Re-designing the Blood Transfusion Procedure in Operating Theatres
Makiko Takizawa, Rie Mieda, Akihiko Yokohama, Kazue Nakajima · 2021
We observed a gap between Work-as-Imagined and Work-as-Done in blood transfusion procedures in operating theatres. By examining procedures at genba (‘actual workplace’), we found an adaptive procedure that was attributable to physical challenges of using an optical barcode identification system. Introduction of a barcode system in a hospital in Japan affected the work of frontline staff in unintended ways, though they managed to pursue their own tasks and created a tangled procedure using paper-based forms. Round table discussion revealed how staff did not understand each other’s tasks and priorities, how they shared the value of safe and efficient procedures and how tasks were connected to each other. This understanding helped align the gap between Work-as-Imagined and Work-as-Done, and re-design the blood transfusion procedure under shared values. We evaluated the new procedure and showed that it was successfully adhered to for over a year. This chapter illustrates an example of muddling through decisions at all levels which connect to and influence each other, and have unexpected consequences that create the gap between Work-as-Done and Work-as-Imagined. We also discuss the need for the gap to be reconciled; it is essential that all relevant professionals come together and redesign the work under mutual understanding and shared values.