Socio-technical Systems Analysis of Medical Ward Rounds in an Acute Teaching Hospital

Ward Rounds (WR) are an essential organisational process at the interface between patients, their families/carers and the clinicians who provide their care. WRs are also complex socio-technical systems (STS) involving interactions between people and technology commonly occurring in environments not fit for purpose. This study was undertaken as part of a longitudinal improvement project in relation to WRs taking an STS approach. A STS analysis (STSA) called the Cube was undertaken to understand current ‘AS IS’ WR practice from a Human Factors and Safety Science perspective. Key findings are broken into the domains of the Cube and include the following: Time constraints on all disciplines make it difficult for shared sense-making; Goals are not always shared in relation to the purpose of WRs; there is variation in practice in relation to pre-rounds, board rounds and handover; Safari WRs make relationship-building, collaboration and trust between disciplines difficult; there is a lack of defined outcome metrics for ‘success’ in relation to WRs. This initial STSA has helped us to identify areas which we need to improve. Reforming care for patients who require unscheduled care in acute hospitals is a healthcare priority. Given the resources required by WRs and the pivotal role they play, improving WRs will significantly contribute to this reform.