COLLABORATIVE RESEARCH: Antecedents of Complexity in Healthcare Routines

摘要本研究的目的是了解社会和技术因素对医疗保健组织常规复杂性的影响。我们知道，复杂性受到工作组织方式的影响，但目前的理论和方法并没有提供有效的方法来检验这种关系。这项研究将开发和测试新的方法来分析医疗程序的复杂性，使用电子医疗记录（EMR）和来自罗切斯特大学医学中心的一系列临床专业的访谈，包括皮肤病学、皮肤外科、骨科、儿科肿瘤学和放射肿瘤学。这项研究将加深我们对驱动医疗保健组织复杂性的因素的理解，在这种情况下，迫切需要更好的组织方式。该项目将提供一种方法来分析医疗保健程序的复杂性，并更好地理解复杂性作为医疗保健成本和质量的一个因素。复杂性是组织科学中的一个基本概念，惯例是组织完成工作的基本方式。然而，目前组织科学的技术水平还没有提供有效、可靠的方法来衡量或比较它们的复杂性。本研究将展示一种新颖的图论方法，将社会和物质维度纳入日常生活的描绘。该方法可用于评估和比较各种前因对临床常规复杂性的影响。这个项目还将产生新的研究基础设施，以算法和软件的形式，可以应用于未来任何一种过程或常规的研究。这种新的研究基础设施特别及时和有价值，因为数字跟踪数据的可用性越来越高，例如这里使用的电子病历数据。

AbstractThe goal of this research is to understand how social and technological factors contribute to the complexity of organizational routines in healthcare. We know that complexity is influenced by the way work is organized, but current theory and methods do not provide useful ways to examine this relationship. This research will develop and test new methods for analyzing the complexity of healthcare routines using electronic medical records (EMR) and interviews from a range of clinical specialties at the University of Rochester Medical Center, including Dermatology, Dermatologic Surgery, Orthopedics, Pediatric Oncology, and Radiation Oncology. This research will deepen our understanding of the factors that drive the complexity of healthcare organizations, a context where there is an urgent need for better ways of organizing. This project will provide a way to analyze the complexity of healthcare routines, and better understand complexity as a factor in the cost and quality of healthcare.Complexity is a basic concept in the science of organization, and routines are the fundamental way that organizations accomplish work. However, the state of the art in organizational science currently provides no valid, reliable way to measure or compare their complexity. This research will demonstrate a novel, graph-theoretic methodology that incorporates social and material dimensions into the portrayal of routines. This methodology can be used to assess and compare the influence of various antecedents on the complexity of clinical routines. This project will also result in new research infrastructure, in the form of algorithms and software that can be applied in future research on any kind of process or routine. This new research infrastructure is particularly timely and valuable because of the increasing availability of digital trace data, such as the electronic medical record data used here.