Browsing by Subject "social interaction"
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Item Open Access Making Sense of Health Information Technology(2012) Kitzmiller, Rebecca RutherfordBackground: Hospital adoption of health information technology (HIT) systems is promoted as essential to decreasing medical error and their associated 44,000 annual deaths and $17 billion in healthcare costs (Institute of Medicine, 2001; Kohn, Corrigan, & Donaldson, 1999). Leading national healthcare groups, such as the Institute of Medicine, Agency for Healthcare Research and Quality, Institute for Healthcare Improvement, and the Leap Frog Group continue to advocate for increased use of HIT (AHRQ, 2010; Beidler, 2010; Institute of Medicine, 2001; Page, 2003; The Leapfrog Group, 2009), such as provider order entry and electronic health record systems, as a way to improve healthcare quality in hospitals. Even under intense pressure to adopt HIT, however, a mere 2% of US hospitals report having a comprehensive electronic health record system. Further, more than 50% of US hospitals have only rudimentary HIT systems (Jha et al., 2009). With the ARRA HITECH Act of 2009, the pressure on hospitals to quickly adopt HIT and achieve meaningful use is mounting.
While a large body of literature exists about HIT implementation, the majority is anecdotal case reports. The remaining studies investigated attitudes about HIT or the impact of HIT on patient care processes and outcomes. Thus, best strategies for implementing HIT in hospitals remain unknown. Study design choices, such as the use of self report data, retrospective data collection methods, subjects from single care units or single healthcare professions further limit our understanding HIT implementation in complex hospital care settings.
Methods: This prospective, longitutdinal case study used a novel approach, sensemaking, to understanding how project teams may work to implement HIT in an academic medical center. Sensemaking, defined as the social process of establishing the meaning of events and experiences (Weick, 1995), is associated with learning and problemsolving in research studies of healthcare and nonhealthcare settings. Through direct observation and document review I observed project team social interaction and activities over the course of the 18 month preimplementation phase of an HIT implementation project in a single tertiary care hopsital.
Conclusions: In this study, I described team actions and activities that enhanced clinician team member sensemaking including: frequent, collective interaction with HIT and focusing team members' attention on specific aspects of HIT function. Further, study findings demonstrated that team members' perceptions of HIT and care processes varied across healthcare professions, management levels, and departments. Supportive social interaction from team leaders and members encouraged team member participation and resulted in members' voicing observations, perceptions and attitudes about the HIT and hospital care processes. Sensemaking of HIT teams not only resulted in identification of needed HIT design changes, but also revealed assumptions and information which may prove critical to successful HIT implementation in hospital care environments. Based on study findings, I suggested strategies for selecting and preparing HIT team members as well as for HIT team activities. This study advanced our understanding of how project teams function and bring about change in complex hospital care environments by not only identifying HIT implementation issues within but also describing the link between team member social interaction and implementation actions.
Item Open Access Simultaneous Multiplexing of Movement Execution, Observation, and Reward in Cortical Motor Neurons(2021) Byun, Yoon WooNeural activities of the motor cortices have been traditionally known to represent motor information such as velocity of the movement and muscle force. Recent studies show that motor cortices, including primary motor cortex (M1), also represent non-traditional information such as observed movements of others and reward-related signal. However, how the neurons simultaneously multiplex such non-traditional information along with traditional motor parameters and whether the multiplexing leads to significant interactions are not well understood. Furthermore, understanding how the non-traditional information are encoded and they interact with motor information may help the development of more error-resistant, autonomous brain-to-machine interface and the understanding of underlying mechanism behind joint action and motor skill learning. In this dissertation, we investigate in detail how the observed movements and reward are simultaneously multiplexed along with traditional motor information and how each pair of neural representations interact with each other. First, regarding movement observation, we show that significant fraction of M1 neurons simultaneously encode the presence and direction of the movement of others along with those of self-movements. Neurons respond differently to joint action than to self-movements and show an interaction effect from the two representations of observed and executed movements rather than simple averaging of the two. Some neurons that separately encode observed and executed movements turn to suppress the representation of observed movements in joint action. In simultaneous actions, the representation of self-executed movement gets weaker, which suggests an interaction between two information and may possibly lead to behavioral interference. Preferred directions also change to be decoupled for noncongruent joint actions as to allow simultaneous multiplexing of both information with phase difference, while being synced for congruent ones. Conditional probabilities from the distribution of encoding neurons suggest a shared circuitry for movement observation, execution, and simultaneous actions. Shared circuitry with interactions between representations may explain why people can perform movements freely while watching others move; yet if the interaction between the two goes up due to simultaneous occurrence, it may result in interferences in behavior. Second, regarding the multiplexing of reward-related signal with movement signals, we show that both signals are multiplexed in individual and population neurons in M1 and S1. The activity of neural population in M1 and S1 distinguished whether the reward timing before the delivery of the reward. Furthermore, reward per se, reward anticipation, and reward prediction error (RPE) were encoded along with the motor information. The encoding of the reward-related signal interacted with the motor information in that the preferred direction changed when the reward was omitted. Change of spatial tuning of neurons due to reward prediction error signifies that there is interaction between the neural representation of reward and motor information, which may impact and underlie motor skill learning. In conclusion, both observed movements and reward are simultaneously multiplexed with traditional motor information. Co-representation of the two non-traditional information then leads to interaction between them and the motor information. Such interaction suggest that such simultaneous multiplexing may lead to behavioral interferences and motor skill learning.