Towards a Hybrid Method to Categorize Interruptions and Activities in Healthcare

Authors

Juliana J. Brixey, School of Health Information Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
David J. Robinson, School of Health Information Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA; Memorial Hermann Hospital Houston, TX, USA
Craig W. Johnson, School of Health Information Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
Todd R. Johnson, School of Health Information Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
James P. Turley, School of Health Information Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
Vimla l. Patel, Department of Biomedical Informatics, Columbia University Medical Center, NY, USA
Jiajie Zhang, School of Health Information Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA

Publication Date

2007

Journal

Int J Med Inform. 2007; 76(11-12): 812–820.

Abstract

ObjectiveInterruptions are known to have a negative impact on activity performance. Understanding how an interruption contributes to human error is limited because there is not a standard method for analyzing and classifying interruptions. Qualitative data are typically analyzed by either a deductive or an inductive method. Both methods have limitations. In this paper a hybrid method was developed that integrates deductive and inductive methods for the categorization of activities and interruptions recorded during an ethnographic study of physicians and registered nurses in a Level One Trauma Center. Understanding the effects of interruptions is important for designing and evaluating informatics tools in particular and for improving healthcare quality and patient safety in general.

MethodThe hybrid method was developed using a deductive a priori classification framework with the provision of adding new categories discovered inductively in the data. The inductive process utilized line-by-line coding and constant comparison as stated in Grounded Theory.

ResultsThe categories of activities and interruptions were organized into a three-tiered hierarchy of activity. Validity and reliability of the categories were tested by categorizing a medical error case external to the study. No new categories of interruptions were identified during analysis of the medical error case.

Conclusions Findings from this study provide evidence that the hybrid model of categorization is more complete than either a deductive or an inductive method alone. The hybrid method developed in this study provides the methodical support for understanding, analyzing, and managing interruptions and workflow.

Keywords

Interruption, Activity, Qualitative Methods, Categorization, Emergency Department, Efficiency, Organizational, Emergency Service, Hospital/organizaiton and administration, Task Performance and Analysis

Comments

PMCID: PMC2211388