Inefficient Processes and Associated Factors in Primary Care Nursing: System Configuration Analysis

Area of Science:

• Healthcare Systems Engineering
• Primary Care Practice
• Health Information Technology (HIT) Implementation

Background:

• Primary care nursing is increasingly complex and team-oriented.
• Mobile health information technologies (HITs) have had mixed success in aiding nurses with indirect care tasks.
• Past HIT introductions may have failed due to poor integration with existing work systems, particularly in primary care settings.

Purpose of the Study:

• To characterize primary care nurses' and health technicians' perceptions of process inefficiencies.
• To identify work system factors contributing to these inefficiencies.

Main Methods:

• Exploratory work system analysis using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model.
• Semistructured contextual interviews with primary care nurses and health technicians in urban and rural settings.
• Directed qualitative content analysis and configuration analyses of interview transcripts.

Main Results:

• Participants identified managing patient calls and clinic walk-in visits as inefficient processes.
• Organizational policies and technology usability issues, such as tablet-based check-ins, contributed to frequent, repetitive, and difficult tasks.
• Organizational and technological factors were perceived as most adaptable, with suggestions for new tools for triage and symptom reporting.

Conclusions:

• Process adaptations in response to organizational policy and technology changes, without system-wide adjustments, indicate work inefficiencies.
• Understanding the impact of policy implementation on the primary care work system is crucial for improving HIT effectiveness.
• Future HIT interventions must consider influential work system factors and their effects on work processes for successful implementation.