DyNADS: A Dynamic Network Analysis Decision Support Tool for Nurse Managers

描述（由申请人提供）： 美国医院的医疗质量继续令人担忧。作为一个恰当的例子，医疗差错以令人痛心的速度持续存在，并产生巨大的成本，尽管广泛的宣传和大量的研究。由于医疗保健是一个复杂的社会技术系统，这些医疗错误通常没有简单的单一原因。相反，这些错误通常是系统故障的结果，涉及许多个人，许多促成因素，并涵盖多个层次的医疗保健系统。在我们以前的研究中，我们已经表明，使用OrgAhead的计算建模是一个有价值的研究工具，用于处理这些类型的复杂，多层次的问题。在这项工作的基础上，我们建议使用基于网络的组织理论作为复杂的自适应系统来开发桌面决策支持工具和方法，帮助管理人员（a）评估其单位的当前绩效，（B）预测潜在的单位创新的影响，以提高有针对性的安全和质量结果。拟议项目的目的是开发一个简单的虚拟环境，允许护士管理人员通过动态网络分析决策支持工具（DyNADS）评估其患者护理单位的组织健康状况，然后通过使用自动化“假设”分析技术进行战略规划，在虚拟单位上进行测试，潜在创新的可能性，以改善其实际单位的安全和质量结果。具体目标是： 1.优化和简化DyNADS的数据收集要求，以适应单位管理工作流程。 2.设计一个原型桌面动态网络分析决策支持工具（DyNADS），便于：（a）识别急性护理环境中系统故障的基础结构或通信模式，以及（B）测试潜在创新的可能性，以提高安全性和质量结果。 3.通过现场测试评估DyNADS的有效性、可扩展性和实用性。 4.评估实施DyNADS或护理单元的可行性。

DESCRIPTION (provided by applicant): The quality of care in U.S. hospitals continues to alarm. As a case in point, medical errors persist at a distressing rate and incur enormous costs, despite extensive publicity and considerable research. Because healthcare is a complex sociotechnical system, these medical errors generally have no simple, single cause. Instead, the errors typically are the result of system failures that involve many individuals, many contributing factors, and encompass multiple levels of the health care system. In our previous research we have shown that computational modeling using OrgAhead is a valuable research tool for dealing with these types of complex, multi-level problems. Building on that work, we propose using a network-based theory of organizations as complex adaptive systems to develop desktop decision support tools and methods that help managers (a) assess their unit's current performance, and (b) predict the impact of potential unit innovations to improve targeted safety and quality outcomes. The purpose of the proposed project is to develop a simple virtual environment that allows nurse managers to assess, through a dynamic network analysis decision support tool (DyNADS), the organizational health of their patient care units and then engage in strategic planning by using automated "what-if" analysis techniques to test, on the virtual units, the likelihood of potential innovations to improve their actual units' safety and quality outcomes. Specific aims are to: 1. Refine and streamline data collection requirements for DyNADS to fit within the unit management workflow. 2. Design a prototype desktop dynamic network analysis decision support tool (DyNADS) that facilitates: (a) identifying structures or communication patterns that are the basis for system failures in acute care settings and (b) testing the likelihood of potential innovations to improve safety and quality outcomes. 3. Evaluate DyNADS' validity, scalability, and usefulness through a field test. 4. Evaluate the feasibility of implementing DyNADS or nursing units.