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Rsd3 jun2

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Rsd3 jun2

  1. 1. Human Factors & Complex Systems Group Loughborough Design School Complex multi-layered system maps Does zoom in/out interaction help for better systems understanding? Alfred Clatworthy Holmen Thomas Jun Loughborough Design School Loughborough University, UK
  2. 2. Human Factors & Complex Systems Group Loughborough Design School Background
  3. 3. System/Process Maps Soft system models Hard system models Real time system modelling Object Oriented modelling IDEF0 UML Influence diagramsWorkflow models Business process modelling Cognitive Work Analysis Data Flow Diagrams State Transition Diagrams IDEF3 Flowcharts Entity Relation Diagram SysML
  4. 4. Human Factors & Complex Systems Group Loughborough Design School Mapping/Modelling allows us to  Identify complexity  Aid understanding  Improve communication
  5. 5. Basic elements of modelling methods Nodes Links Nodes Hierarchical links processcontent diagrams sub- task2 sub- task1 goal Sequential links flowcharts process decision start state transition diagrams state1 state2 state3 Information links communication diagrams person1 person2 person3 data flow diagrams activity1 activity2data storage
  6. 6. Sequential linkInformation link Hierarchical link
  7. 7. Activity view Stakeholder view Information /material view Sequential linkInformation link Hierarchical link
  8. 8. Activity view Stakeholder view Information /material view Sequential linkInformation link Hierarchical link stakeholder diagram information diagram process content diagram group1
  9. 9. Activity view Stakeholder view Information /material view Sequential linkInformation link Hierarchical link flowchart swim lane activity diagram state transition diagram group2 group3
  10. 10. Activity view Stakeholder view Information /material view Sequential linkInformation link Hierarchical link communication diagram group4 sequence diagram
  11. 11. Activity view Stakeholder view Information /material view Sequential linkInformation link Hierarchical link data flow diagram IDEF0 group5
  12. 12. Activity view Stakeholder view Information /material view Sequential linkInformation link Hierarchical link stakeholder diagram information diagram process content diagram data flow diagram IDEF0 flowchart swim lane activity diagram communication diagram state transition diagram group1 group5 group4 group2 group3 sequence diagram
  13. 13. Human Factors & Complex Systems Group Loughborough Design School Study 1–Perceived ease of use and usefulness Reality    Patient Discharge Processes Activity view Stakeholder view Information /material view Sequential linkInformation link Hierarchical link stakeholder diagram information diagram process content diagram data flow diagram IDEF0 flowchart swim lane activity diagram communication diagram state transition diagram group1 group5 group4 group2 group3 sequence diagram Healthcare workers
  14. 14. 1. Stakeholder diagrams
  15. 15. 2. Information diagrams
  16. 16. 3. Process content diagrams
  17. 17. 4. Flowcharts
  18. 18. 5. Swim lane activity diagrams
  19. 19. 6. State transition diagrams
  20. 20. 7. Communication diagrams
  21. 21. 8. Sequence diagrams
  22. 22. 9. Data flow diagrams
  23. 23. 10. IDEF0
  24. 24. Human Factors & Complex Systems Group Loughborough Design School Diagram Acceptance Perceived Usefulness Behavioral Intention to Use Perceived Ease of Use Technology Acceptance Model (Davis, F.D., 1989) Diagram Acceptance Model Actual System Use Actual Diagram Use
  25. 25. Findings Ease of use (Jun, G., et. al., 2010) Usefulness
  26. 26. Findings  A single diagram cannot effectively capture the full range of perspectives present in complex healthcare State Transition Diagram
  27. 27. Reality Adult mental health service for intake and treatment 1 working day TimelineActionOutcomeFacilitator 0-2weeks 2-4weeks 4 weeks-3 months 4-6 months 7-12months Referra lreceive d Assessment Appoin tment with care co-ordinator assigne d Formula tion andagreem ent of treatment/carepla n / riskmanage ment/ crisisplan Interven tionmenu:Introduc tionto serviceand CPA Review of workingdiagnos is / needs/ goalsand initialtreatmen tadvice Feedba ck to serviceuserand carer Liaisonw ith otherservice sRiskass essment Treatment / careplan / interventionimplemented Interven tionmenu: (Refertotreatmen tsub-menu)Pharma cological interven tions, medica tion manage ment'Wholelife'- employment/tra ining/educationand leisure(social inclusio n),mainten anceof relation shipswith family and friends. Carers' needsassess ment, relapse plan,Inf ormation aboutill ness,WRAPSignpo stingto partnera gencies. Management offinancia land housing issues. Casem anagem entinclu dingcommissionin g of care. Psycho logicaltreatmen te.g.CBT,CA T MDTCPA review Discha rge toprimary careor otherca re pathwa y Agreed treatmen tcomplet ed Service usergoa lsachie ved Letterse nttoserviceu ser, GP and relevan totherssummar isingtre atment,progres s,follow-up, relapseand crisisplan, primarycare plan and process to re-accesssecond arymental healthcare Referra ladminis tered and assessment booked Assessment complet ed Firstavailab lecareco-ordinatorand /or consult antappointment booked CPAfoldergiven toservic e user Care plan withagreedgoals devised ,signed byserviceu ser.Service userinfo rmed ofdiagnos is and informatio n on illnessprovide d.Referra lsto otherse rvicesent. Riskmanage mentplanreviewe d Medica lreviewa ndmedi cationcoordin ance Psycho logicalformula tioncomp letedand shared with serviceuse rand carer.Carers needsas sessmentcompleted and carer's carepla n devised and implemented. Relaps epreventionand crisisplan agreed with serviceu sercare rand otheragenc ies. Copiesto serviceu serand mental healthnotes. Service usergoa lsre: employm ent/ training/ education/ leisurea chieved . Perman ent safe and securehousing . Able to manage financia lissues. Access ing partnerage nciesprov iding special ist helpe.g .busine ssforpeop le, drug and alcohol service s Team membe r Team membe r Team membe r Care co- ordinator,serviceu ser, carer Care co- ordinator,serviceu ser, carer Care co- ordinator,serviceu ser, carer Care co- ordinator,serviceu ser, carer CPAupdated ,signed by user.Discus sionanddocume ntationofuser recover ygoals (thechange srequired fordischar ge)incluserand carer'sview onhowtheseca n beachieve d Recove rygoalsac hieved.Goals requirin gfurthertr eatment identified. Care plan following dischar ge, relapse preventionand crisisplan agreed, copy given toservice userand placed in mental healthno tes.Lettersummar isingtrea tment, progres s,follow-upcare plansen tto serviceu ser,GP and others. Howto re-access second arymental healthcare. Transfer/ transitio nof care toother service/ pathway organis ed. Date ofreview or follow-upsession e.g.CA T,CBTplanned . Repeatformal outcome measur es e.g.CORE ,BDI Continu etreatmen t Care Pathway Ely Soham Histon Sawsto n Melbou rn Gamlin gay CambridgeCity North Cam South Cam Burwel l Geographic Map Patient meets acare coordin ator AmI going to see again Action outside the team(e.g. housing , etc) Action inside the team Team support work Advice or Arrange to see patient Other profess ionals Psycho logy Medica l review Assess ment - Psycho logy work - Advice Is someon e else inI&T? No Yes No Yes They get a newCare Coordin ator Discha rge R&R Nothing working get better Is anyothe rservice s going towork? Yes refer Discha rge Accept ance into pathwa y I&TAssess ment Not accepte d GP IAPT Otherservice e.g. CAME O Doctor assess espt (Mon/Th u, 1hr) I&Tteam meeting (Tue, 9.30) No referral (only OOH) Phone (urgent) Letteror fax Assess ment schedu le (Acute) referral comew ith referralassess ment(w eekly) List ofpatien ts &assess menttyp es patient list when mild, referral (tray) GP Acute care I&T duty worker (sit by phone) 9-4.30, Mon-Fri Gatewa y worker Admin schedu ling I&T referral meeting Tue,9.00 IAPT Patient phone appoint ment Comew ithclinicali nfo phone appoint ment Free Form Diagram Organisation Diagram C P FTAdul t Service s fo rCa m bridge Rehab &Rec ove ry Service s C om plex Cases Service s CAME O (Early Interv e nti o nService ) Eating D is o rders Ser vices Liais o n P sychiat ry Service Gatewa y w o rkers Acute care Service s Crisis Res o luti o nTea m (CRHT T) In -patient w ards C omm unity P sychiat ric Nu rse*+ Doctor* Occupa ti o nal Therapi st* + P sych o lo gist* Supp o rt w o rker S o cial w o rker* + Alc o ho l Ser vices Ca m quit (St o p-smo kingService ) C o nsultan ts* Intake &Treat me nt Service s Intake& Treatm ent(Cambr idge No rth) Other Ser vices N o rth S o uth *: Care Coordin ator+: Duty Worker Tea m ma nager Tea m leader * + S o cial Inclusi o nTeam IA P T (I m pr ov ing Acess to P sych o lo gicalTh erapies ) Whenu rgent & OOHGP refer patient to acute care Admini strator arrangeassessm ent schedu le When Notaccepte d into pathwa y I&Ttea m refer patient to suitable service s e.g. GP,IAP T,CAM EO,etc P atient referred to IA P T P atient referred toGatewa y w o rker P atient referred to I&T team P atient referred toacute care P atient referred toduty w o rker P atient assess ed byGatewa y w o rker Whenm ild Gatewa y worker passreferral to IAPT(tr ay) P atient assess ed by I&T team Whenu rgent & normal hourGP call patient to duty worker When not urgentGP referpati ent to gatewa yworker P atient at the first meeting with a carecoo rdinat o r P atient referred to R&R When more actions and monitor ing are needed , CCarrange furthera ctions* P atient dischar ged Whenp rolonge dCCrefer patient to R&R Whenre coveredCCdischar ge patient When unclear Admini strator arrangeassessm ent schedu le When modera te or severe When accepte d into pathwa y I&Ttea m designa te care coordin ator (CC)for patient CCarrange a meeting with patient When modera te or severe Whenm ild P atient referred to o ther ser vices P atient under treat me nt Care Coordin atoragree treatme nt / care plan / risk manage ment / crisispl an with patient and arrange treatme nt Pati ent stat es wi thin I&T Transition conditio nTransition actions Pati ent stat esou tsid e of I&T P atient at GP P atient discuss ed at MDT meeting When patients get worse,uncerta in or recover ed CC discuss patients at weekly MDTmeeting When more actions and monitor ingare needed CCreview progres sand arran ge further actions* *Further actions-medicationmanageme nt -psycho logicaltreatme nt-carers' needs assess ment -manag ementof financialandhou singissues Whenhome treatme nt orward admiss ion isneede d Whend ischarg ed,but follow-u p is needed P atient at o ther service s Whens pecific needsGatewa y worker recomm ends other suitable service s State Transition Diagram Communication Diagram When urgent &OOH, enquiry (phone call) When urgent &norma l hour ,enquir y (phone call) When not urgent,referral (letter or fax) Assessm e nt schedule Assessm e nt re sults When se rious,referral (phone) Referra l &assess me nt re sults Li st of patient s &assess me nt types Li st of patient s &assess me nt types When mild, referral (tray) External stakeho lders Stakeh older s in I&T report Referra l GP Acute care D uty w o rker Gatewa y w o rker MDT tea m (weekly meeting ) Schedu ling ad m in I&T referral team I&T assess me nt team IA P T Care coo rdinat o r GP R&R Discharge letter conditi on informa tion IAP T: Impro ving Acce ss to P sychol ogical Therap y I& T: Intake and Treatm ent R&R: Rehab and Reco ve ry MD T: Multidi sciplinar y Te am deci sion Other pr o fessi o nals in team Other pr o fessi o nals o utside team referrals referrals report report referrals referrals Other service s When specific needs GP referpati entto Gatewa y worker Get assessm ent I&Ttea m assess patient Agree with care plan Receiv einfo on care coordin ator Gatewa y worker assess patient Gatewa y worker refer pt to I&T I&Ttea mdesigna te carecoordin ator Care Coordin atorcontact patient CCdevelop care plan CCinform care plan See profess ionalsas referred by CC MDTdecide next step Care coordin ator see patient P hysical Eviden ce Service User Acti o ns Visible C o ntact Service P rov ider Acti o ns In visible C o ntact Service P rov ider Acti o ns Supp o rt P ro cesses Gatewa y workercontact patient Receiv ereferral info is informe d ofthe next step I&Tclin ic I&Twa iting room I&T receptio n I&T website CCreferpt to necess ary actions Referre dprofess ionalsee patients CCreport pt to MDT CCmonitor pt progres s CC:Ca re Coordin atorMDT: Multidis ciplinaryTeam Service Blueprint    Study II – Choice and Usage Healthcare workers Adult mental health service for intake and treatment
  28. 28. Human Factors & Complex Systems Group Loughborough Design School Study II – Choice and usage
  29. 29. Diagram Choice and Usage Model Perceived Ease of Use Choice to use certain diagrams Actual use of certain diagrams Perceived Usefulness Diagram Characteristics Social Influence Facilitating Conditions Individual Differences (Adjusted from Venkatesh, V., 2008)
  30. 30. Diagram Choice and Usage Model Perceived Ease of Use Choice to use certain diagrams c Perceived Usefulness Participant’s communication style (visual/non-visual) Diagram’s relevance to issues discussed Diagram’s consistency wtih participant’s mental models Participant’s familiarity wtih real pathways Individual Differences Diagram Characteristics (Jun, G., under review)
  31. 31. Study III - Workshops Reality    Safer Medicine Management Pathways Hospitals General practices District nurses Community pharmacies Hospital pharmacies Social care workers Voluntary services (e.g. AgeUK, EPP* ) Ambulances Drug companies Equipment suppliers Distributors Medical device agency Rehap services Medicine control agency Backstage communication Frontstage communication Patients Phone PostFax Internet @ NHS email Phone emis web pharmacy IT system Hospital patient record Care agency workers IAS Family & friends Visiting books - Patient takes medicine Patient with low on medicine When patient/carer does it him/herself - Patient/carer fills in the repeat prescriptionslip - Patient/carer drops the repeat prescriptionslip at GP (visit/call?) - Patient/carer collects repeat prescription (within 48 hrs?) - Patient/carer drops repeat prescription to pharmacy When pharmacy has agreed to act on behalf of patient (prescriptioncollectionservice) - Pharmacy contacts patient (every patient?) - Pharmacy fills in the repeat prescriptionslip - Pharmacy drops the repeat prescriptionslip to GP - Pharmacy collects a repeat prescription from GP Patient at home with sufficient medicine New (repeat) prescription at pharmacy Patient admitted to hospital When patient needs hospital care - Patient goes to hospital - Patient takes own medicine to hospital (?) When patient ready to go home - Hospital discharges patient - Hospital provides medicine for 0/2/4 weeks? - Hospital informs GP and pharmacy? - Pharmacy checks prescription - Pharmacy contacts GP for enquiry (if required) - Pharmacy dispenses medicine Patient seen by GP or nurse When patient has appointment at GP - Patient visits GP When no change in medicine - Patient goes home When need for medicinechange - GP issues prescription - GP calls pharmacy (?) - Patient drops it to pharmacy When pharmacy offers delivery and patient chooses to get it - Pharmacy delivers medicineto patient's home Otherwise - Patient/carer collects medicine Patient at home with sufficient medicine (over 4 medicines) Medicine dispensed (ready to be collected)
  32. 32. Human Factors & Complex Systems Group Loughborough Design School Issues  Not enough time for systems mapping  Inconsistent and uneven participation  Potential of using online engagement  How to present complex system maps?
  33. 33.  Open IDEO
  34. 34. http://www.nhscitizen.org.uk/
  35. 35. Study IV- Interactive zoom in/out Reality    Patient Discharge Processes 20 students Zoom in/out Ward Hospital Pharmacy Central record Home, Nursing/care home, Interim beds Transitional care team GPs (pt’s, facility’s) 1. Assessment notification (Fax1) [pt detail, reason for transition care] 2. Assessment notification (Fax2) [discharge date] 3. Assessment notification (Fax2) [confirmation, name of carer] 4. discharge summary 5.TTO medicine 7. discharge summary 7. discharge summary 6. discharge summary 6.TTO medicine 6. patient 5. discharge summary Nurse Multidisciplinary team Doctor (SHO, HO) Ward pharmacist Pharmacy technician Ward clerk 0. Transitional Care needed 1.1 discharge date 1.1 discharge date 3.1 draft discharge summary 3.2 confirmed discharge summary 4. discharge summary 5. TTO medicine NurseMedicine storage 7. discharge summary Ward 5. 1 TTO medicine 5. 1discharge summary 5. 1discharge summary 5. 1 TTO medicine 6.1 discharge summary Hospital Pharmacy Central record Home, Nursing/care home, Interim beds Transitional care team GPs (pt’s, facility’s) 5.TTO medicine 7. discharge summary 7. discharge summary 6. discharge summary 6.TTO medicine 5. discharge summary Nurse Multidisciplina ry team Doctor (SH O, H O) Ward pha rmacist Pharma cy technician Ward cle rk 0.Transitional Care needed 1.1 discharge date 1.1 discharge date 3.1 draft discharge summary discharge summary NurseMedicine storage 5. 1TTO medicine 5. 1discharge summary 5. 1discharge summary 5. 1TTO medicine summary
  36. 36. Human Factors & Complex Systems Group Loughborough Design School Hospital Pharmacy Central record Home, Nursing/care home, Interim beds Transitional care team GPs (pt’s, facility’s) 5.TTO medicine 7. discharge summary 7. discharge summary 6. discharge summary 6.TTO medicine 5. discharge summary Nurse Multidisciplina ry team Doctor (SH O, H O) Ward pha rmacist Pharma cy technician Ward cle rk 0.Transitional Care needed 1.1 discharge date 1.1 discharge date 3.1 draft discharge summary discharge summary NurseMedicine storage 5. 1TTO medicine 5. 1discharge summary 5. 1discharge summary 5. 1TTO medicine summary
  37. 37. Human Factors & Complex Systems Group Loughborough Design School Ward Hospital Pharmacy Central record Home, Nursing/care home, Interim beds Transitional care team GPs (pt’s, facility’s) 1. Assessment notification (Fax1) [pt detail, reason for transition care] 2. Assessment notification (Fax2) [discharge date] 3. Assessment notification (Fax2) [confirmation, name of carer] 4. discharge summary 5.TTO medicine 7. discharge summary 7. discharge summary 6. discharge summary 6.TTO medicine 6. patient 5. discharge summary Nurse Multidisciplinary team Doctor (SHO, HO) Ward pharmacist Pharmacy technician Ward clerk 0. Transitional Care needed 1.1 discharge date 1.1 discharge date 3.1 draft discharge summary 3.2 confirmed discharge summary 4. discharge summary 5. TTO medicine NurseMedicine storage 7. discharge summary Ward 5. 1 TTO medicine 5. 1discharge summary 5. 1discharge summary 5. 1 TTO medicine 6.1 discharge summary
  38. 38. Evaluation – Performance and preference  Time taken till participants felt they had a good understanding of the map contents  Usability - Questionnaire  Easily understandable (ease of use)  Helpful in understanding and communicating how the system works (usefulness)  Enjoyable to use the map  Semi-structured interviews
  39. 39. Human Factors & Complex Systems Group Loughborough Design School Results - Time Ave Std Max Min Zoom in/out interaction 6 min 57 sec 55 sec 8 min 56 sec 5 min 52 sec No interactions 7 min 27 sec 49 sec 8 min 54 sec 6 min 12 sec
  40. 40. Results - Questionnaire 1. Easily understandable 2. Helpful in better understanding and communicating 3. Enjoyable 0 2 4 6 8 10 Strongly Agree Agree Neutral Disagree Strongly Disagree Zoom in/out interaction No interaction 0 2 4 6 8 10 Strongly Agree Agree Neutral Disagree Strongly Disagree 0 2 4 6 8 10 Strongly Agree Agree Neutral Disagree Strongly Disagree
  41. 41. Human Factors & Complex Systems Group Loughborough Design School Results- Interviews Positive Negative Etc Zoom in/out interaction Fun and easy Interesting Daunting and overwhelming Hard to control Top-down vs bottom-up Clearer instruction No interactions Easy and useful Complicated, unclear and overwhelming Better use of colour
  42. 42. Human Factors & Complex Systems Group Loughborough Design School Conclusion  Interactive zoom in/out map took less time in understanding  Interactive zoom in/out map was rated better in the interview (more fun)  However, little difference between them in terms of perceived ease of use and usefulness
  43. 43. Human Factors & Complex Systems Group Loughborough Design School Diagram Choice and Usage Model Perceived Ease of Use Choice to use certain diagrams Actual use of certain diagrams Perceived Usefulness Diagram Characteristics Social Influence Facilitating Conditions Individual Differences (Venkatesh, V., 2008) Perceived Fun?
  44. 44. Human Factors & Complex Systems Group Loughborough Design School Thank You! Alfred Clatworthy Holmen Thomas Jun, g.jun@lboro.ac.uk Loughborough Design School Loughborough University, UK Activity view Stakeholder view Information /material view Sequential linkInformation link Hierarchical link stakeholder diagram information diagram process content diagram data flow diagram IDEF0 flowchart swim lane activity diagram communication diagram state transition diagram group1 group5 group4 group2 group3 sequence diagram Perceived Ease of Use Choice to use certain diagrams Perceived Usefulness Diagram Characteristics Social Influence Facilitating Conditions Individual Differences

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