A qualitative study of workflow and information systems within Emergency Departments in the UK. By: Eliza M Mazlan A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy The University of Sheffield Faculty of Social Sciences Information School JANUARY 2017 TABLE OF CONTENTS CONFERENCE PAPERS AND POSTER ................................................................. i DOCTORAL CONSORTIUM ............................................................................... i LIST OF FIGURES .............................................................................................. ii LIST OF TABLES ............................................................................................... iv LIST OF APPENDICES ........................................................................................ v GLOSSARY OF ACRONYMS ............................................................................. vii GLOSSARY OF TERMS ...................................................................................... x FLOW CHART DIAGRAM KEYS ........................................................................ xv ACKNOWLEDGMENT .................................................................................... xvi ABSTRACT ................................................................................................... xvii CHAPTER 1: INTRODUCTION ............................................................................1 1.1. Overview .................................................................................................................................. 1 1.2. Background to the research .................................................................................................... 2 1.3. Importance of the research ..................................................................................................... 5 1.4. Aim of the research ................................................................................................................. 7 1.5. Objectives ................................................................................................................................ 7 1.6. Structure of thesis ................................................................................................................... 7 CHAPTER 2: LITERATURE REVIEW ....................................................................9 2.1 Introduction ............................................................................................................................. 9 2.2 Literature review methods ...................................................................................................... 9 2.3 Health Information Technology ............................................................................................ 10 2.4 HIT integration into healthcare workflows ........................................................................... 12 2.4.1 Unintended consequences of HIT implementation ...................................................... 12 2.4.2 Workflow – an introduction .......................................................................................... 15 2.4.3 Workflow-related research outside healthcare ............................................................ 16 2.4.4 Workflow-related research in healthcare ..................................................................... 19 2.5 Emergency Department Information System (EDIS) ............................................................. 26 2.5.1. Characteristics and information behaviour in emergency care setting ........................ 26 2.5.2. HIT in emergency care ................................................................................................... 27 2.5.3. Emergency Department (ED) workflow......................................................................... 29 2.5.4. England National Programme for IT .............................................................................. 34 2.6 Frameworks ........................................................................................................................... 36 2.6.1. Socio-technical framework ............................................................................................ 36 2.6.2. Computer Supported Cooperative Work (CSCW) ......................................................... 40 2.6.3. CSCW and HIT ................................................................................................................ 41 2.7 Synthesis ................................................................................................................................ 47 2.8 Limitations of existing research ............................................................................................. 49 2.9 Conclusion and research questions ....................................................................................... 51 CHAPTER 3: RESEARCH METHODOLOGY ........................................................ 52 3.1 Introduction ........................................................................................................................... 52 3.2 Research philosophy ............................................................................................................. 52 3.3 Research methodology .......................................................................................................... 53 3.3.1. Research approach ........................................................................................................ 53 3.3.2. Qualitative methods ...................................................................................................... 55 3.4 Methods ................................................................................................................................ 58 3.4.1. Gaining access to the research settings ........................................................................ 58 3.4.2. Ethical considerations.................................................................................................... 59 3.4.3. Pilot study and immersion in the fields ......................................................................... 60 3.4.4. Data collection methods ............................................................................................... 62 3.4.5. Sampling and recruitment ............................................................................................. 70 3.4.6. Saturation ...................................................................................................................... 72 3.4.7. Triangulation ................................................................................................................. 74 3.4.8. Data analysis .................................................................................................................. 75 3.4.9. Triangulation of interviews and observational field notes with documentary sources 81 3.4.10. Research trustworthiness .............................................................................................. 81 3.5 Methodological limitation ..................................................................................................... 83 3.6 Conclusion ............................................................................................................................. 84 CHAPTER 4: RESEARCH SETTINGS .................................................................. 85 4.1 The adult Emergency Department (ED) ................................................................................ 85 4.1.1 Description .................................................................................................................... 85 4.1.2 Physical layout ............................................................................................................... 85 4.2 The paediatric Emergency Department (ED)......................................................................... 87 4.2.1 Description .................................................................................................................... 87 4.2.2 Physical layout ............................................................................................................... 87 CHAPTER 5: CASE STUDY 1 – ADULT ED ......................................................... 89 5.1 Components of the ED workflow .......................................................................................... 91 5.1.1. Emergency care services ............................................................................................... 91 5.1.2. Members of the ED team .............................................................................................. 93 5.1.3. Patient flows .................................................................................................................. 96 5.1.4. Collaborative work processes ...................................................................................... 100 5.2 Information artefacts in supporting the ED workflow ........................................................ 118 5.2.1. Information artefacts .................................................................................................. 119 5.2.2. Characteristics of the information artefacts in supporting collaborative work .......... 129 5.2.3. Integration issues of the information artefacts into the ED workflow ....................... 136 5.3 Synthesis .............................................................................................................................