Ageing and Care Giving in the United States: Policy Contexts and the Immigrant Workforce

The ageing population of the United States is generating an increasing demand for care and foreign-born workers will supply an important part of that demand. This article discusses the ways in which U.S. healthcare and immigration policies affect the supply of the foreign born to professional and lesser skilled, direct care jobs. The U.S. market for long term care is shifting away from hospitals and institutionalised facilities to the direct provision of private services and long term care in homes. A well designed immigration policy would complement the demand generated by the healthcare system. Yet, there are few dedicated avenues of legal admission that select for professional care workers and none at all that target direct care workers. There is concern over shortages of professional workers and a substantial number of unauthorized workers in direct care work that flag deficiencies in immigration policies. Our examination of data, nevertheless, finds that the foreign born play an important role in the supply of workers. In the provision of direct care they are roughly one-quarter of the workforce that provides 80% of all long term care. Among professional care workers they are highly concentrated in the home care industry. These national-level concentrations, however, do not fully reveal the remarkable concentration of immigrants in just a few metropolitan areas.     

Balancing documentation and direct patient care activities: A study of a mature electronic health record system

US hospitals now fully embrace electronic documentation systems as a way to reduce medical errors and improve patient safety outcomes. Whether spending time on electronic documentation detracts from the time available for direct patient care, however, is still unresolved. There is no knowledge on the permanent effects of documenting electronically and whether it takes away significant time from patient care when the healthcare information system is mature. To understand the time spent on documentation, direct patient care tasks, and other clinical tasks in a mature information system, we conducted an observational and interview study in a midwestern academic hospital. The hospital implemented an electronic medical record system 11 years ago. We observed 22 health care workers across intensive care units, inpatient floors, and an outpatient clinic in the hospital. Results show that healthcare workers spend more time on documentation activities compared to patient care activities. Clinical roles have no influence on the time spent on documentation. This paper describes results on the time spent between documentation and patient care tasks, and discusses implications for future practice.Relevance to industryThe study applies to healthcare industry that faces immense challenges in balancing documentation activities and patient care activities.     

CancerSpace: A Simulation-Based Game for Improving Cancer-Screening Rates

Serious games are seeing use in a variety of fields, from the military to corporate management, and are finally being employed in healthcare. One of the biggest, most challenging areas is modeling simulations for medical training, particularly for managing chronic illness and providing system-level population-based care. CancerSpace (Cancer: Simulating Practice and Collaborative Education) is an interactive, Web-based learning application in a game format. CancerSpace, developed by the National Cancer Institute and Oak Ridge Institute for Science and Education, aims to facilitate cancer screening and consequently increase cancer-screening rates in federally qualified health centers. Our goal is to promote strategies and research-tested interventions that physicians and other healthcare workers can implement to overcome barriers and make cancer screening more efficient and cost-effective. This article reports on the development efforts required to create an e-learning tool designed for practitioners in community health centers. It concludes that the computer graphics and animation community has an important role in helping healthcare researchers design higher-fidelity educational games and simulations for improving the delivery of chronic care to the millions requiring it.     

Occupational and environmental risk factors for falls among workers in the healthcare sector

Falls are a leading cause of occupational injury for workers in healthcare, yet the risk factors of falls in this sector are understudied. Falls resulting in workers' compensation for time-loss from work from 2004–2007 for healthcare workers in British Columbia (BC) were extracted from a standardised incident-reporting database. Productive hours were derived from payroll data for the denominator to produce injury rates; relative risks were derived through Poisson regression modelling. A total of 411 falls were accepted for time-loss compensation. Compared to registered nurses, facility support workers (risk ratio (95% CI) = 6.29 (4.56–8.69)) and community health workers (6.58 (3.76–11.50)) were at high risk for falls. Falls predominantly occurred outdoors, in patients' rooms and kitchens depending on occupation and sub-sector. Slippery surfaces due to icy conditions or liquid contaminants were a leading contributing factor. Falls were more frequent in the colder months (January–March). The risk of falls varies by nature of work, location and worker demographics. The findings of this research will be useful for developing evidence-based interventions.

Statement of Relevance: Falls are a major cause of occupational injury for healthcare workers. This study examined risk factors including occupation type, workplace design, work setting, work organisation and environmental conditions in a large healthcare worker population in BC, Canada. The findings of this research should contribute towards developing evidence-based interventions.     

Patient source of learning about health technologies and ratings of trust in technologies used in their care

In order to design effective health technologies and systems, it is important to understand how patients learn and make decisions about health technologies used in their care. The objective of this study was to examine patients' source of learning about technologies used in their care and how the source related to their trust in the technology was used. Individual face-to-face and telephone interviews were conducted with 24 patients. Altogether, 13 unique sources of information about technology were identified and three major themes emerged: outside of the work system vs. inside the work system; when the health information was provided; the medium used. Patients used multiple sources outside of the healthcare work system to learn about technologies that will be used in their care. Results showed a relationship between learning about technologies from web sources and trust in technologies but no relationship between learning about technologies from healthcare providers and trust in technologies. STATEMENT OF RELEVANCE: The value of considering human attitudes about elements in health systems has been illustrated. This research shows a relationship between patient attitudes about medical technologies used in their care and healthcare work system design. Results show that patient attitudes are formed about technologies used in their care by sources within and outside of the sociotechnical work system.     

Patient source of learning about health technologies and ratings of trust in technologies used in their care

In order to design effective health technologies and systems, it is important to understand how patients learn and make decisions about health technologies used in their care. The objective of this study was to examine patients' source of learning about technologies used in their care and how the source related to their trust in the technology was used. Individual face-to-face and telephone interviews were conducted with 24 patients. Altogether, 13 unique sources of information about technology were identified and three major themes emerged: outside of the work system vs. inside the work system; when the health information was provided; the medium used. Patients used multiple sources outside of the healthcare work system to learn about technologies that will be used in their care. Results showed a relationship between learning about technologies from web sources and trust in technologies but no relationship between learning about technologies from healthcare providers and trust in technologies.

Statement of Relevance: The value of considering human attitudes about elements in health systems has been illustrated. This research shows a relationship between patient attitudes about medical technologies used in their care and healthcare work system design. Results show that patient attitudes are formed about technologies used in their care by sources within and outside of the sociotechnical work system.     

Temporality in Medical Work: Time also Matters

CSCW has long been concerned with the distribution of activities in time and in space, but the problems of distributed work have often taken analytic and technical precedence. In this paper, we are interested in the issue of temporality in collaborative work. In particular, we want to examine how the temporal organization of action is experienced by those who are involved in it. To investigate this phenomenon, we conducted a field study of medical workers in a surgical intensive care unit. Through this study, we highlight the temporal organization of the work. In particular, we introduce and describe three temporal features – temporal trajectories, temporal rhythms, and temporal horizons – that emerge from and influence the work of healthcare providers as they attempt to seek, provide, and manage information during the course of their daily work.     

Regularly irregular: how groups reconcile cross-cutting agendas and demand in healthcare

The flow of technical work in acute healthcare varies unpredictably, in patterns that occur regularly enough that they can be managed. Acute care organizations develop ways to hedge resources so that they are available if they are needed. This pragmatic approach to the distribution of work among and across groups shows how rules can be used to manage a response to irregular demands for care. However, no rule set can be complete enough to cover this setting’s variety of care demands. Expertise is also needed to tie together the loose ends of conflicts that remain where rules no longer suffice. Many informal solutions to systemic problems go unnoticed unless they are the subjects of study. Naturalistic decision making (NDM) methods such as observational study, interviews, and process tracing reveal the activities of workers in their natural settings. Results of findings from such explorations of technical work can improve understanding of large scale work processes and, ultimately, patient safety. We have explored how practitioners cope with the demands that the system presents to them. While not all succeed, successful initiatives workers have developed demonstrate how their solutions create resilience at large scale.     

Sleeping situation monitoring system in ubiquitous environments

In recent years, because of the development of ubiquitous technology in health care, research is actively progress. We describe a sleeping situation monitoring system, created to support home healthcare services. We discuss the method we used to develop the system and how to use the sleep activity monitor to support home health care. Information about the sleeping situation is collected from motion detection, sound, and vibration sensors. And this information is based on real-time processing, we used the TMO (Time-trigger and Message-trigger Object) schema and TMOSM (TMO Support Middleware) into the development software environment of the healthcare application. To verify the practical use of sleeping situation information as recorded by the system discussed in this paper, we relate an example of the monitoring of a sleeping situation using our system, and we describe the results of an experimental evaluation.     

Service robots in hospitals: new perspectives on niche evolution and technology affordances

Changing demands in society and the limited capabilities of health systems have paved the way for robots to move out of industrial contexts and enter more human-centered environments such as health care. We explore the shared beliefs and concerns of health workers on the introduction of autonomously operating service robots in hospitals or professional care facilities. By means of Q-methodology, a mixed research approach specifically designed for studying subjective thought patterns, we identify five potential end-user niches, each of which perceives different affordances and outcomes from using service robots in their working environment. Our findings allow for better understanding resistance and susceptibility of different users in a hospital and encourage managerial awareness of varying demands, needs, and surrounding conditions that a service robot must contend with. We also discuss general insights into presenting the Q-methodology results and how an affordance-based view could inform the adoption, appropriation, and adaptation of emerging technologies.     

Mining the optimal clustering of people’s characteristics of health care choices

In Asian countries, there has been a multi-choice healthcare environment for many years. In Taiwan, people’s multiple health care seeking behavior has resulted in much heavier financial burden of National Health Insurance Program (NHIP) in recent years: investigating the characteristics of people who use multiple health care resources has gained increasing importance for health authorities. In this study, we investigated the socioeconomic and demographic characteristics which underlined people’s choice of health care by using a population representative database. A novel methodology which incorporated k-means cluster analysis with v-fold cross-validation into Multiple Correspondence Analysis (MCA) is proposed. This novel methodology can help us to find the optimal attribute clustering of multiple health care utilization. By using this methodology, researchers not only can avoid the ambiguities of identifying clusters resulted from the traditional hierarchical cluster analysis (HCA), but also can provide more solid and evidence-based analysis for health policy making.     

Federating Policy-Driven Autonomous Systems: Interaction Specification and Management Patterns

Ubiquitous systems and applications involve interactions between multiple autonomous entities—for example, robots in a mobile ad-hoc network collaborating to achieve a goal, communications between teams of emergency workers involved in disaster relief operations or interactions between patients’ and healthcare workers’ mobile devices. We have previously proposed the Self-Managed Cell (SMC) as an architectural pattern for managing autonomous ubiquitous systems that comprise both hardware and software components and that implement policy-based adaptation strategies. We have also shown how basic management interactions between autonomous SMCs can be realised through exchanges of notifications and policies, to effectively program management and context-aware adaptations. We present here how autonomous SMCs can be composed and federated into complex structures through the systematic composition of interaction patterns. By composing simpler abstractions as building blocks of more complex interactions it is possible to leverage commonalities across the structural, control and communication views to manage a broad variety of composite autonomous systems including peer-to-peer collaborations, federations and aggregations with varying degrees of devolution of control. Although the approach is more broadly applicable, we focus on systems where declarative policies are used to specify adaptation and on context-aware ubiquitous systems that present some degree of autonomy in the physical world, such as body sensor networks and autonomous vehicles. Finally, we present a formalisation of our model that allows a rigorous verification of the properties satisfied by the SMC interactions before policies are deployed in physical devices.     

Editorial

The UK health service, which had been diagnosed to be seriously out of step with good design practice, has been recommended to obtain knowledge of design and risk management practice from other safety-critical industries. While these other industries have benefited from a broad range of systems modelling approaches, healthcare remains a long way behind. In order to investigate the healthcare-specific applicability of systems modelling approaches, this study identified 10 distinct methods through meta-model analysis. Healthcare workers' perception on ‘ease of use’ and ‘usefulness’ was then evaluated.

The characterisation of the systems modelling methods showed that each method had particular capabilities to describe specific aspects of a complex system. However, the healthcare workers found that some of the methods, although potentially very useful, would be difficult to understand, particularly without prior experience. This study provides valuable insights into a better use of the systems modelling methods in healthcare.

Statement of Relevance: The findings in this study provide insights into how to make a better use of various systems modelling approaches to the design and risk management of healthcare delivery systems, which have been a growing research interest among ergonomists and human factor professionals.     

A manufacturing-oriented model for evaluating the satisfaction of workers – Evidence from Turkey

Job satisfaction, in terms of worker's satisfaction, is one of the intensively studied areas in human resource and management. However, there is little information available on how ergonomics and the manufacturing environment affect job satisfaction. This study analyzes the extent of the relationship between job satisfaction and work and workplace related conditions. A conceptual model is proposed to evaluate job satisfaction that considers 34 elements in four categories: manufacturing systems, facility design, safety and ergonomics, and human resources and management. A survey of 169 blue-collar workers working in the automotive industry was conducted to investigate the applicability of the model. A comprehensive exploratory factor analysis was used to determine inter-related elements, their underlying factors and their effects on job satisfaction. The analysis revealed 6 factors with 18 related elements. From a multi linear regression analysis, we develop a job satisfaction model built on factors of human resource policies, safety, ergonomics, air quality, thermal comfort and disturbing equipment. The results reveal that ergonomics plays the most important role in workers' satisfaction for the respondent Turkish automotive workers. In contrast, human resource policies seem not play a critical role in job satisfaction because of higher standards in automotive industry compared to other industries in Turkey.     

An e-patient’s End-user community (EUCY): The value added of social network applications

Decreasing revenues and increasing expenses has led many healthcare organizations to adopt newer technological applications in order to address the informational needs of their patients. One such adoption technique is to develop a more robust e-patient environment. Health care organizations may increase their effectiveness in meeting the needs of a growing e-patient population through the implementation of high-quality social networking applications such as Twitter. These applications may help to support and maintain a valuable and informed community. A literature review identifies three characteristics that have an impact on information exchange inherent to social networks: number of members, contact frequency, and type of knowledge. Data from a case study of a juvenile diabetic using Twitter helps to demonstrate these aforementioned characteristics. A framework is developed that may be used by health care organizations to better align social network objectives with expectations of an End user community (EUCY). Managerial implications of this study are discussed that can help information technology professionals as well as health administrators when implementing social networks.     

Healthcare knowledge sharing among a community of specialized physicians

Healthcare organizations strive to make the best use of their organizational knowledge. The collective know-hows of the medical workers directly affect the quality of the delivered healthcare services. This study addresses the healthcare knowledge-sharing among a community of specialized physicians. An extensive study of the literature on knowledge-sharing in industries generally and healthcare organizations specifically were presented. Six focal elements were detected in previous attempts to address the knowledge-sharing status in healthcare organizations. Additionally, three previous models for healthcare knowledge management were analyzed. The studied literature along with the three studied models helped in constructing the framework and suggesting a suitable research methodology for primary data collection. Qualitative approach of in-depth interview technique was used for interviewing eight specialized physicians. The data collected from the interviewees were then analyzed and produced explanatory themes and codes. These themes are physicians’ acquisition of medical knowledge, staff participating in the knowledge sharing, knowledge-sharing culture, ICT-based knowledge sharing and top management involvement. The findings resulted in recognizing four considerations which ought to be taken into account for successful knowledge-sharing activities and learning initiatives in the healthcare organization. Conclusions and recommendations for future studies were presented based on the implications of this research study.     

Understanding process change management in electronic health record implementations

Electronic health record (EHR) implementations involve changes to core organizational processes, and management of these changes is critical to the success of such implementation efforts. This research describes how process change issues relate to implementation of large IT projects in healthcare settings. Specifically, we draw on extant literature and conduct directed content analysis on project reports by past HIMSS Davies Award recipients to present process change related best practices occurring in EHR implementations. The results from this study can influence implementation strategies for future health information technology implementation efforts in the healthcare sector.     

A mashup based framework for multi level healthcare interoperability

Healthcare delivery is evolving from disease-centered to patient-centered care delivery where patients are active participants in their healthcare delivery. This calls for more communication and collaboration among all healthcare actors. There is also an increasing demand for personalized healthcare systems that provide effective information management, facilitate communication and collaboration, and support applications to meet user requirements. To address these challenges, we need to advance the integration and interoperability of healthcare applications in a controlled manner. Drawing upon a conceptual model from a collaborative care case study, we identified a set of interoperability requirements and developed a Mashup based interoperability framework. Our framework allows patients and other healthcare actors to engage in collaborative processes through online applications facilitated by mashups. We then use proof-of-concept implementations to demonstrate how our framework is able to facilitate different types of interoperability. We believe that collaborative technologies such as mashups can implement process interoperability requirements to support collaborative care delivery, particularly for asynchronous care delivery.     

Offspring in Squeeze: Health and Sick Leave Absence among Middle-aged Informal Caregivers

This paper is motivated by the major future challenges that an ageing population would bring on a demand for an increase in the workforce and potential health outcomes on informal caregivers. Understanding the individual health and sick leave costs of caregiving is important for improving work and family policy and for ensuring that eldercare policies do not counteract other public goals. The main concern of this article has been to illuminate the relationship between full-time working caregivers and their health and sick leave absence outcomes. Using probit estimation, we found that that those combining full-time work with parental care were more prone to report poor health and had a higher probability of sick leave absence. However, the effect of giving parental care on health and sickness absence was differently distributed between male and female caregivers. For instance, male caregivers had a higher probability of reporting poor health compared to male non-caregivers. We did not find any significant differences in self-reported poor health among female caregivers and non-caregivers. In contrast, giving parental care indicated a higher probability of sick leave absence among female caregivers compared to female non-caregivers, while no significant difference was found among male workers.     

Social positioning matters: A socialized affordance perspective of mHealth in India

Existing research on technology affordance rarely considers the role of social structures in shaping the interaction between human actors and technology. In this paper, we draw upon the concept of social positioning to explore how socialized affordances of technology adoption, as well as their impact in work and social life, are shaped by the social positions that human actors occupy within multiple social structures. We do so by examining the adoption of mHealth devices by community health workers in India. The study generates theoretical implications for research on affordances of technology and social structures by integrating social positioning of actors in the analysis of a digital practice, and enriching IS research by incorporating the broader social arrangements and power relations.