Complexity in Emergency Care
2008 - Present
I started the PhD program at The University of Texas School of Health Informatics August 2008. My research is conducted under the supervision of Dr. Todd R. Johnson and Dr. Jiajie Zhang.
The Emergency Room is a non-deterministic environment where decisions are made on an ad-hoc basis through opportunistic and collaborative planning. The emergent behavior of the ER results in errors that arise from system complexity and can be arduous to predict based solely upon a unitary clinical agent. Modeling emergency care as a Complex Adaptive System avoids over simplification through reductionist linear decomposition of the system by emphasizing the non-linear interactions of clinicians that lead to self-organization and emergent behavior. The view of the emergency room as a superorganism with medical error as an emergent property may lead to process change or interventions that could improve health care quality.
Distributed cognition holds that collaborative work is the result of cognitive processes whose collective knowledge is distributed among groups of people, artifacts, and internal/external object representations. As such, emergent behavior can arise from such a complex system that is non-linear and impossible to predict by examining the function of a unitary agent. Identifying global behaviors that have a tendency to yield the emergent property medical error may allow for development of decision support applications that can identify unsafe operational modes that will permit identification of potential failures before death of the system occurs.
My research is comprised of two interrelated Complexity Science substrates. The overarching goal of my research is to understand the emergent behavior of medical error. To accomplish this, I am utilizing two approaches: i). simulation and ii). Radio Frequency Identification (RFID) tracking of clinicians and assets. The simulation is being developed using ethnographic observation and Cognitive Task Analysis (CTA) to understand the workflow and cognitive processes of the level-one trauma center at Hermann Memorial Hospital in Houston TX. The RFID tags will enhance the development of the simulation, assist in the validation of the simulation, and allow for studying the socio-technical system using Social Network Analysis.
Preliminary Model
Below is the physical layout for the Memorial Hermann Level-One trauma center at Houston Texas.
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Below is the GIS layout used in the simulation.
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Below is a video of the preliminary simulation in action.
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Below is a video of the simulation with cognitive mapping of patients and electronic medical record information driving behavior. |
Complexity in Health Care Lecture
This talk gives an overview of complexity science and how the theory can be applied to prevent EMR implementation failure.
Relevant Publications
Poster Abstracts
J.C. Goodwin, J. Zhang, and T.R. Johnson. (2008, Abstract). Modeling Emergency Care as a Complex Adaptive System: Implications for Quality Improvement. 2008 Keck Anual Research Conference.
J.C. Goodwin, J. Zhang, and T.R. Johnson. (2008, Abstract). Modeling Emergency Care as a Complex Adaptive. 2008 University of Texas Health Science Center Research Day.
Abstract
Modeling Emergency Care as a Complex Adaptive System: Implications for Patient Safety
Abstract: The Emergency Room is a non-deterministic environment where decisions are made on an ad-hoc basis through opportunistic and collaborative planning. The emergent behavior of the ER results in errors that arise from system complexity and can be arduous to predict based solely upon a unitary clinical agent. Modeling emergency care as a Complex Adaptive System avoids over simplification through reductionist linear decomposition of the system by emphasizing the non-linear interactions of clinicians that lead to self-organization and emergent behavior. The view of the emergency room as a superorganism with medical error as an emergent property may lead to process change or active interventions that could improve health care quality.