Visualizing dermatology clinic routines using narrative networks

Healthcare routines consist of interdependent events essential to patient care, and understanding each role's contribution is critical for effective processes. Aggregating these interdependent events and perspectives into patterns has been recognized as a central problem in empirical research on routines. The problem is harder when participants have different understandings of an organizational routine. We combine qualitative structured interviews and narrative event networks using ThreadNet, an R-based software, to visualize the clinic process in dermatology. Structured interviews captured role-specific clinic visit activities from 36 dermatology clinic staff members. Narrative event networks illustrated the role-specific activities. Physicians had the highest cross-role awareness, whereas outpatient access specialists and residents were the least informed. Physicians reported 54% of actions, reflecting only half of the total clinic activity. Licensed practical nurse, residents, and outpatient access specialists showed less understanding of the complete visit process (37, 27, and 25%, respectively). The application of narrative networks to sequence data (ie, structured interviews, electronic health record) can aggregate multiple fragmented interdependent patterns to enhance our understanding of clinic processes and routines.