SYFSA: A framework for Systematic Yet Flexible Systems Analysis
ABSTRACT Although technological or organizational systems that enforce systematic procedures and best practices can lead to improvements in quality, these systems must also be designed to allow users to adapt to the inherent uncertainty, complexity, and variations in healthcare. We present a framework, called Systematic Yet Flexible Systems Analysis (SYFSA) that supports the design and analysis of Systematic Yet Flexible (SYF) systems (whether organizational or technical) by formally considering the tradeoffs between systematicity and flexibility. SYFSA is based on analyzing a task using three related problem spaces: the idealized space, the natural space, and the system space. The idealized space represents the best practice-how the task is to be accomplished under ideal conditions. The natural space captures the task actions and constraints on how the task is currently done. The system space specifies how the task is done in a redesigned system, including how it may deviate from the idealized space, and how the system supports or enforces task constraints. The goal of the framework is to support the design of systems that allow graceful degradation from the idealized space to the natural space. We demonstrate the application of SYFSA for the analysis of a simplified central line insertion task. We also describe several information-theoretic measures of flexibility that can be used to compare alternative designs, and to measure how efficiently a system supports a given task, the relative cognitive workload, and learnability.
- SourceAvailable from: Blackford Middleton[Show abstract] [Hide abstract]
ABSTRACT: While evidence-based medicine has increasingly broad-based support in health care, it remains difficult to get physicians to actually practice it. Across most domains in medicine, practice has lagged behind knowledge by at least several years. The authors believe that the key tools for closing this gap will be information systems that provide decision support to users at the time they make decisions, which should result in improved quality of care. Furthermore, providers make many errors, and clinical decision support can be useful for finding and preventing such errors. Over the last eight years the authors have implemented and studied the impact of decision support across a broad array of domains and have found a number of common elements important to success. The goal of this report is to discuss these lessons learned in the interest of informing the efforts of others working to make the practice of evidence-based medicine a reality.Journal of the American Medical Informatics Association 11/2003; 10(6):523-30. DOI:10.1197/jamia.M1370 · 3.93 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The information conveyed by a stimulus was varied in 3 ways: "(a) the number of equally probable alternatives from which it could be chosen, (b) the proportion of times it could occur relative to the other possible alternatives, and (c) the probability of its occurrence as a function of the immediately preceding stimulus presentation. The reaction time to the amount of information in the stimulus produced a linear regression for each of the three ways… ." (PsycINFO Database Record (c) 2012 APA, all rights reserved)Journal of Experimental Psychology 04/1953; 45(3):188-96. DOI:10.1037/h0056940 · 4.70 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: To determine whether a multifaceted systems intervention would eliminate catheter-related bloodstream infections (CR-BSIs). Prospective cohort study in a surgical intensive care unit (ICU) with a concurrent control ICU. The Johns Hopkins Hospital. All patients with a central venous catheter in the ICU. To eliminate CR-BSIs, a quality improvement team implemented five interventions: educating the staff; creating a catheter insertion cart; asking providers daily whether catheters could be removed; implementing a checklist to ensure adherence to evidence-based guidelines for preventing CR-BSIs; and empowering nurses to stop the catheter insertion procedure if a violation of the guidelines was observed. The primary outcome variable was the rate of CR-BSIs per 1,000 catheter days from January 1, 1998, through December 31, 2002. Secondary outcome variables included adherence to evidence-based infection control guidelines during catheter insertion. Before the intervention, we found that physicians followed infection control guidelines during 62% of the procedures. During the intervention time period, the CR-BSI rate in the study ICU decreased from 11.3/1,000 catheter days in the first quarter of 1998 to 0/1,000 catheter days in the fourth quarter of 2002. The CR-BSI rate in the control ICU was 5.7/1,000 catheter days in the first quarter of 1998 and 1.6/1,000 catheter days in the fourth quarter of 2002 (p = .56). We estimate that these interventions may have prevented 43 CR-BSIs, eight deaths, and 1,945,922 dollars in additional costs per year in the study ICU. Multifaceted interventions that helped to ensure adherence with evidence-based infection control guidelines nearly eliminated CR-BSIs in our surgical ICU.Critical Care Medicine 11/2004; 32(10):2014-20. DOI:10.1097/01.CCM.0000142399.70913.2F · 6.15 Impact Factor