Clinician Communication and Patient Safety in Pediatrics: A Practical Application of Human-Centered Design for Problem Identification and Analysis

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Abstract
Background: We established a Patient Safety Learning Lab (AHRQ R18HS029473) to examine the sociotechnical system that drives interprofessional communication in pediatric inpatient settings in the context of evolving communication technologies, and to co-create and evaluate solutions with clinician end users. Here, we describe the use of human-centered design and system engineering processes for the Problem Analysis phase of this project. Methods: We applied the “Empathize” and “Define” steps of the design thinking process to our Problem Analysis. The goal of the Empathize step is to generate a comprehensive understanding of a problem(s) as experienced by the end user. We conducted interviews and observations with interprofessional clinicians from pediatric inpatient units in a single children’s hospital. We used other operational and clinical data to triangulate findings (clinician secure messaging metadata, survey data, and policies/procedures). In the “Define” step, we iteratively developed user-centered problem statements. Results: Data synthesized for the problem analysis included: interviews with 28 clinicians, 32 hours of unit observations; metadata for 433,432 secure messages; 155 free-text clinician survey responses; and 40 communication-related policies/procedures. The Problem Analysis revealed communication challenges in the following domains for clinicians providing frontline care (i.e., bedside nurses, residents, frontline fellows): (1) efficiently locating and contacting other members of the care team; (2) communicating urgency level of information; and (3) managing high volume of minimally informative messages. Conclusions: Practical application of human-centered design and systems thinking contributed to a more holistic understanding of communication challenges, and their patient safety implications, from the perspective of multiple end-user groups.

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