The project studies the problem that exists in communication among healthcare providers, and the framework with which the problem can be organized. The problem definition is based on interviews, observations and validation studies conducted at Palomar Medical Center.
Current Situation
In healthcare, the number of providers that may be involved in patient-care at any one point in time could range between 7 and 20. In an environment where errors come with a proportionally higher consequence, effective communication is a necessity in order for patients to be adequately cared for.
The lack of a mediator in asynchronous communication seems to be the root cause of the
problem.
What is mediator and how can it be applied?
A mediator is a trusted third party that helps in asynchronous delivery of information from a sender to the right receiver(s) at the right time. It follows a set of rules for the delivery of the message and does not make any decisions on its own.
What is the problem we are trying to solve?
Our problem space analysis finds that the current methods of communication (both synchronous and asynchronous) and the lack of consistency in delivering patient results between caregivers creates breakdowns that prevent efficient and timely information transfer to take place. The result is a very unstable and unreliable information transmission system.
Our goals are as follows:
• Develop a reliable method to contact/reach the person responsible.
• Create a read-back/callback/feedback process that is set as standard to ensure information is conveyed and interpreted correctly.
• Maintain a record of the information transmission for legal/liability purposes.
• Ensure that the end person responsible receives the information accurately and in a timely manner (in this case the physician, or if escalated, the medical director).
• Provide a framework to make notifications a “one to many” communication without having to repeat the same process manually several times.
• Knowledge of who is responsible and on-duty at any given time.
Methodology
The process of Stakeholder Identification involved finding various stakeholders to interact with during the course of the study. The identification was based on recommendations by hospital administrators and in some cases, studying org charts of the department to identify a minimum set of people and then following the processes to identify other stakeholders.
Work flow and Cross-departmental analysis
The process flow study involved an in-depth look at the innerworkings of the departments within the hospital, and understanding the various steps involved in their respective event generation and notification process. A cross departmental study was done to determine if there were any significant differences in the notification process flow in or between departments that generate events.
This study was mainly focused on Pathology and Radiology departments, in attempt to discover the similarities and differences of these departments, as well as analyzing in depth the divisions within each department. The following section gives a summary of the findings
In User Task Modeling, the objective is to examine the various roles within the hospital and understand the specific tasks each role performs. A closer inspection of the roles may reveal the ways in which tasks may overlap or intertwine, and when tasks are confined to the roles of that one individual.
Use Cases
After the analysis of the problem, we needed to validate our findings with the healthcare professionals and get their feedback. We created scenarios that are close to what happens at a hospital under various circumstances. For instance, a patient suffering from a critical respiratory condition may be asked to go in for a blood examination or a chest x-ray. In both cases there are a number of people involved and a number of problems that may arise during communication of the lab results. We built characters/personas and
weaved a story around it to help put forth/ highlight the problems to the healthcare staff.
Usage Scenarios
Most of the models derived out of the analysis were all technical containing lines and arrows….. They were a set of communication models and sequence diagrams that only the head doctors would understand. However, when we try to explain the problem and our proposed solution to the actual users of the system (nurses/ physicians/lab staff), the models do not make any sense to them. It is critical that we show them something that they comprehend and that they can relate to. When we present data visually it is clearer to
understand. This is where story boarding and visualization play a big part. We have tried to visualize some complex scenarios that occur currently in event reporting and how asynchronous mediation will solve the problem efficiently.
Validated Scenarios with Stakeholders at PPH
After creating the scenarios using the findings of problems along with the proposed solutions, the workflow diagrams, use cases and usage scenarios were presented to the stakeholders at Palomar Pomerado Hospital. The purpose in doing so was to receive a confirmation from the stakeholder of the validity of our research
and our understanding of their work setting and recognition of the problem at hand, and indeed this was the case.
