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Sociotechnical Analyis of a Neonatal ICU

Leanne CURRIE,a,b,e Barbara SHEEHAN,a Phillip L. GRAHAM III,c,e Peter STETSON,b,d,e Kenrick CATO, a and Adam WILCOX b,d,e

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aSchool of Nursing, bDept of Biomedical Informatics, cDept of Pediatrics, dDept of Medicine,Columbia University;

and eNew York Presbyterian Hospital, New York, N.Y, USA

Abstract: Sociotechnical theory has been used to inform the development of computer systems in the complex and dynamic environment of healthcare. The key components of the sociotechnical system are the workers, their practices, their mental models, their interactions, and the tools used in the work process. We conducted a sociotechnical analysis of a neonatal intensive care unit towards the development of decision support for antimicrobial prescribing. We found that the core task was to save the baby in the face of complex and often incomplete information. Organizational climate characteristics were pride in clinical and educational practice. In addition, the structure of work identified interdisciplinary teamwork with some communication breakdown and interruptive work environment. Overall, sociotechnical analysis provided a solid method to understand work environment during the decision support development process.

Keywords: Sociotechnical analysis, Clinical decision support

1. Introduction

Clinical information systems are gradually being integrated into the healthcare environment. Many systems have shown improvement in preventing medical errors[1], however, some systems have resulted in increasing medical errors [2]. One of the main reasons attributed to failed systems is lack of understanding of the sociotechnical environment before, during and after system implementation [2, 3]. Sociotechnical theory has been used to inform the development of systems in the complex and dynamic environment of healthcare [4]. The key components of the sociotechnical system are the workers, their practices, their mental models, their interactions, and the tools (or artefacts) that are used in the work process. Proponents of sociotechnical theory posit that with a deep understanding of the work processes and work environment of the workers, technologies can be developed to support the work, rather than having technologies replicate poorly designed non-technical systems.

2. Objective

The purpose of this study was to examine the sociotechnical environment of the neonatal intensive care unit prior to the development of a clinical decision support system for antibiotic prescribing and management. Ethnographic observations, focus groups and key informant interviews were conducted with clinicians responsible for antimicrobial prescribing with the goal of understanding the sociotechnical environment.

3. Background

Safety scientists have used sociotechnical theory to understand complex systems such as work related to nuclear reactors, chemical industries and others. Complex

Connecting Health and Humans K. Saranto et al. (Eds.)

IOS Press, 2009 © 2009 The authors and IOS Press. All rights reserved.

doi:10.3233/978-1-60750-024-7-258

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sociotechnical systems are socially constructed and dynamic cultures that are defined by their stories and rituals [5]. In contrast to an open systems model of organizational behaviour, in which activities are thought to be rational and orderly, activities in socially constructed systems may be irrational or disorderly. In this context, there is a ‘continual and collective reality building process’ that provides meaning to the work. In order to understand sociotechnical culture, one must understand the meaning of the work. However, one cannot grasp the meaning of work without knowing the core task.

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