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Human Factors

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Basic Concepts and Theories of Coordination and Planning – Systems View

• Objectives: To understand– The global perspectives of coordination– New frontiers of coordination research

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Human Factors

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Medicine

Coordination: What it is

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Human Factors

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Coordination: Scales and Perspectives

• Temporal scales– Seconds/minutes

– Hours/shifts

– Weeks/months

– Years

• Org scales– Individuals/groups

– Teams/work units

– Organization

– Industry

• Perspectives– “Mechanical”: articulation

& concatenation

– Social: willingness to work together

– Artifacts: supporting tools

– Organizational: models of firms

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Human Factors

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Relevant Disciplines

• Cognitive psychology: eg, human planning, monitoring, problem solving

• Computer support cooperative work: eg, groupware, mediated communication, common information space

• Team performance: eg, shared mental models, crew resource management, leadership, team coordination

• Scheduling and workflow: eg, constraints, slacks, sensitivity analysis

• Organizational behavior: eg, culture, norms, standard operating procedures

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Examples of Problems in Healthcare

• Management of surgical operating rooms• Management of intensive care unit

resources (“bed management”)• Flows in emergency department• High intensive situations, such as high risk

child birth, surgery, resuscitation• Hand-offs• Care coordination for chronic diseases

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Medicine

Coordination is about managing interdependencies

• Coordination is managing dependencies between activities (E.g., Malone & Crowston, 1994)– Major types of dependencies

• Shared resources (resource allocation)

• Prerequisite constraints (sequencing)

• Simultaneity constraints (synchronization)

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Coordination is about process management

• “To many it seems as if the classical theory and real industrial problems reside in quite different worlds.”

• “In practice planning and scheduling do not come packaged as discrete problems that can be ‘solved’, optimally or otherwise. Rather they are dynamic processes that need to be managed over time. People, individual or teams manage the processes.”

BL MacCarthy & J Welson, 2001

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Human Factors

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Medicine

Coordination for a case start-time

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Medicine

Coordination is about information

• Monitoring deviations

• Identifying threats and opportunities

• Understanding intentions of others

• Monitoring activities of others

• Establishing “common grounds”

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Human Factors

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Medicine

Coordination is about anticipatory behaviors

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Human Factors

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Medicine

Xiao et al, 1997

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Human Factors

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Medicine

Xiao et al, 1997

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Medicine

Coordination is about sharing mental models

• Sharing strategies and concerns is part of coordination to promote anticipatory behavior

• Team briefing/debriefing

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Human Factors

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Medicine

Coordination is about resolution of conflicts

• Establishing consensus of norms and expectation

• Maintaining credibility

• Negotiating priorities

• Assigning accountability

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Human Factors

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Medicine

Coordination is about multiple levels of control

• Using both feedforward and feedback control

• Resolving mutual information needs on – Timing– Specification of tasks– Goals and priorities– Procedures for resolving exceptions

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Human Factors

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Medicine

Coordination is about relations (not just information)

• Inter-personal relations can be the foundation of information sharing as a human activity (relational coordination)– Coordination carried out through relationships of

• Shared goals– Subgoal versus overall work process

• Shared knowledge– Input/output requirements

• Mutual respect– Considering impact of their actions

Gittell, 2002, Management Science

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Human Factors

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Summary

• Coordination is about – managing interdependencies

– process management

– information

– anticipatory behaviors

– sharing mental models

– resolution of conflicts

– relations (not just information)

– multiple levels of control

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Human Factors

Techno-logy

Medicine

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Medicine

Southwest’s Culture is Focused on Relationships

• Southwest’s most distinctive organizational competency is its ability to build and sustain relationships characterized by – Shared goals– Shared knowledge– Mutual respect

• Focus on relationships is the fundamental driver of leadership, culture, strategy, and coordination at Southwest(Gittell, 2003)

Jim Messina, Ph.D

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Medicine

Impact of Strong Relationships at Southwest

• Employees embrace their connections with one another

• Which allows them to coordinate more effectively across all functions (Gittell, 2003)

• ““We at Southwest Airlines foster and embrace fun, We at Southwest Airlines foster and embrace fun, creativity, individuality, and empowerment. We creativity, individuality, and empowerment. We love our employees. We trust our employees.” love our employees. We trust our employees.” (West, 2005)(West, 2005)

Jim Messina, Ph.D

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Human Factors

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Medicine

Impact of Shared Goals at Southwest

• Motivates individuals to move beyond what is best for their own narrow area of responsibility within their own function

• Motivates them to to act in the best interests of the overall process of the organization and lessens competition between different functions within the organization (Gittell, 2003)

• “Hire People who can Laugh at themselves.” (West, 2005)(West, 2005)

Jim Messina, Ph.D

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Human Factors

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Medicine

Impact of Shared Knowledge at Southwest

• Shared knowledge at Southwest is about how the tasks of one person or group are related to all other tasks

• This enables the workforce to act with regard for the total process

• This enables the workforce to be more competent, efficient and coordinated than their competitors(Gittell, 2003)

• ““The philosophy at Southwest has always been, The philosophy at Southwest has always been, ‘Never forget where you came from’.” ‘Never forget where you came from’.” (West, 2005)(West, 2005)

Jim Messina, Ph.D

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Human Factors

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Medicine

Impact of Respect for Others at Southwest

• Encourages all employees to value the contributions of their colleagues

• Encourages all employees to consider the impact of their actions on others

• Reinforces the tendency to act in the best interests of the overall work process (Gittell, 2003)

Jim Messina, Ph.D

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Human Factors

Techno-logy

Medicine

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Human Factors

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Medicine

Coordination: Sample Research Questions

What are the information needs for coordination?

How is coordination achieved?

How to support coordination?

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Human Factors

Techno-logy

Medicine

Concepts Useful for Observations

• Distributed cognition (Hutchins)– Unit of analysis is work systems, not individuals (e.g., humans +

their tools)

• Common information space (Bossom)– Implicit communication achieved through sharing (e.g.,

whiteboard)

• Awareness (Dourish)– Information about activities of others should be provided in the

peripheral without explicit efforts of asking

• Trajectory (Strauss)– Expertise in anticipating temporal courses of events is key for

anticipatory behaviors

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Medicine

Fundamentals of observations• Goals of observations

– Evaluation, design requirements

• Tools of observations– Time & motion (e.g., distributions of activities)– Task analysis (e.g., purposes of activities)– Link analysis (e.g., sequence of activities)

• Biases and limitations of observations– Sampling, interference, time-consuming

• Theoretical perspectives : know your “units” and “objects”

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Human Factors

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Medicine

Video Analysis Methodology

• Task templates

• Thematic analysis

• Time-motion studies

• Communication analysis

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Medicine

Model

30Farbod N. Hagigi

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Medicine

National Trauma Center IT Survey

• Description of field-hospital communication related information technology

• Field communication accuracy and completeness

• Intra-hospital expertise coordination

• Trauma team organizations and culture

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Respondents

• Settings: 456 Level I and Level II Trauma Centers in the US

• Subjects– 145 hospitals completed sets of survey

(1 director, 1 coordinator, and > 2 clinicians)

– 1233 respondents from 308 hospitals • 254 Trauma Directors

• 212 Trauma Coordinators

• 767 Trauma Clinicians from 207 hospitals

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Medicine

IT Devices for Alerting The Trauma Team by Admission Volume

0

20

40

60

80

100

<500 500-1000 1001-2000 >2000

Computerized group page Manual group page

%

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Medicine

Summary

• Qualitative methods can be very effective in theorizing about coordination

• Surveying through questionnaires may be useful in understanding mechanisms of coordination