation of how tasks are distributed throughout the work system through an investigation of interactions and the resultant emergent properties. We studied MM during older adults' hospital-to-SHHC transitions through interviews and observations with 60 older adults, their 33 caregivers, and 79 SHHC providers at 5 sites associated with 3 SHHC agencies. Study findings identified key cross-system characteristics not observable at the task-level: (1) identification of emergent properties (e.g., role ambiguity, loosely-coupled teams performing MM) and associated barriers; and (2) examination of barrier propagation across system boundaries. Findings highlight the importance of a process-level view of healthcare delivery occurring across system boundaries.

Keywords: Frail elderly; Home care agencies; Medication management; Process; Sociotechnical system; System boundaries; Transitional care; Work system.

Publication types

Observational Study

MeSH terms

Adult
Aged
Aged, 80 and over
Female
Home Care Services / organization & administration*
Humans
Male
Medication Therapy Management*
Middle Aged
Patient Discharge
Patient Transfer / methods*
Process Assessment, Health Care*
Transitional Care*

Abstract

Publication types

MeSH terms

Grants and funding