Presentation
Importance of Representation Throughout the Organizational Environment to Support Risk Reduction in Hospital Systems
DescriptionBackground: The organizational environments of hospital systems in the U.S. are complex, even to those working within them. The complicated nature of administrative systems can make it easier for frontline healthcare workers to fall between the cracks. When this occurs, workers may begin to feel powerless over their daily problems, having a direct influence on their performance, health, and well-being. This became increasingly apparent as the COVID-19 pandemic placed extreme pressure on frontline workers and the systems employing them. We examined these issues within the healthcare system further from the perspective of ultrasound users, primarily echocardiographers, vascular technologists, and sonographers conducting abdominal, obstetric, and gynecologic examinations.
Methods: Two questionnaires were distributed via email to an existing registry of ultrasonography professionals participating in a longitudinal study focused on understanding factors associated with worker health and well-being. Among other items in these two questionnaires, we included forced-choice and open-ended free-text questions related to the effects of the COVID-19 pandemic on medical ultrasound professions and multiple free-text questions asking for solutions to support health and well-being concerning the administrative and organizational environment and training and general health practices. Following an initial review of free-text responses, we conducted a member check through interviews with select respondents across different sonography subfields (e.g., OB-GYN, cardiac) to explore whether our initial solution themes were consistent with their field experiences and to garner additional insight into this worker population’s pandemic experiences.
Using a grounded theory approach, we completed thematic analyses of 600 responses focused on the effects of COVID-19 and 377 responses to questions seeking experience-informed solutions. In our analysis of responses to both surveys, we applied a collaborative analytic approach to generate a set of comprehensive themes describing respondents’ reflections. We pursued validation for both analyses through collaborative analyses where the research teams shared memos written during individual coding. Throughout this process, we could see alignment across coding of researchers with and without sonography backgrounds. We similarly coded our interview transcripts as we constructed the final set of themes.
Findings: After analyzing the COVID-19 survey responses and interviews, we identified a unifying theme of “Healthcare Heroes’ Kryptonite” that describes the powerlessness felt by healthcare workers who experienced extrinsic limits to the care they could provide to patients. Implicated among these limits was the work system, particularly heavy workloads and changes to daily workflow enacted upon the workers. As a result of these factors, ultrasound users felt impeded in their ability to adequately provide patient care. As we heard about the difficulties workers experienced due to extrinsic pressures on the healthcare system, we became interested in exploring this population’s reflections on potential solutions to address worker health. Through our analysis of these responses, we generated five themes to characterize respondent solutions for broadly addressing their health and well-being.
These five themes aligned well with Neville Moray’s systems model of ergonomics, which we adapted to form a conceptual model for understanding worker support and resources across administrative levels. This adapted model acted as a tool for us to consider the levels of influence extant within hospital systems more deeply. We were able to visualize the five solution themes as related to administrative structures, which were implicated throughout multiple responses. The model portrays a series of squares situated within one another. This nestedness represents the dominant top-down authoritative relationships at play throughout the hospital administrative system. Moving from the outermost layer to the innermost, the levels considered were Societal and Cultural Pressures, Legal and Regulatory Rules, Organization and Management, Team and Group Behavior, and Individual Behavior.
As we fit our solution themes within the conceptual model, we observed a hierarchical or top-down effect between the sonographer-provided solutions. The process of situating sonographer-generated solution themes into our model consisted of determining whether a solution could be implemented at the Individual Behavior level or needed to be elevated to a level with greater authority. When combined with what we learned about the effects of COVID-19 on the hospital system, the visualization of a hierarchical relationship between levels of solution implementation helped us to arrive at an overarching conclusion, “Risk reduction relies on proper employee representation.” That is, there must be people with knowledge that reflects frontline workers’ experiences embedded throughout the system to reduce the risk of injury and ensure workers can conduct their work properly.
Implications: These findings have implications for the broader healthcare system, particularly for solution implementation throughout hospitals’ administrative environments. The conceptual model generated by our research team has implications for how problem-solving related to health workers’ daily work may occur via a systems approach. Additionally, our findings suggest the relevance of multidimensional relationships between the various authoritative bodies in a hospital’s administrative system. Our sampling of ultrasound users may not represent all sonography subfields; thus, the findings are only descriptive of our sample of the ultrasound user workforce. Future efforts to understand enabling relationships within specific hospital environments and subfields may directly assist in organizational change to better facilitate solutions to healthcare workers’ daily challenges. Effective solutions will go on to directly influence healthcare workers’ personal health, well-being, and ability to provide quality patient care. Building such pathways to solution implementation may serve the healthcare system particularly well in the case of emergencies, such as the recent COVID-19 pandemic, which placed unprecedented stress upon hospitals’ organizational environments and the individuals employed within them.
Methods: Two questionnaires were distributed via email to an existing registry of ultrasonography professionals participating in a longitudinal study focused on understanding factors associated with worker health and well-being. Among other items in these two questionnaires, we included forced-choice and open-ended free-text questions related to the effects of the COVID-19 pandemic on medical ultrasound professions and multiple free-text questions asking for solutions to support health and well-being concerning the administrative and organizational environment and training and general health practices. Following an initial review of free-text responses, we conducted a member check through interviews with select respondents across different sonography subfields (e.g., OB-GYN, cardiac) to explore whether our initial solution themes were consistent with their field experiences and to garner additional insight into this worker population’s pandemic experiences.
Using a grounded theory approach, we completed thematic analyses of 600 responses focused on the effects of COVID-19 and 377 responses to questions seeking experience-informed solutions. In our analysis of responses to both surveys, we applied a collaborative analytic approach to generate a set of comprehensive themes describing respondents’ reflections. We pursued validation for both analyses through collaborative analyses where the research teams shared memos written during individual coding. Throughout this process, we could see alignment across coding of researchers with and without sonography backgrounds. We similarly coded our interview transcripts as we constructed the final set of themes.
Findings: After analyzing the COVID-19 survey responses and interviews, we identified a unifying theme of “Healthcare Heroes’ Kryptonite” that describes the powerlessness felt by healthcare workers who experienced extrinsic limits to the care they could provide to patients. Implicated among these limits was the work system, particularly heavy workloads and changes to daily workflow enacted upon the workers. As a result of these factors, ultrasound users felt impeded in their ability to adequately provide patient care. As we heard about the difficulties workers experienced due to extrinsic pressures on the healthcare system, we became interested in exploring this population’s reflections on potential solutions to address worker health. Through our analysis of these responses, we generated five themes to characterize respondent solutions for broadly addressing their health and well-being.
These five themes aligned well with Neville Moray’s systems model of ergonomics, which we adapted to form a conceptual model for understanding worker support and resources across administrative levels. This adapted model acted as a tool for us to consider the levels of influence extant within hospital systems more deeply. We were able to visualize the five solution themes as related to administrative structures, which were implicated throughout multiple responses. The model portrays a series of squares situated within one another. This nestedness represents the dominant top-down authoritative relationships at play throughout the hospital administrative system. Moving from the outermost layer to the innermost, the levels considered were Societal and Cultural Pressures, Legal and Regulatory Rules, Organization and Management, Team and Group Behavior, and Individual Behavior.
As we fit our solution themes within the conceptual model, we observed a hierarchical or top-down effect between the sonographer-provided solutions. The process of situating sonographer-generated solution themes into our model consisted of determining whether a solution could be implemented at the Individual Behavior level or needed to be elevated to a level with greater authority. When combined with what we learned about the effects of COVID-19 on the hospital system, the visualization of a hierarchical relationship between levels of solution implementation helped us to arrive at an overarching conclusion, “Risk reduction relies on proper employee representation.” That is, there must be people with knowledge that reflects frontline workers’ experiences embedded throughout the system to reduce the risk of injury and ensure workers can conduct their work properly.
Implications: These findings have implications for the broader healthcare system, particularly for solution implementation throughout hospitals’ administrative environments. The conceptual model generated by our research team has implications for how problem-solving related to health workers’ daily work may occur via a systems approach. Additionally, our findings suggest the relevance of multidimensional relationships between the various authoritative bodies in a hospital’s administrative system. Our sampling of ultrasound users may not represent all sonography subfields; thus, the findings are only descriptive of our sample of the ultrasound user workforce. Future efforts to understand enabling relationships within specific hospital environments and subfields may directly assist in organizational change to better facilitate solutions to healthcare workers’ daily challenges. Effective solutions will go on to directly influence healthcare workers’ personal health, well-being, and ability to provide quality patient care. Building such pathways to solution implementation may serve the healthcare system particularly well in the case of emergencies, such as the recent COVID-19 pandemic, which placed unprecedented stress upon hospitals’ organizational environments and the individuals employed within them.
Event Type
Discussion Panel
Oral Presentations
TimeTuesday, March 2610:30am - 10:50am CDT
LocationSalon A-1
Hospital Environments