Informating Hospital Workflow Coordination

Abstract

Through a qualitative case study at Kalnes general hospital in Norway, we investigate the use of workflow information to manage hospital resources and coordinate patient flow from emergency unit admission to patient transfer and discharge. We draw on Zuboff’s (1988) notion of “informating” – turning descriptions and measurements of activities, events and objects into information – to examine how hospital staff leverage an integrated hospital information infrastructure to share, validate and use workflow information. We contribute to CSCW literature by explicating how information transparency, the meticulous boundary-spanning work of dedicated coordinators, and the regular conduct of coordinative meetings can help to establish the legitimacy of workflow information in practice. In our case, interdepartmental visibility of workflow information raises awareness of menial and often-overlooked hospital housekeeping work, and simultaneously motivates collaborative efforts to monitor and improve workflows. Our findings highlight the need for a broad and inclusive approach to the legitimation of workflow information, both in daily coordinative practice and in efforts to streamline hospital workflows.

This is a preview of subscription content, access via your institution.

Figure 1
Figure 2
Figure 3
Figure 4

Notes

  1. 1.

    The notion of information infrastructure developed by Star and Ruhleder (1996) refers to interdependent socio-technical arrangements including heterogeneous components of hardware and software, standards, work practices and policies that together constitute organizational IT capabilities.

  2. 2.

    Suchman (1995, p. 574) provides a broad and inclusive definition of legitimacy as: “a generalized perception or assumption that the actions of an entity are desirable, proper, or appropriate within some socially constructed system of norms, values, beliefs, and definitions”.

References

  1. Abraham, Joanna; and Madhu C. Reddy (2008). Moving patients around: A field study of coordination between clinical and non-clinical staff in hospitals. In CSCW’08: Proceedings of the ACM 2008 conference on computer supported cooperative work, 8–12 November 2008, San Diego, California. New York: ACM, pp. 225–228.

  2. Abraham, Joanna; and Madhu C. Reddy (2010). Challenges to inter-departmental coordination of patient transfers: A workflow perspective. International Journal of Medical Informatics. Vol. 79, no. 2, pp. 112–122.

    Google Scholar 

  3. Aronsky, Dominic; Ian Jones; Kevin Lanaghan; and Corey M. Slovis (2008). Supporting patient care in the emergency department with a computerized whiteboard system. Journal of the American Medical Informatics Association. Vol. 15, no. 2, pp. 184–194.

    Google Scholar 

  4. Bardram, Jakob E. (2000). Temporal coordination–on time and coordination of collaborative activities at a surgical department. Computer Supported Cooperative Work (CSCW). Vol. 9, no. 2, pp. 157–187.

    Google Scholar 

  5. Bardram, Jakob E.; and Claus Bossen (2005). Mobility work: The spatial dimension of collaboration at a hospital. Computer Supported Cooperative Work (CSCW) Vol. 14, no. 2, pp. 131–160.

    Google Scholar 

  6. Bjørn, Pernille; and Ellen Balka (2007). Health care categories have politics too: Unpacking the managerial agendas of electronic triage systems. In ECSCW ‘07: Proceedings of the Tenth European Conference on Computer Supported Cooperative Work, 24-28 September 2007, Limerick, Ireland. London: Springer, pp. 371–390.

  7. Bjørn, Pernille; and Morten Hertzum (2011). Artefactual multiplicity: A study of emergency-department whiteboards. Computer Supported Cooperative Work (CSCW). Vol. 20, no. 1–2, pp. 93–121.

    Google Scholar 

  8. Boochever, Stephen S. (2004). HIS/RIS/PACS integration: Getting to the gold standard. Radiology Management. Vol. 26, no. 3, pp. 16–24.

    Google Scholar 

  9. Bossen, Claus; and Martin Foss (2016). The collaborative work of hospital porters: Accountability, visibility and configurations of work. In CSCW 2016: Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing, 27 February - 2 March 2016, San Francisco, USA. New York: ACM Press, pp. 965–979.

  10. Bossen, Claus; and Randi Markussen (2010). Infrastructuring and ordering devices in health care: Medication plans and practices on a hospital ward. Computer Supported Cooperative Work (CSCW). Vol. 19, no. 6, pp. 615–637.

    Google Scholar 

  11. Bossen, Claus; Lotte Groth Jensen; and Flemming Witt Udsen (2012). Medical secretaries’ care of records: the cooperative work of a non-clinical group. In CSCW 2012: Proceedings of the ACM 2012 conference on Computer Supported Cooperative Work, 11-15 February 2012, Seattle, WA, USA. New York: ACM, pp. 921–930.

  12. Bowers, John; Graham Button; and Wes Sharrock (1995). Workflow from within and without: Technology and cooperative work on the print industry shop floor. In ECSCW’95: Proceedings of the Fourth European Conference on Computer-Supported Cooperative Work, 10–14 September 1995, Stockholm, Sweden. Dordrecht: Kluwer Academic, pp. 51–66.

  13. Bygstad, Bendik (2016). Generative innovation: A comparison of lightweight and heavyweight IT. Journal of Information Technology. https://doi.org/10.1057/jit.2016.15.

  14. Carlile, Paul R. (2004). Transferring, translating, and transforming: An integrative framework for managing knowledge across boundaries. Organization Science. Vol. 15, no. 5, pp. 555–568.

    Google Scholar 

  15. Cross, Robert L.; and Andrew Parker (2004). The hidden power of social networks: Understanding how work really gets done in organizations. Harvard Business School Press.

  16. De Vries, Jan; and Robbert Huijsman (2011). Supply chain management in health services: An overview. Supply Chain Management: An International Journal. Vol. 16, no. 3, pp. 159–165.

    Google Scholar 

  17. Deephouse, David L.; and Mark Suchman (2008). Legitimacy in organizational institutionalism. In R. Greenwood, et al, (eds.): The Sage Handbook of Organizational Institutionalism. London: Sage, pp. 49–77.

  18. Devaraj, Sarv; Terence T. Ow; and Rajiv Kohli (2013). Examining the impact of information technology and patient flow on healthcare performance: A Theory of Swift and Even Flow (TSEF) perspective. Journal of Operations Management. Vol.31, no. 4, pp. 181–192.

  19. Dourish, Paul (2001). Process descriptions as organisational accounting devices: The dual use of workflow technologies. In Proceedings of the 2001 international ACM GROUP 2001: SIGGROUP conference on supporting group work, 30 September - 3 October 2001, Boulder, Colorado, USA. New York: ACM, pp. 52–60.

  20. Drupsteen, Justin; Taco van der Vaart; and Dirk Pieter van Donk (2013). Integrative practices in hospitals and their impact on patient flow. International Journal of Operations & Production Management. Vol. 33, no. 7, pp. 912–933.

    Google Scholar 

  21. Egger, Edeltraud; and Ina Wagner (1992). Time-management: A case for CSCW. In M. M. Mantei; R. M. Baecker; and R. E. Kraut (eds): CSCW’92: Proceedings of the conference on computer-supported cooperative work, 31 October–4 November 1992, Toronto, Canada. New York: ACM Press, pp. 249–256.

  22. Egger, Edeltraud; and Ina Wagner (1993). Negotiating temporal orders. Computer Supported Cooperative Work (CSCW). Vol. 1, no. 4, pp. 255–275.

    Google Scholar 

  23. Ellingsen, Gunnar; and Eric Monteiro (2003). Big is beautiful: Electronic patient records in large Norwegian hospitals 1980s-2001. Methods of Information in Medicine. Vol. 42, no. 4, pp. 366–370.

    Google Scholar 

  24. Ellingsen, Gunnar; and Eric Monteiro (2006). Seamless integration: Standardisation across multiple local settings. Computer Supported Cooperative Work (CSCW). Vol. 15, no. 5–6, pp. 443–466.

    Google Scholar 

  25. Ellingsen, Gunnar; and Kristoffer Røed (2010). The role of integration in health-based information infrastructures. Computer Supported Cooperative Work (CSCW). Vol. 19, no. 6, pp. 557–584.

  26. Fitzpatrick, Geraldine; and Gunnar Ellingsen (2013). A review of 25 years of CSCW research in healthcare: Contributions, challenges and future agendas. Computer Supported Cooperative Work (CSCW). Vol. 22, no. 4–6, pp. 609–665.

    Google Scholar 

  27. France, Daniel J.; Scott Levin; Robin Hemphill; Kong Chen; Dorsey Rickard; Renee Makowski; … Dominik Aronsky (2005). Emergency physicians’ behaviors and workload in the presence of an electronic whiteboard. International Journal of Medical Informatics. Vol. 74, no. 10, pp. 827–837.

    Google Scholar 

  28. Gerring, John (2007). Case study research: Principles and practices. Cambridge: Cambridge University Press.

  29. Glouberman, Sholom; and Henry Mintzberg (2001). Managing the care of health and the cure of disease—Part II: Integration. Health Care Management Review. Vol. 26, no. 1, pp. 70–84.

    Google Scholar 

  30. Hanseth, Ole; and Nina Lundberg (2001). Designing work-oriented infrastructures. Computer Supported Cooperative Work (CSCW). Vol. 10, no. 3, pp. 347–372.

  31. Haraden, Carol; and Roger K. Resar (2004). Patient flow in hospitals: Understanding and controlling it better. Frontiers of Health Services Management. Vol. 20, no. 4, pp. 3–15.

    Google Scholar 

  32. Hertzum, Morten; and Jesper Simonsen (2013). Work-practice changes associated with an electronic emergency department whiteboard. Health Informatics Journal. Vol. 19, no. 1, pp. 46–60.

    Google Scholar 

  33. Hertzum, Morten; and Jesper Simonsen (2015). Visual overview, oral detail: The use of an emergency-department whiteboard. International Journal of Human-Computer Studies. Vol. 82, pp 21–30.

    Google Scholar 

  34. Kohli, Rajiv; and William J. Kettinger (2004). Informating the clan: Controlling physicians’ costs and outcomes. Management Information Systems Quarterly (MISQ). Vol. 28, no. 3, pp. 363–394.

    Google Scholar 

  35. Kudyba, Stephan; and Thomas Gregorio (2010). Identifying factors that impact patient length of stay metrics for healthcare providers with advanced analytics. Health Informatics Journal. Vol. 16, no. 4, pp. 235–245.

    Google Scholar 

  36. Lave, Jean; and Etienne Wenger (1991). Situated learning: Legitimate peripheral participation. Cambridge: Cambridge University Press.

  37. Lega, Federico; and Carlo DePietro (2005). Converging patterns in hospital organization: Beyond the professional bureaucracy. Health Policy. Vol. 74, no. 3, pp. 261–281.

    Google Scholar 

  38. Lenz, Richard; and Manfred Reichert (2007). IT support for healthcare processes–premises, challenges, perspectives. Data & Knowledge Engineering. Vol. 61, no. 1, pp. 39–58.

    Google Scholar 

  39. Levina, Natalia; and Emmanuelle Vaast (2005). The emergence of boundary spanning competence in practice: Implications for implementation and use of information systems. Management Information Systems Quarterly (MISQ). Vol. 29, no. 2, pp. 335–363.

    Google Scholar 

  40. Malone, Thomas W.; and Kevin Crowston (1990). What is coordination theory and how can it help design cooperative work systems? In CSCW 1990: Proceedings of the 1990 ACM conference on computer-supported cooperative work, 7–10 October 1990, Los Angeles, California, USA. New York: ACM, pp. 357–370.

  41. McHugh, Megan; Kevin Van Dyke; Mark McClelland; and Dina Moss (2011). Improving patient flow and reducing emergency department crowding: A guide for hospitals. Rockville, Maryland: Agency for Healthcare Research and Quality. — AHRQ Publication No. 11(12)-0094

  42. Miles, Matthew B.; and Michael A. Huberman (1994). Qualitative data analysis: An expanded sourcebook. SAGE publications, Inc.

    Google Scholar 

  43. Mintzberg, Henry (1993). Structure in fives: Designing effective organizations. Englewood-Cliffs, New Jersey: Prentice-Hall, Inc.

  44. Monteiro, Eric; Neil Pollock; Ole Hanseth; and Robin Williams (2013). From artefacts to infrastructures. Computer Supported Cooperative Work (CSCW). Vol. 22, no. 4–6, pp. 575–607.

    Google Scholar 

  45. Mykkänen, Juha; Jari Porrasmaa; Juha Rannanheimo and Mikka Korpela (2003). A process for specifying integration for multi-tier applications in healthcare. International Journal of Medical Informatics. Vol. 70, no. 2, pp. 173–182.

    Google Scholar 

  46. Orlikowski, Wanda J. (2002). Knowing in practice: Enacting a collective capability in distributed organizing. Organization Science. Vol. 13, no. 3, pp. 249–273.

    Google Scholar 

  47. Rotter, Thomas; Leigh Kinsman; Erica L. James; Andreas Machotta; Holger Gothe; Jon Willis; … Joachim Kugler (2010). Clinical pathways: Effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD006632.pub2.

  48. Sayah, Assad; Loni Rogers; Karthik Devarajan; Lisa Kingsley-Rocker; and Luis F. Lobon (2014). Minimizing ED waiting times and improving patient flow and experience of care. Emergency Medicine International. https://doi.org/10.1155/2014/981472.

  49. Star, Susan Leigh; and Karen Ruhleder (1996). Steps toward an ecology of infrastructure: Design and access for large information spaces. Information Systems Research. Vol. 7, no. 1, pp. 111–134.

    Google Scholar 

  50. Stisen, Allan; Nervo Verdezoto; Henrik Blunck; Mikkel Baun Kjærgaard; and Kaj Grønbæk (2016). Accounting for the invisible work of hospital orderlies: Designing for local and global coordination. In CSCW 2016: Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing, 27 February - 2 March 2016, San Francisco, CA, USA. New York: ACM, pp. 980–992.

  51. Suchman, Lucy (1993). Do categories have politics? The language/action perspective reconsidered. In ECSCW’93: Proceedings of the third European conference on computer-supported cooperative work, 13–17 September 1993, Milan, Italy. Springer Netherlands, pp. 1–14.

    Google Scholar 

  52. Suchman, Mark C. (1995). Managing legitimacy: Strategic and institutional approaches. Academy of Management Review. Vol. 20, no. 3, pp. 571–610.

    Google Scholar 

  53. Symon, Gillian; Karen Long; and Judi Ellis (1996). The coordination of work activities: Cooperation and conflict in a hospital context. Computer Supported Cooperative Work (CSCW). Vol. 5, no. 1, pp. 1–31.

    Google Scholar 

  54. Tang, Anthony; Joel Lanir; Saul Greenberg; and Sidney S. Fels (2009). Supporting transitions in work: Informing large display application design by understanding whiteboard use. In GROUP 2009: Proceedings of the ACM 2009 international conference on Supporting group work, 10-13 May 2009, Sanibel Island, Florida. New York: ACM, pp. 149–158.

  55. Tang, Charlotte; Yunan Chen; and Soyoung Lee (2015). Non-clinical work counts: Facilitating patient outflow in an emergency department. Behaviour & Information Technology. Vol. 34, no. 6, pp. 585–597.

    Google Scholar 

  56. van Lent, Wineke A. M.; Elizabeth M. Sanders; and Wim H. van Harten (2012). Exploring improvements in patient logistics in Dutch hospitals with a survey. BMC Health Services Research, https://doi.org/10.1186/1472-6963-12-232.

  57. Wong, Hannah J.; Michael Caesar; Salim Bandali; James Agnew; and Howard Abrams (2009). Electronic inpatient whiteboards: Improving multidisciplinary communication and coordination of care. International Journal of Medical Informatics. Vol. 78, no. 4, pp. 239–247.

    Google Scholar 

  58. Zhao, Xiande; Baofeng Huo; Willem Selen; and Jeff Hoi Yan Yeung (2011). The impact of internal integration and relationship commitment on external integration. Journal of Operations Management. Vol. 29, no. 1–2, pp. 17–32.

    Google Scholar 

  59. Zuboff, Shoshana (1988). In the age of the smart machine: The future of work and power. New York: Basic Books.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Terje Aksel Sanner.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sanner, T.A., Øvrelid, E. Informating Hospital Workflow Coordination. Comput Supported Coop Work 29, 387–417 (2020). https://doi.org/10.1007/s10606-019-09362-z

Download citation

Keywords

  • Informating
  • Legitimation
  • Workflow coordination
  • Hospital
  • Information infrastructure