Harnessing workarounds to improve quality of care

Transcription

1 Harnessing workarounds to improve quality of care Deborah Debono 1, Julie Johnson 2, David Greenfield 1, Deborah Black 3, Jeffrey Braithwaite 1 1 Australian Ins?tute of Health Innova?on, Macquarie University, Australia 2 Feinberg School of Medicine, Northwestern University, United States of America 3 Faculty of Health Sciences, University of Sydney, Australia HRT 1520 Innova?ons Workshops and Awards November 2015, Sydney

2 2 Presenters Summary Key Problem: Strategies developed away from the clinical coalface to reduce clinical varia8on and improve pa8ent safety are frequently based on work- as- imagined (W- A- I) rather than on work- as- done (W- A- D). When implemen8ng these strategies, healthcare professionals must reconcile W- A- I versus W- A- D. Current Situa2on: Workarounds are used to bridge the gap between W- A- I and W- A- D. Workarounds, which may differ from organisa8onally intended or prescribed behaviours, are employed to circumvent a perceived or actual hindrance to achieve a goal or to achieve it more easily 1. Rather than harness their poten8al to contribute to quality improvement, workarounds are mostly reprimanded, ignored or hidden. Aim: To illustrate, from a case study of nurses use of medica8on administra8on workarounds, the poten8al of workarounds to contribute to an organisa8on s quality improvement strategies. Case study: Electronic medica8on management systems (EMMS) were implemented in two hospitals to improve medica8on safety. Rather than use the EMMS as intended, in some situa8ons nurses used workarounds. Outcomes: Explora8on of nurses enactment, explana8on and experience of workarounds highlighted: points of discord between the introduc8on of EMMS and how care was performed; poten8al threats to pa8ent safety introduced by EMMS; how the EMMS challenged nurses being good at their jobs; and work- as- imagined versus work- as- done. Lessons learned: Illumina8ng workarounds exposes how care is actually delivered. Doing so provides opportunity to improve quality and safety by: measuring the impact of W- A- D rather than W- A- I; iden8fying and addressing shoroalls that lead to poten8ally unsafe workarounds; or to formalising and sharing workarounds that offer improved ways of delivering care. Contact details: Deborah Debono deborah.debono@mq.edu.au Macquarie University

3 3 Key Problem Quality improvement strategies developed away from the clinical coalface to reduce clinical varia8on and improve pa8ent safety are frequently based on work- as- imagined (W- A- I) rather than on work- as- done (W- A- D) Implementa8on requires healthcare professionals to reconcile gaps between W- A- I and W- A- D

4 4 Current situa8on Workarounds: Bridge the gap between W- A- I and W- A- D Differ from organisa8onally intended or prescribed behaviours Circumvent a perceived or actual hindrance to achieve a goal or to achieve it more easily 1 Rather than harness their poten8al to contribute to quality improvement, workarounds are mostly reprimanded, ignored or hidden

5 5 Aim of this innova8on To illustrate the poten8al of workarounds to contribute to an organisa8on s quality improvement strategies

6 6 Case study An ethnographic study examined nurses use of electronic medica8on management systems (EMMS) in everyday prac8ce (W- A- D) in six wards in two Australian hospitals Data collec?on methods Process mapping (W- A- I) Interviews Focus Groups Observa8on Analysis Induc8ve thema8c analysis framed by the purpose of the research 2

7 7 Outcomes Explora8on of nurses enactment, explana8on and experience of workarounds highlighted: Points of discord between the introduc8on of EMMS and how care was performed Poten8al threats to pa8ent safety introduced by EMMS Ways in which the EMMS was perceived to challenge nurses being good at their jobs Gaps between W- A- I and W- A- D

8 8 Lessons Learnt Illumina8ng workarounds: Exposes how care is actually delivered Provides opportunity to improve quality and safety through: Ø measuring the impact of work- as- done rather than work- as- imagined Ø iden8fying and addressing shoroalls that lead to poten8ally unsafe workarounds Ø formalising and sharing workarounds that offer improved ways of delivering care

9 9 References 1. Debono D, Greenfield D, Travaglia J, Long J, Black D, Johnson J, Braithwaite J: Nurses' workarounds in acute healthcare setngs: a scoping review. BMC Health Services Research 2013, 13(175). 2. Thomas DR: A general induc?ve approach for analyzing qualita?ve evalua?on data. American Journal of Evalua2on 2006, 27(237).

10 10 Contact for this Innovation For more informa8on Contact Dr Deborah Debono