Obstacles to research on the effects of interruptions in healthcare

Abstract

The authors of The Institute of Medicine report ‘To Err is Human’ concluded that interruptions can contribute to medical errors.1 Given this risk, healthcare researchers have generally, and often solely, viewed interruptions as obstacles to work—as factors that thwart progress, create stress, increase workload, interfere with memory for current and future tasks2 ,3 and harm efficiency, productivity and safety.4 For example, researchers reported a positive association between interruptions and errors.5

A contrasting view is to see interruptions as promoting safety and high-quality patient care. From this view, interruptions function as interventions,6–8 such as a call to cease or change work if the interruptee is potentially committing an error.9 Other industries encourage interruptions for that reason. Many researchers investigating interruptions in healthcare cite the sterile cockpit principle10 as a rationale for reducing interruptions—but it is less often noted that copilots are trained to speak up with safety concerns even if it means interrupting a senior pilot's work.11

These different views on studying interruptions have made it difficult to draw conclusions from the research. Granted, diverse perspectives and methods can generate a greater variety of ideas and solutions than single perspectives and methods.12 However, such diversity also makes it more difficult to compile and compare research results or identify critical research questions. The present paper draws attention to three obstacles to research on the effects of interruptions that arise from differing views and methods: definitions, processes and data collection. We discuss possible solutions that may lead us to a better understanding of the effects of interruptions and to a multidisciplinary view on the effects of interruptions in healthcare.