Methodologies and Challenges Associated with Exploring Flow Disruptions in Hospital Environments
Event Type
Discussion Panel
TimeThursday, April 1512:30pm - 1:30pm EDT
LocationHospital Environments
DescriptionThis panel will address the methodologies and challenges associated with studying flow disruptions (observable deviations in the natural progression of a task) in a variety of hospital environments.

To truly understand the function of a given system, many have emphasized the importance of understanding “work as done” as opposed to “work as imagined”. One of the best methods to explore work as done in healthcare involves the direct observation of a healthcare process, allowing researchers and other interested parties to understand the common challenges facing clinical workers. Moreover, these observations have brought to light the underlying systems issues that may negatively impact patient and provider safety, efficiency, and healthcare quality. In an effort to move away from more retrospective threat management methods, studying flow disruptions can help researchers and healthcare managers better understand areas of systemic vulnerability.

Flow disruptions, or observable deviations in the natural progression of a task, have been studied in healthcare for more than a decade. Since the term ‘flow disruption’ was coined by Wiegmann and colleagues in 2007, several research teams have explored these deviations (and the like) in a variety of clinical environments including surgery (cardiac, robotic, general), trauma care, and OBGYN. Flow disruptions have been studied to both understand the deviation from expected system function as well as their association with negative patient outcomes.

Because flow disruptions have been studied in a variety of domains, research teams have developed an array of methodologies for studying ‘work as done’ using flow disruptions. Variability can exist in the data collection style, definition and classification of the disruptions and analysis/interpretation of the results. With respect to data collection, some have used direct observation while others have utilized audio/video recording tools to identify flow disruptions at a later point in time. The observers used to collect flow disruptions have also varied – some have had medical background while others have had a human factors or psychology-related background. Moreover, how an observer is trained to collect this data has varied between studies. In most cases, observable flow disruptions are later classified into a taxonomy, either one that was previously developed by a group of researchers or one that was created based on the specific data observed. As a result, there is variability in not only the methodologies but also the applications and implications of flow disruption research, creating the opportunity for a unique discussion on the different methods used as well as challenges and lessons learned.

We will hear from a multi-professional panel with experience in collecting, classifying, and analyzing flow disruptions in various healthcare settings including the operating room, intensive care units and ambulances. Each speaker will discuss their experience in studying flow disruptions in their respective domains by providing an overview of (1) how they designed their study(s), (2) methods used to collect and analyze flow disruptions, (3) challenges of their methods and (4) lessons learned or next steps for advancing their studies.
Director, Surgical Safety and Human Factors Research
Professor of Architecture and Industrial Engineering
Assistant Professor in Pediatrics