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Involving end-users in the design of an audit and feedback intervention in the emergency department setting – a mixed methods study

BACKGROUND: Long length of stays (LOS) in emergency departments (ED) negatively affect quality of care. Ordering of inappropriate diagnostic tests contributes to long LOS and reduces quality of care. One strategy to change practice patterns is to use performance feedback dashboards for physicians. W...

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Autores principales: van Deen, Welmoed K., Cho, Edward S., Pustolski, Kathryn, Wixon, Dennis, Lamb, Shona, Valente, Thomas W., Menchine, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489283/
https://www.ncbi.nlm.nih.gov/pubmed/31035992
http://dx.doi.org/10.1186/s12913-019-4084-3
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author van Deen, Welmoed K.
Cho, Edward S.
Pustolski, Kathryn
Wixon, Dennis
Lamb, Shona
Valente, Thomas W.
Menchine, Michael
author_facet van Deen, Welmoed K.
Cho, Edward S.
Pustolski, Kathryn
Wixon, Dennis
Lamb, Shona
Valente, Thomas W.
Menchine, Michael
author_sort van Deen, Welmoed K.
collection PubMed
description BACKGROUND: Long length of stays (LOS) in emergency departments (ED) negatively affect quality of care. Ordering of inappropriate diagnostic tests contributes to long LOS and reduces quality of care. One strategy to change practice patterns is to use performance feedback dashboards for physicians. While this strategy has proven to be successful in multiple settings, the most effective ways to deliver such interventions remain unknown. Involving end-users in the process is likely important for a successful design and implementation of a performance dashboard within a specific workplace culture. This mixed methods study aimed to develop design requirements for an ED performance dashboard and to understand the role of culture and social networks in the adoption process. METHODS: We performed 13 semi-structured interviews with attending physicians in different roles within a single public ED in the U.S. to get an in-depth understanding of physicians’ needs and concerns. Principles of human-centered design were used to translate these interviews into design requirements and to iteratively develop a front-end performance feedback dashboard. Pre- and post- surveys were used to evaluate the effect of the dashboard on physicians’ motivation and to measure their perception of the usefulness of the dashboard. Data on the ED culture and underlying social network were collected. Outcomes were compared between physicians involved in the human-centered design process, those with exposure to the design process through the ED social network, and those with limited exposure. RESULTS: Key design requirements obtained from the interviews were ease of access, drilldown functionality, customization, and a visual data display including monthly time-trends and blinded peer-comparisons. Identified barriers included concerns about unintended consequences and the veracity of underlying data. The surveys revealed that the ED culture and social network are associated with reported usefulness of the dashboard. Additionally, physicians’ motivation was differentially affected by the dashboard based on their position in the social network. CONCLUSIONS: This study demonstrates the feasibility of designing a performance feedback dashboard using a human-centered design approach in the ED setting. Additionally, we show preliminary evidence that the culture and underlying social network are of key importance for successful adoption of a dashboard. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4084-3) contains supplementary material, which is available to authorized users.
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spelling pubmed-64892832019-06-05 Involving end-users in the design of an audit and feedback intervention in the emergency department setting – a mixed methods study van Deen, Welmoed K. Cho, Edward S. Pustolski, Kathryn Wixon, Dennis Lamb, Shona Valente, Thomas W. Menchine, Michael BMC Health Serv Res Research Article BACKGROUND: Long length of stays (LOS) in emergency departments (ED) negatively affect quality of care. Ordering of inappropriate diagnostic tests contributes to long LOS and reduces quality of care. One strategy to change practice patterns is to use performance feedback dashboards for physicians. While this strategy has proven to be successful in multiple settings, the most effective ways to deliver such interventions remain unknown. Involving end-users in the process is likely important for a successful design and implementation of a performance dashboard within a specific workplace culture. This mixed methods study aimed to develop design requirements for an ED performance dashboard and to understand the role of culture and social networks in the adoption process. METHODS: We performed 13 semi-structured interviews with attending physicians in different roles within a single public ED in the U.S. to get an in-depth understanding of physicians’ needs and concerns. Principles of human-centered design were used to translate these interviews into design requirements and to iteratively develop a front-end performance feedback dashboard. Pre- and post- surveys were used to evaluate the effect of the dashboard on physicians’ motivation and to measure their perception of the usefulness of the dashboard. Data on the ED culture and underlying social network were collected. Outcomes were compared between physicians involved in the human-centered design process, those with exposure to the design process through the ED social network, and those with limited exposure. RESULTS: Key design requirements obtained from the interviews were ease of access, drilldown functionality, customization, and a visual data display including monthly time-trends and blinded peer-comparisons. Identified barriers included concerns about unintended consequences and the veracity of underlying data. The surveys revealed that the ED culture and social network are associated with reported usefulness of the dashboard. Additionally, physicians’ motivation was differentially affected by the dashboard based on their position in the social network. CONCLUSIONS: This study demonstrates the feasibility of designing a performance feedback dashboard using a human-centered design approach in the ED setting. Additionally, we show preliminary evidence that the culture and underlying social network are of key importance for successful adoption of a dashboard. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-019-4084-3) contains supplementary material, which is available to authorized users. BioMed Central 2019-04-29 /pmc/articles/PMC6489283/ /pubmed/31035992 http://dx.doi.org/10.1186/s12913-019-4084-3 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
van Deen, Welmoed K.
Cho, Edward S.
Pustolski, Kathryn
Wixon, Dennis
Lamb, Shona
Valente, Thomas W.
Menchine, Michael
Involving end-users in the design of an audit and feedback intervention in the emergency department setting – a mixed methods study
title Involving end-users in the design of an audit and feedback intervention in the emergency department setting – a mixed methods study
title_full Involving end-users in the design of an audit and feedback intervention in the emergency department setting – a mixed methods study
title_fullStr Involving end-users in the design of an audit and feedback intervention in the emergency department setting – a mixed methods study
title_full_unstemmed Involving end-users in the design of an audit and feedback intervention in the emergency department setting – a mixed methods study
title_short Involving end-users in the design of an audit and feedback intervention in the emergency department setting – a mixed methods study
title_sort involving end-users in the design of an audit and feedback intervention in the emergency department setting – a mixed methods study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489283/
https://www.ncbi.nlm.nih.gov/pubmed/31035992
http://dx.doi.org/10.1186/s12913-019-4084-3
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