Adaptive Behaviors in Complex Clinical Environments
In an ideal scenario, hospital systems would deliver care in a timely manner to a large number of patients with a variety of diseases. There would be no hospital-acquired infections, staff-related oversights or prescription errors that result in complicat
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Adaptive Behaviors in Complex Clinical Environments Mithra Vankipuram, Vafa Ghaemmaghami, and Vimla L. Patel
Introduction In an ideal scenario, hospital systems would deliver care in a timely manner to a large number of patients with a variety of diseases. There would be no hospitalacquired infections, staff-related oversights or prescription errors that result in complications. As patients, we would want to be treated in such an institution. Insurance companies, a principal (financial) driving force in the healthcare industry, would prefer that their customers visit hospitals where reduced complications result in Portions of this chapter has been adapted from (a) an open access article in the proceedings of the 2012 annual symposium American Medical Informatics Association, Vankipuram et al., Adaptive Behaviors of Experts in Following Standard Protocol in Trauma Management: Implications for Developing Flexible Guidelines, and (b) Kahol et al., Deviations from protocol in a complex trauma environment: errors or innovations? Journal of Biomedical Informatics, 44(3), 425–31. The description of research methods and results for this chapter has been adapted from (a) Kahol K, et al. Deviations from protocol in a complex trauma environment: errors or innovations? Journal of Biomedical Informatics. 44(3): 425–31. M. Vankipuram, MS, PhD (*) HP Labs, Hewlett-Packard (HP), Palo Alto, CA 94304, USA e-mail: [email protected] V. Ghaemmaghami, MD, FACS Trauma Division, Department of Surgery, Banner Good Samaritan Hospital, Phoenix, AZ 85006, USA University of Arizona College of Medicine, Phoenix, AZ USA V.L. Patel, PhD, DSc, FRSC Center for Cognitive Studies in Medicine and Public Health, New York Academy of Medicine, New York, NY 10029, USA Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ 85259, USA V.L. Patel et al. (eds.), Cognitive Informatics in Health and Biomedicine, Health Informatics, DOI 10.1007/978-1-4471-5490-7_8, © Springer-Verlag London 2014
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shorter hospital stays and lower overall costs due to better outcomes. From the clinicians’ point of view, working in a safe and efficient system increases their reputation and work morale. Such an institution would attract a large volume of patients. This will result in greater reimbursement, which would make a strong case for improving quality of care from a business perspective as well. Although not all the features described may be practicably achievable, quality of care is a fundamental concept that is critical to building a safe, cost-effective and sustainable healthcare system. Unlike other domains such as aviation and nuclear power [1], medicine continues to rely on individual error-free performance as opposed to designing systems around principles of safety [2]. In order to build safer systems, understanding the cognitive mechanisms that drive errors and other adaptive deviations in complex systems is needed. The
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