Trust in medical technology by patients and healthcare providers in obstetric work systems

Multiple types of users (i.e. patients and care providers) have experiences with the same technologies in healthcare environments and may have different processes for developing trust in those technologies. The objective of this study was to assess how patients and care providers make decisions about the trustworthiness of mutually used medical technology in an obstetric work system. Using a grounded theory methodology, we conducted semi-structured interviews with 25 patients who had recently given birth and 12 obstetric healthcare providers to examine the decision-making process for developing trust in technologies used in an obstetric work system. We expected the two user groups to have similar criteria for developing trust in the technologies, though we found patients and physicians differed in processes for developing trust. Trust in care providers, the technologies' characteristics and how care providers used technology were all related to trust in medical technology for the patient participant group. Trustworthiness of the system and trust in self were related to trust in medical technology for the physician participant group. Our findings show that users with different perspectives of the system have different criteria for developing trust in medical technologies.     

Patient safety and reprocessing: A usability test of the endoscope reprocessing procedure

When endoscopes are reprocessed correctly, endoscopy is a safe procedure. Recent incidents of insufficient reprocessing, however, have resulted in public concern. Results of a usability test of the reprocessing procedure identified that none of 24 users, naïve to the procedure, could reprocess endoscopes correctly, nor could they correctly complete any of the component tasks in the procedure. Five of the 76 subtasks were identified as particularly critical. These were 1) brushing the instrument channel, 2) attaching the channel plug and injection tube, 3) identifying leaks, 4) blowing water out of the endoscope's internal channels during high‐level disinfection, and 5) aspirating solution through the endoscope to remove debris loosened by brushing. Additionally, three themes were identified as causes of the majority of problems: 1) lack of visibility, 2) high memory demands, and 3) insufficient user feedback. Design recommendations for these problems are discussed. © 2012 Wiley Periodicals, Inc.     

Patient flow modelling and performance analysis of healthcare delivery processes in hospitals: A review and reflections

Analysis of hospital processes is essential for development of improved methods, policies and decision tools for overall performance improvement of the hospital system. Amidst the current scenario of continuously increasing healthcare costs and scarcity of resources, optimal utilization of resources without hampering the quality of care has gained importance in any country. Modelling, analysis and management of patient flows, in this context, plays a key role in performance analysis and improvement of hospital processes as appropriate modelling of patient flows may help healthcare managers make decisions related to capacity planning, resource allocation and scheduling, appointment scheduling and for making necessary changes in the process of care. The concept of patient flow and its modelling has gained much attention in healthcare management literature over past few decades. In this paper, the existing approaches pertaining to modelling of patient flows in hospital systems have been classified and critically appraised focussing on the recent advancements in order to identify future research avenues. A generic framework for patient flow modelling and performance analysis of hospital systems that may serve as a guide for the practitioners dealing with similar kinds of problems to improve healthcare delivery has also been provided.     

Patient views of adverse events: comparisons of self-reported healthcare staff attitudes with disclosure of accident information

In the present paper, we report results of surveys in 2003 in Japan and Denmark about patients' views about adverse events, focusing on the actions of healthcare staff involved in a medical accident. Results show that patients were more likely to indicate negative expectations to a doctor's reactions after a medical accident when asked in general terms than when asked in relation to concrete case stories. When asked in general terms, 66% (47%) of Japanese (Danish) respondents expected that doctors sometimes hold back on providing information to patients about a medical accident, while 37% (7%) did so when asked about a concrete, mild-outcome case. We examine some possible reasons for the relatively high level of distrust of Japanese patients, and we discuss whether the seemingly lower level of disclosure in Japan than in Denmark and the negative stories in the Japanese press may have an impact. We also suggest some implications for introducing a patient-centred or customer-centred approach to risk management in healthcare and other domains.     

Improving efficiencies and patient safety in healthcare through human factors and ergonomics

Efficiencies and patient safety can be improved through modeling of healthcare systems with consideration of human factors and ergonomics. With focus on predicting individual and system performance, safety and satisfaction can be considered from various perspectives including the clinician, patient, pharmacist and healthcare organization. The basis for predictions are models and hypotheses developed from scientific principles, methods and technology implementation strategies demonstrated, observed and reported through research. This paper provides a brief review and reappraisal of recent articles and book chapters to give some insights into how efficiencies and patient safety can be improved through human factors and ergonomics. Current needs and potential future research are also outlined. Web-resources from the World Health Care Congress, Agency for Healthcare Research & Quality, Institute for Healthcare Improvement, National Institutes of Health, the Veterans Administration, Regenstrief Center for Healthcare Engineering (RCHE) and the Institutional Review Board at Purdue, and recent special broadcasts from C-SPAN and PBS support and motivate further research. In considering the new research, it is proposed that a great deal more focus is needed on the process, methods and structuring of research studies, than on the implementations of a particular healthcare practice, technology or model. Students at cross-disciplinary research centers like RCHE at Purdue University are focusing on developing their ability to evaluate research based on the selected course readings and a “List of 10 ways” to look at a research paper systematically for critical analysis. With foundations in human factors and ergonomics it is expected that new potential healthcare systems engineering related research projects can be considered and developed through the semester projects and built upon as extensions that may lead to theses and dissertations. Recent project examples will be discussed. Research issues will be outlined along various health systems issues as follows: Modeling Systems and Economic Aspects, Healthcare Information Technologies, Electronic Prescribing and Computerized Physician Order Entry Systems, Cognitive Aspects and Human–Computer Interaction, Healthcare Work Analysis & Design, International and Cultural Issues, Human Factors, Ergonomics and Patient Safety, Technology Adoption, Data Collection and Analysis.     

Care transitions in the outpatient surgery preoperative process: facilitators and obstacles to information flow and their consequences

Patient care transitions have been shown to be critical points at which failure as well as recovery from potential failure may occur. The purpose of this research was to identify transitions in patient care and the flow of associated information at different steps in the outpatient surgery preoperative care process and, in turn, attempt to identify breakdowns in the information flow process and their ramifications. A study of one organization’s preoperative process for outpatient surgery was conducted, employing four means of data collection to gather information on preoperative work processes: employee shadowing, patient shadowing, clinic observation, and dictated feedback. Various facilitators and obstacles in information flow were found to be present in the preoperative care process. Obstacles often resulted in negative consequences for healthcare providers and patients. Helping care providers understand how their actions affect the various elements of the preoperative process, through improved awareness, may be one way to improve information flow problems within the outpatient surgery process.     

Fuzzy fault tree analysis for patient safety risk modeling in healthcare under uncertainty

Nowadays healthcare becoming more important aspect for everybody. Healthcare institutions now giving more attention to their patients’ safety by reducing the frequency of medical errors and trying to provide all kinds of best facilities to them. Clinical processes can be understood as a series of interactions between patients, providers, and technologies. Therefore, there are some chances exist for medical errors due to the involvement of human beings and machines. A number of tools exist to prospectively analyze processes in healthcare which generally needs precise numerical data. In general, available or extracted data is not precise and sufficient to assess the clinical processes upto a desired degree of accuracy due to various practical and economic reasons. Thus, collected data may have some sort of uncertainties and quantification of these uncertainties should be done very carefully before analysing further. In this paper, a new fuzzy fault tree approach has been presented for patient safety risk modeling in healthcare. This approach applies fault-tree, trapezoidal fuzzy numbers, α-cut set, and the weakest-t-norm (T_ω) based approximate arithmetic operations to obtain fuzzy failure probability of the system. The effectiveness of the developed approach is illustrated with two different kinds of problems taken from literature related to healthcare. Also, Tanaka et al.'s approach has been used to rank the critical basic events of the considered problems. Computed results have been compared with results obtained from other existing techniques.     

Understanding patients’ trust toward community healthcare providers under different primary care settings in China: Impact of hospital ownership and registration mode

China is currently undertaking healthcare reform, and promoting general practitioner (GP) practice is a major improvement. The key to the success of the GP practice is whether or not patients are willing to accept and trust in GPs in community healthcare centers (CHCs). The objective of this study is to evaluate the impact of hospital ownership (public or private) and registration mode (registering with a CHC or a GP on patients’ trust in community health services. A user experiment was conducted, and 204 nonstudent participants were invited to finish simulated registration tasks in a self‐developed online registration system. Patients’ trust in CHCs, GPs, and GPs’ treatment outcomes was measured. The results indicated that patients had a significantly higher level of trust in private CHCs and private sector GPs, but they showed a higher level of trust in the treatment outcomes of public sector GPs due to the influence of their past medical experience seeing community doctors. The registration mode only influenced patients’ trust in GPs’ professional skills, that is, patients had a higher level of trust in GPs’ professional skills when registering with CHCs compared to registering with individual GPs.     

IT in healthcare: progress report

The paper considers how increasing computerization and recent regulatory changes are putting new pressures on healthcare information management. Healthcare providers must interact with many insurers, each with a different set of procedures for filing claims and making payments. To simplify the process and reduce the overhead associated with filing insurance claims, HIPAA provides a standard set of electronic transaction formats as well as regulations to ensure the privacy and security of healthcare-related transactions.     

Patient safety during medication administration: the influence of organizational and individual variables on unsafe work practices and medication errors

Medication errors are a leading cause of unintended harm to patients, both in Australia and internationally, and there is now a concerted attempt to identify and correct individual and workplace factors that encourage medication errors. The current study used structural equation modelling to measure organizational climate and to test a model with hypothesized links between climate and unsafe medication administration behaviours. The study also examined the possible mediating role of stress and morale. Data were collected from 176 nurses working in rural areas in Australia. The model provided a reasonable fit to the data with organizational climate accounting for 39% of the variance in individual distress, which in turn explained 7% of the variance in self-reported violations. The only variable that made a direct contribution to errors was violations, which accounted for 24% of the variance in medication errors. These findings highlight the importance of monitoring the state of the whole health system. Deficiencies at the organizational level affect the psychological well-being of hospital employees, and distressed employees are more likely to engage in substandard work practices that ultimately endanger the patients under their care.     

Structures in systems 2: viewpoint cohomology of general systems

This paper introduces new homology and cohomology functors designed to analyze a broad range of logical systems including representations of enterprise information systems. Such systems contain nested relations and are a class of higher order logic. The homology and cohomology augment simplex constructions with ideas of type extensions to capture the logic of the system. Here logical systems, including large-scale information systems, have a class of derived objects called “scenarios” that give the connective logic of the system. Scenarios have a “secondary” logic derived from the underlying business rules of the enterprise. A “viewpoint” is a flexible classification logic which creates “proxy” variables so that the (co)homology functors can be applied to the secondary (and higher) scenario logics but with different (but functionally related) variables. These viewpoint (co)homologies can then analyze structures in emergent phenomena that reflect structures in the logic of the original system.     

A macro-ergonomic work system analysis of the diagnostic testing process in an outpatient health care facility for process improvement and patient safety

The diagnosis of illness is important for quality patient care and patient safety and is greatly aided by diagnostic testing. For diagnostic tests, such as pathology and radiology, to positively impact patient care, the tests must be processed and the physician and patient must be notified of the results in a timely fashion. There are many steps in the diagnostic testing process, from ordering to result dissemination, where the process can break down and therefore delay patient care and reduce patient safety. This study was carried out to examine the diagnostic testing process (i.e. from ordering to result notification) and used a macro-ergonomic work system analysis to uncover system design flaws that contributed to delayed physician and patient notification of results. The study was carried out in a large urban outpatient health-care facility made up of 30 outpatient clinics. Results indicated a number of variances that contributed to delays, the majority of which occurred across the boundaries of different systems and were related to poor or absent feedback structures. Recommendations for improvements are discussed.     

Legal responsibility of internet service providers: Part 2

Over the past 10 years, the Internet has grown from being a series of networks used to communicate information by a small number of organizations to a data superhighway capable of linking users together in sufficient places in the world to rival the leading international telecommunication carriers and distributing sufficient information to rival the leading publishing houses. Such changes have brought with them enormous benefits. Information can now be shared more quickly amongst a greater number of people than would have ever have been thought possible as late as 1991 when the World Wide Web was first created. This technological change has in turn, brought sociological change. People are now starting to buy books, pay for tickets, give instructions to their banks over the Internet. In time to come, it is reasonable to think that all our day to day tasks, going shopping, speaking to our friends, listening to music etc. will all take place via the Internet.     

Selling safety: the use of celebrities in improving awareness of safety in commercial aviation

The aim of this study was to investigate the influential power of a celebrity to convey key safety messages in commercial aviation using a pre-flight safety briefing video. In addition, the present research sought to examine the effectiveness of subtitles in aiding the recall of these important messages as well as how in-cabin aircraft noise affects recall of this information. A total of 101 participants were randomly divided into four groups (no noise without subtitles, no noise with subtitles, noise without subtitles and noise with subtitles) and following exposure to a pre-recorded pre-flight safety briefing video were tested for recall of key safety messages within that video. Participants who recognised and recalled the name of the celebrity in the safety briefing video recalled significantly more of the messages than participants who did not recognise the celebrity. Subtitles were also found to be effective, however, only in the presence of representative in-cabin aircraft noise.

Practitioner Summary: Passenger attention to pre-flight safety briefings on commercial aircraft is poor. Utilising the celebrity status of a famous person may overcome this problem. Results suggest that celebrities do increase the recall of safety-related information.     

Legal responsibility of Internet service providers: Part 1

Over the past 10 years, the Internet has grown from being a series of networks used to communicate information by a small number of organizations to a data superhighway capable of linking users together in sufficient places in the world to rival the leading international telecommunication carriers and distributing sufficient information to rival the leading publishing houses. Such changes have brought with them enormous benefits. Information can now be shared more quickly amongst a greater number of people than would have ever have been thought possible as late as 1991 when the World Wide Web was first created. This technological change has in turn, brought sociological change. People are now starting to buy books, pay for tickets, give instructions to their banks over the Internet. In time to come, it is reasonable to think that all our day to day tasks, going shopping, speaking to our friends, listening to music etc. will all take place via the Internet.