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ItemAn Exploratory Study on how to Improve Bedside Change-of-Shift Process: Evidence from One Hospital Using Technology to Support Verbal Reporting( 2018-01-03)Change-of-shift report, often referred to as patient handoff in the inpatient setting involves exchange of accurate and critical information between providers to ensure continuity of patient care. Inefficient communication significantly contributes to medical errors, affecting patient safety, and care quality. The current exploratory study was conducted to understand the issues associated with change-of-shift reporting that occurs throughout one hospital in its various nursing units. Nurses participating in the study were assigned a simulated patient case to develop a shift report to transfer to the incoming nurse. After completing the report, each nurse was interviewed using open-ended questions. Based on qualitative analysis of data obtained from sixteen one-on-one nurse interviews, ten themes were identified. The themes highlighted issues that posed coordination challenges for nurses, impeded nurse workflow, and underscored deficiencies in the bedside reporting process followed at the hospital. Recommendations are discussed on how to overcome these challenges.
ItemHorizontal Affordances for Patient Centred Care in Hospitals( 2018-01-03)While it is generally accepted that patient centred care should be the guiding principle for the delivery of health services, it is not yet clear how this should be digitalised. What is clear, however, is that the current IT solutions are not satisfactory. In this research, we suggest the affordance construct as an analytical lens to understand how technological artefacts and human agency can generate action possibilities to support horizontal process innovation by asking: (i) which affordances enable digitalisation of patient centred healthcare, and (ii) how can these identified affordances be leveraged to innovate patient centred digital hospitals. Our empirical evidence is a comparative study of two hospitals in Sweden and Norway. Our theoretical contribution is the identification of six horizontal affordances for patient centred care. The practical contribution is that horizontal affordances emerge through configurations of human actors and lightweight IT solutions, loosely coupled to heavy weight systems.
ItemCreating Coordinative Paths from admission to discharge: The role of lightweight IT in hospital digital process innovation( 2018-01-03)In this paper, we examine the role of IT in process innovations related to patient flow from emergency care admission, through subsequent patient transfers, and discharge. In particular, we explore how digital technology helps create and improve coordinative paths. We find that the interplay between traditional "heavyweight IT" (resilient, secure and stable) and "lightweight IT" (mobile, context-aware and flexible) enable process innovation in complex health care settings. Drawing on Zuboffs "informate" perspective, we highlight the strength of digital information technology as a process innovation enabler. We provide two contributions. First, we shed light on the innovative capacity of lightweight IT as a flexible, dynamic and distributed technology for process innovation. Second, using Garud and Kumaraswamys framework of vicious and virtuous circles, we identify and discuss potential positive and negative outcomes of process innovation.