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Table 1 SCOPE STS analysis to be applied to the current ED system

From: Study protocol for evaluating the implementation and effectiveness of an emergency department longitudinal patient monitoring system using a mixed-methods approach

System component

Description

Analysis

Methods

Process functionality

The sequence of steps involved in the patient pathway through the ED where this relates to ED-ACE. The basic organising principle of STS is sequence, not necessarily in a simple linear fashion, but encompassing parallel activities, feedback loops and iterations. Resources (people/information/material) are transformed through tasks into outcomes that have value.

This will build on the EMP process map of the patient pathway and delve deeper into where the ED-ACE will be used. Critical points along the ED care pathway and key dependencies at these points will be identified. STS analysis will be carried out on the nature of these dependencies and in particular on the nature of any uncertainty being managed. In particular we will explore the supply of resources (people, information and material), their transformation through tasks and the co-ordination or management of associated dependencies.

The post-doctoral researcher will undergo a period of immersion in the day-to-day working of the ED shadowing staff members, tracking patients through the system, observations (e.g., of communication and information sharing at board rounds), corridor conversations and informal meetings, taking of ethnographic field notes. How work actually happens (the informal system) will be compared to the existing EMP map of how work should happen (the formal system).

The flow of information and the sharing of knowledge

Shared information, knowledge and understanding drive co-ordination, and other intentional acts. This knowledge and understanding is not necessarily explicit, expressed and formalised; it provides the practical ‘know-how’ that justifies and supports action and anticipates the consequences of action. Such actions and interactions (of people and technology) create facts/data that are then used to re-shape our understanding of the system.

Current documentation in use will be examined including patient charts, patient monitoring and recording, workflow charts, staffing quotas, performance reports including patient flow, quality reports and safety reports. The current key performance indicators (KPIs) and safety performance indicators (SPIs) will be examined, how are these measured, how are they displayed, fed back to staff, communicated to patients, how is the data that is currently gathered used for system improvement, what are the current drivers of system performance.

The post-doctoral researcher will attend monthly clinical risk meetings and hospital seminars on patient care flow, analysis of EMP-relevant KPIs, SPIs and flow charts, exploration of data captured on the hospitals patient information monitoring system (PIMS) reports (e.g., times along patient care pathway), ED documentation analysis including patient charts.

The social system

Work happens in organisations because people facilitate it happening through a series of social relations, team structures, trust relationships and accountability.

An analysis of the social system will be formed through observations of activity in ED and carrying out interviews with key stakeholders in the hospital’s emergency care system including triage nurses, nurses, clinical nurse managers, non-consultant hospital doctors, registrars and consultants in emergency medicine, administration, management, risk management and patient representation.

Interviews will be carried out with a sample of nurses and clinicians and administrative staff. The exact sample size will be determined by the data gathered – once data saturation has been reached the interviews will stop. Purposive sampling will be employed for the interviews. Coding and thematic analysis will be carried out on the data by two researchers. The coding will be supported by NVivo software package.