Organizational simulation of medical work: An information processing approach

Modern medical care is a collaborative activity among health care providers who work in complex, interconnected and dynamic organizations. To design effective and efficient work processes and organizations, health-care administrators must be able to understand and analyze the complex relationships among work processes, organizational structure, organizational participants, and the unexpected events of medical care.; Ideally, before subjecting their organizations to change, health-care administrators could simulate how well a proposed organization would perform in discharging a given set of protocols for its patient population. Simulation systems such as the Virtual Design Team (VDT) have been shown to make accurate predictions about the effectiveness and efficiency of alternative engineering project organizations. Unfortunately, these simulation tools, based on Galbraith's information-processing perspective, have models of work processes and organizations that are too rigid to represent and reason about the correspondingly more dynamic organizational structures, found in medical organizations.; My work extends the information-processing theory of organizations, described by Galbraith and encoded in “emulation” simulation systems such as VDT so that these simulation systems can be used to model the non-routine, “diagnose and repair” work processes and the flexible organizational assignments that are required for delivering medical care. My research develops a theoretical framework and simulation system in which organizational questions about these more flexible organizations can be posed, tested in a simulation environment, and used to guide medical administrators charged with designing new organizations and protocols.; I have extended Galbraith's notion of exceptions by creating four new exception types: activity addition, activity deletion, activity re-assignment, and activity substitution. These process exceptions can model activities in which agent-activity responsibilities are dynamic and activity exceptions alter the topology of the work process. I have tested these extensions to theory in an information-processing simulation system called OCCAM and modeled diagnostic and therapeutic exception-driven medical work processes.; This research: (1) adds to current understanding of how exceptions are modeled in the information-processing theory of organizations; (2) extends the range of organizations that can be modeled and simulated using an information-processing theory of organizations; and (3) provides useful tools to designers of medical organizations and work processes.