A qualitative study of analogue and electronic escalation Visual Management Tools in maternity healthcare in England using Socio-Technical Systems theory

Background

Visual Management (VM) is the use of visual devices to influence behaviour. Visual Management Tools (VMTs) are those used to relay information quickly for shared cognition. Existing healthcare VMT research focuses on user-experiences without comparisons with policies and reports to better situate findings within context. Maternity Services Operations Management (OM) in England is used as a case study.

Aim

To explore and develop a new understanding of how particular maternity escalation VMTs, Early Warning Scores (EWS); Situation, Background, Assessment, and Recommendation (SBAR); and Sepsis tools are working in practice, particularly in the transition from paper-based analogue to electronic devices.

Methods

This was a qualitative study incorporating semi-structured interviews combined with relevant documentary review. Data collection involved 55 interviews across a variety of maternity professional groups, and a collection of 37 policies, guidelines and reports, drawing on Shorrock’s Varieties of Human Work theory. A pragmatic Human Factors and Ergonomics (HFE) approach using humancentric Socio-Technical Systems (STS) theory was used as a framework for analysis.

Findings and Conclusions

This research improves our understanding of the relationship between escalation VMTs and contemporary maternity healthcare work systems in the transition from paper-analogue to electronic devices, highlighting the significance of VMTs for efficiency (allocation of resources), shared repertoires (shared language), and for providing legitimacy to staff voices in bridging hierarchical and professional boundaries.

VMTs make the invisible properties of a system visible, and in doing so they identify exemplars and areas for attention within the business system. This research has identified that an inherent tension exists in using healthcare VMTs, between management layers of accountability, and creating a manageable clinical workload for staff. The findings open a conversational space about Continuous Quality Improvements (CQI) in maternity healthcare, adding to the VMT research genre by linking user-eudaimonia with healthcare safety, making a practical contribution to HFE within STS systems-theory.