Priyanka Tewani’s research while affiliated with The Ohio State University and other places

As machines increasingly behave more like active cognitive agents than passive tools, additional heuristics for supporting joint human-machine activity are urgently needed to complement existing usability heuristics. Despite the rich and extensive design guidance produced by forty years of cognitive systems engineering (CSE) and related fields, the lack of large-scale impact can be attributed, in part, to insufficient translation of CSE principles and guidelines to language and tools that are ready for designers and other decision-makers responsible for these automation-infused solutions. Towards this need, we synthesized a partial and preliminary list of ten machine requirements intended to capture some of the essentials of joint activity. We believe solidifying these essentials and their implications for machines is a first and necessary step towards deriving joint activity design heuristics that are valuable, practical, and sustainable for operational personnel. Through iterative refinement, we believe the combination of strong ideas and strong practicality in these tools can be the basis for a large-scale shift in the design and evaluation of human-machine teams.

Abstraction hierarchies (AHs) are essential to a work domain analysis (WDA), the “most important and unique” phase of cognitive work analysis (CWA) (Vicente, 1999). Although AHs have been the industry standard for assessing and describing work systems for several decades, they are not without limitations (Vicente, 2002). We have developed an evolution of AHs called Abstraction Networks (ANs) to address several of the limitations Vicente identified. ANs are designed to (1) improve engagement with practitioners, thereby facilitating greater shared understanding of the system, (2) better integrate with existing systems analysis tools, and (3) provide a more direct bridge between systems analysis and display design. We document a case study that uses ANs to better understand a sterile processing department (SPD) at a Southeastern tertiary care hospital, detailing the extent to which AN’s achieve these three goals.

Description: Efficient, effective, and safe surgical services are a key financial and operational concern for many hospitals that are vital for patient care and wellbeing. Sterile Processing Departments (SPDs) must clean, maintain, store, and organize surgical instruments which are then delivered to Operating Rooms (ORs) using a Courier Network. Ensuring that thousands of tools and devices needed for surgeries each day are delivered to the right OR at the right time involves regular coordination across the SPD, OR, and Courier Network. The SPD must carefully clean and organize the instruments, the OR must utilize the instruments and return them to the SPD in good condition, and the Courier Network must deliver the instruments between the SPD and OR in a timely manner. While our prior work had examined work systems within the SPD, we had not explored in depth the relationships between the SPD, OR and Courier Network. Doing so might benefit quality, safety and efficiency, including the reduction of healthcare-associated infections (HAIs). To represent the relationships between these three departments, we utilized the Systems Engineering Initiative for Patient Safety (SEIPS), which helps model how health-related outcomes are affected by healthcare work systems. The SEIPS model can be used to represent the complexity of healthcare systems and may enhance efforts to develop effective solutions to systemic problems which directly affect patient and provider wellbeing. The SEIPS 101 toolkit, developed for the application of SEIPS methodology to various work environments, provided a possible starting point. Through a series of observations and interviews which built on prior work system analyses, we developed a SEIPS 101 journey map, PETT scan, and tasks matrices to represent the instrument reprocessing work system, aiming to describe the system and the interactions between people, tools, and tasks occurring within it. The processing of surgical instruments is generally organized into five stages: Decontamination, Assembly, Sterilization, Storage, and Case Cart Preparation. In Decontamination, trays of used instruments are both manually and mechanically cleaned and treated to remove fluids and bioburden left behind from surgery. Once physical contamination is removed the trays move to the Assembly stage where their contents are verified, faulty instruments are swapped out or repaired, and sterile filters and indicators are added. Instruments are then given a final inspection before the trays are wrapped and locked in tagged containers for Sterilization. Trays may be sterilized using a variety of methods including steam autoclave, hydrogen peroxide or ethylene oxide gas, and once sterile they are either sent to the OR for reuse or placed in storage until needed. Case carts are composed of procedure-specific combinations of trays requested by the OR which are then delivered to locations throughout the hospital via a Courier Network. Couriers are responsible for the movement of case carts, surgical trays and other supplies between departments and are relied upon to ensure timely delivery so that surgical teams have what they need to start surgical cases. Delayed cases can substantially impact the wellbeing of patients, their family members, and the hospital system both organizationally and financially. Through our prior work (Alfred at al. 2019, 2020, 2021), and analysis of incident reports (Segarra et al., 2022), we identified the Assembly stage as potentially critical point in the system. In Assembly, trays are inspected for potential failures during Decontamination, and instruments are prepared in trays for future use. Once trays are wrapped and locked in Assembly, they cannot be inspected again until they are reopened in the OR. If issues with the sterility of a tray are identified in the OR, it cannot be used for a procedure, requiring additional instruments or trays to be requested. If instruments are missing it can lead to delays or workarounds, both of which can introduce new hazards. By utilizing SEIPS framework to describe and understand the instrument reprocessing work system, we aim to assist healthcare teams and decisionmakers in improving the efficiency of healthcare delivery and ultimately benefiting the patients they care for. To establish an overview of the instrument reprocessing work system, we conducted over three hundred hours of observation sessions and interviews with professionals at multiple levels of the healthcare organization. We then developed a SEIPS 101 journey map for a surgical instrument tray as it moves through the SPD process to the OR and then back to the SPD via the hospital Courier Network. This journey map illustrates the people and tasks involved at each stage of the process as well as relationships and responsibilities between departments as the tray moves through the work system. A system wide PETT scan was constructed showing SEIPS factors such as people, tools, tasks, and selected interactions between those factors. Observations of work as done throughout the system were utilized to build task matrices for the OR, Courier Network, and the Assembly stage in the SPD. All SEIPS tools were validated through additional observations and discussions with hospital staff. The SEIPS 101 journey map and PETT scan demonstrated the importance of cross-departmental coordination in the successful preparation for and completion of surgical procedures and resulting patient outcomes. Tasks being performed in different departments may affect one another at multiple steps of the tray preparation, usage, and delivery processes, even though the departments involved are traditionally thought of as separate. The movement of the tray throughout the hospital system shows the involvement of professional teams in the SPD, OR, and Courier Network during its journey to and from a patient, as well as in its maintenance and preparation for additional incoming patients. The SPD, OR and Courier teams are found to have overlapping responsibilities throughout the journey and a clear co-dependence, with critical implications for the successful functioning of the whole hospital system. Deeper investigation of each department using the tasks matrices revealed additional complexity, illustrating that even relatively simple tasks can still have far-reaching systemic effects. The instrument reprocessing work system is highly complex and interdependent due to the multitude of interactions between factors such as scheduling, staffing, quality assurance, and the delivery of care as it is coordinated between the SPD, OR, Courier Network and other departments within the system. In contrast with traditional views about individual-based solutions to workplace challenges in hospital environments, we suggest that optimizing daily operations and planning for future challenges in instrument reprocessing requires a complete understanding of the complexity of the work systems involved in surgical care and their interdependent relationships with one another. Therefore, proposed workplace solutions which focus on individual workers, teams or departments may still fail to address larger systemic issues. Insights offered by SEIPS may substantially enhance understanding of complex organizational problems throughout the hospital system which facilitates management, decision making, development of workplace interventions and ultimately leads to direct benefits for healthcare institutions and improvement in the quality of patient care.