Power of Technology and Team Work to cope with Clinicians' complex work

Coping with Cognitively Complex Work: The Power of Technology and Team Work

Rare diseases are by definition uncommon, and hence are often extremely complex to identify. It can take some patients as long as 30 years, and many hundreds of visits with doctors, before they receive a diagnosis. Even then, the diagnosis can be wrong[1],[2]. These challenges in finding a diagnosis and the right treatment create a large financial and emotional toll for patients and their families. And, since in Australia around 1.9 million people are currently living with a rare disease, this is a large cost.

The process of diagnosis and treatment is also tough for clinicians. Gareth, who trained as a paediatrician but later specialised in clinical genetics at Genetic Services of Western Australia, sees his job as trying to solve “medical mysteries for children and youth”. As well as trying to diagnose rare diseases, he also guides patients’ treatments, sorts out the implications for other family members, and connects patients to other patients (since “having a rare disease can be very isolating”).  

Gareth describes the cognitive demands in his work as the biggest challenge. Identifying a rare disease requires processing vast amounts of patient-related information, digesting the published medical literature across a range of specialty areas, and then synthesising this information in a comprehensive and creative way. While having cognitive demands in one’s work is usually a contributor to job satisfaction[3], at excess levels, this mental ‘challenge’ can turn into pressure and stress, especially when, as here, the cost of not solving the problem is high[4]. As Gareth explains, he “is only getting an answer for half of the children that are affected by undiagnosed diseases”.

Fortunately, well-designed teams can help with this cognitive burden. To better meet the needs of children with undiagnosed rare diseases, and to help cope with the massive cognitive demands of the work, Gareth and an inter-disciplinary team of clinicians from across Western Australia, in partnership with the WA Department of Health Office of Population Health Genomics (OPHG), implemented the Undiagnosed Diseases Program in Western Australia (UDP-WA)[5].

The UDP-WA brings together clinicians in a monthly Expert Panel Meeting . In these one-hour meetings, clinicians work together as a team to creatively synthesize the patient information and brainstorm new (or previously abandoned) possible diagnoses and next-steps for the patient. Because they work together as a team, the vast complexity of diagnosing a rare disease is shared. The meetings provide clinicians with an opportunity to pool their expertise, and an environment in which ‘silly’ or ‘far-fetched’ ideas are welcome.

Developments in technology in the form of the Patient Archive also help in reducing the cognitive and information processing demands of the clinicians involved in the UDP-WA. The very first UDP-WA patient had their patient files (including their history, symptom information, and various inconclusive test results) brought into the meeting room and stacked in a pile that was almost two meters high. Patient Archive is an Australian digital platform that (1) stores this patient information digitally, so that it is easily accessible by all of the clinicians involved; (2) it also summarises the vast amount of patient information in easily digestible visualisations and tables; and, finally, (3) Patient Archive uses natural language processing and other algorithms to suggest possible diagnoses for the patient. Technology like Patient Archive helps clinicians ascertain and manage complex medical data, and to turn that into knowledge to help patients. It is like having another expert in the room that is part of the team to help the human brains comprehensively and effectively work together to get an answer.

The Expert Panel and Patient Archive together are changing the diagnostic paradigm to help solve the unsolved. . Gareth shared the story of one young girl who had been to hospital more than 200 times before she was even seven years old [6]. The UDP program diagnosed her case in just 45 minutes – a diagnosis with a prevalence of one in a million. The diagnosis has made an enormous difference to the quality of the young girl’s life and that of her families. This, in turn, makes Gareth very happy.

After all, the aspect Gareth most likes about his job is the chance to “serve children and families with a high need for help”.

References

1] European Organisation for Rare Diseases. Survey of the delay in diagnosis for 8 rare diseases in Europe (EurordisCare2). EURORDIS. 2007.

[2] Molster C, Urwin D, Di Pietro L, Fookes M, Petrie D, van der Laan S, et al. Survey of healthcare experiences of Australians living with rare diseases. Orphanet J Rare Dis. 2016;11:30.

[3] Morgeson, F. P., & Humphrey, S. E. (2006). The Work Design Questionnaire (WDQ): developing and validating a comprehensive measure for assessing job design and the nature of work. Journal of applied psychology, 91(6), 1321.

[4] Martin, R., & Wall, T. D. (1989). Attentional demand and cost responsibility as stressors in shopfloor jobs. Academy of Management Journal, 32(1), 69-86.

[5] UDP-WA is part of the Undiagnosed Diseases Network International (UDNI). For more information, see Baynam, G., Broley, S., Bauskis, A., Pachter, N., McKenzie, F., Townshend, S., ... & Schofield, L. (2017). Initiating an undiagnosed diseases program in the Western Australian public health system. Orphanet Journal of Rare Diseases, 12(1), 83.

[6] UDP-WA is part of the Undiagnosed Diseases Network International (UDNI). For more information, see Baynam, G., Broley, S., Bauskis, A., Pachter, N., McKenzie, F., Townshend, S., ... & Schofield, L. (2017). Initiating an undiagnosed diseases program in the Western Australian public health system. Orphanet Journal of Rare Diseases, 12(1), 83.

Entrepreneurs: Growing work for people

by MK Ward

Little is known about how work is designed by entrepreneurs, and scholars have begun to wonder about steady versus changing aspects of start-ups [1]. As entrepreneurs scale up their business, they need to make decisions about people’s roles, such as who should work together in a team and how specialized each role should be etc...

We had the opportunity to talk to one entrepreneur, Matt, about his thinking on work design. Matt started up, and now directs, a digital marketing agency with a focus on programmatic and dynamic ad creation.

Matt’s company has grown quite quickly from 4 people to over 20. An initial change was in Matt’s own work design, and that of Nick’s, the co-founder. In the early days when the company was small, both Matt and Nick were more hands-on, doing the technical work as well as sales. They worked very long hours, with little divide between work and non-work life, with high information processing demands, pressure for speed, and juggling many different tasks.

But now, specialised technical and creative teams have been put in place to handle the daily problem solving. This means Matt and Nick can focus their daily work on strategy and sales. There are also separate teams for advertising operations and accounts management.

Of course, whilst giving Matt and Nick time and energy for bigger picture work, the creation of new functional teams can create challenges for co-ordination. It is also important for teams to not only apply their technical and job specific expertise, but also to understand the strategy of the organisation so they can provide the best long-term solutions for the problems they are facing. All this makes the weekly meetings that Matt has introduced vitally important.

“Even though you might think a programmer doesn’t have any ideas outside of their tech area, we’ve had some fantastic thoughts and ideas (that we’ve passed) over to the creative team. So that’s the left brain and right brain thinking. If you share your experience and what you’ve done during the week, you get good feedback from all areas.”

As the company grows and it becomes impossible for everyone to come together as a whole group, other methods of integrating across the specialised teams and ensuring co-ordination will likely be needed. Conversations between people in different functional areas, sometimes called lateral integration or horizontal coordination [2], is particularly useful for scaling startups that compete on their promise of speed and agility. Quick turn-around times for clients requires fast problem solving and that means talking with co-workers who think differently from each other.

Another future challenge could arise from the emergent approach to work design. So far, the process of growing the company has been based on adding people when the demands of the work have noticeably exceeded the resources to do the work. But such a process, whilst lean and cost-effective, can be stressful for employees because their work load can get very high. High stress can become chronic, leading to burnout [3]. Too much stress can also damage the reputation of the startup as a good employer, increasing the difficulty of attracting talented staff when there are future growth spurts.

We expect that – when the company gets time to take a breath – it will be vitally important to take stock, and think strategically and systematically about how the work is designed. Start ups need to grow when there’s opportunity, and running lean is usually unavoidable, but good work design will be important for sustainability in the long term.

References

[1]DeSantola, A., & Gulati, R. (2017). Scaling: Organizing and Growth in Entrepreneurial Ventures. Academy of Management Annals, 11(2), 640–668. https://doi.org/10.5465/annals.2015.0125

[2]Torraco, R. J. (2005). Work Design Theory : A Review and Critique with Implications for Human Resource Development, 16(1).

[3]Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The job demands-resources model of burnout. Journal of Applied Psychology, 86(3), 499–512.

Theo - The Call Centre Employee

Call Centres: One of my KPIs was to take my breaks at the right time

Theo scored his job 6/10 ten being the most enjoyable job you can imagine).

by Daniela Andrei

Theo worked as a call centre operator at a major health insurance provider in Australia for almost two years. His job involved taking incoming calls from members about new and existing policies, as well as claims. When we interviewed Theo he had already left this job after being offered a different position in another company, but we used this opportunity to obtain another perspective on working in a call centre environment.

One of Theo’s greatest challenges in his role at the call centre was the lack of control (job autonomy) over his work. He felt his work to be very repetitive, with very strict rules around engagement with customers and how much time is spent on the phone, between calls or on breaks. The lack of autonomy became a greater challenge when combined with a lack of ability to have an input into his KPIs and how he might achieve those. For Theo, the call centre role was the first job where he had not had the opportunity to have input or autonomy over how he spends his time at work and how he achieved his targets. Moreover, Theo reported great amounts of emotional labour in his job, as one of the most important part of interacting with clients was maintaining a calm, patient tone, which he found to be very difficult when it was not matched by the customer.

“Probably the hardest part was that I didn’t have much control over what I was doing at work. I had to follow very strict rules about how to engage with the members, how much time I spent on the phone, how much time I had to spend in between phone calls, how much time I spent on my breaks. There was a lack of flexibility, and for me an additional challenge was that I didn’t have much of an input into what was required, my KPIs, what we needed to achieve and how I contributed to that.”

 “The workday was very repetitive. So, every day I would have the same schedule. I would know exactly the times I would have my breaks, to the minute. One of my KPIs was to take my breaks at the right time.”

“The hardest part was to work in a place where I didn’t get to go outside, or to walk around. I didn’t see daylight most because there weren’t any windows uncovered. So basically, all day we were under artificial lights.”