United States Department of Veterans Affairs, Center to Improve Veteran Involvement in Care, VA Medical Center, Portland, Oregon, USA.
United States Department of Veterans Affairs, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
J Am Med Inform Assoc. 2021 Nov 25;28(12):2601-2607. doi: 10.1093/jamia/ocab191.
We examine how physicians and nurses use available communication technologies and identify the implications for communication and patient care based on the theory of workarounds.
We conducted a qualitative study at 4 U.S. hospitals during 2017. Researchers spent 2 weeks at each hospital conducting unit-based observation, shadowing, interviews, and focus groups with nurses and physicians. Using an iterative process, we inductively coded and thematically analyzed data to derive preliminary themes. The theory of workarounds provides an organizational lens on workarounds, consisting of 5 components: antecedents, types, effects, managerial stance, and organizational challenges of workarounds. The first 3 components of the theory helped us to organize and explain our findings.
Communication technologies consisted of pagers and telephones. Antecedents to workarounds included one-way information flow, differential access related to differences in technology types, and technology mismatch. Types of workarounds included bypassing a variety of obstacles and substituting for unavailable resources. Direct effects of workarounds included pager fatigue, interruptions in patient care, and potential errors.
One-way communication technologies created an environment where workarounds could flourish. By placing results within the context of the theory of workarounds, we extend what we know about why and how workarounds develop, and offer strategies to minimize workarounds' adverse effects.
Through the theory of workarounds, we see that there is a trajectory to workarounds with potential consequences for clinicians and patients. Two-way communication technologies could minimize workarounds and gaps in information exchange, and reduce unnecessary interruptions and the potential for adverse events.
我们考察了医生和护士如何使用现有的沟通技术，并根据工作规避理论，确定了这些技术对沟通和患者护理的影响。
我们于 2017 年在美国的 4 家医院进行了一项定性研究。研究人员在每家医院进行了为期 2 周的基于单位的观察、跟随、访谈和护士与医生的焦点小组。我们采用迭代过程，对数据进行了归纳编码和主题分析，以得出初步主题。工作规避理论为工作规避提供了一个组织视角，由 5 个部分组成：工作规避的前因、类型、影响、管理立场和组织挑战。该理论的前 3 个部分有助于我们组织和解释研究结果。
沟通技术包括传呼机和电话。工作规避的前因包括单向信息流、由于技术类型不同而导致的差异访问、以及技术不匹配。工作规避的类型包括绕过各种障碍和替代不可用的资源。工作规避的直接影响包括传呼机疲劳、中断患者护理以及潜在的错误。
单向沟通技术创造了一个工作规避可以蓬勃发展的环境。通过将结果置于工作规避理论的背景下，我们扩展了我们对工作规避为什么以及如何发展的了解，并提供了策略来最小化工作规避的不利影响。
通过工作规避理论，我们可以看到工作规避存在潜在的后果，对临床医生和患者都有影响。双向沟通技术可以最小化工作规避和信息交换中的差距，减少不必要的中断和潜在的不良事件。
