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Managing competing demands through task-switching and multitasking: a multi-setting observational study of 200 clinicians over 1000 hours
  1. Scott R Walter1,
  2. Ling Li1,
  3. William T M Dunsmuir2,
  4. Johanna I Westbrook1
  1. 1Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2Faculty of Science, School of Mathematics and Statistics, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Scott R Walter, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Level 1, AGSM Building, University of New South Wales, Kensington, NSW 2052, Australia; scott.walter{at}unsw.edu.au

Abstract

Objective To provide a detailed characterisation of clinicians’ work management strategies.

Design 1002.3 h of observational data were derived from three previous studies conducted in a teaching hospital in Sydney, Australia, among emergency department (ED) doctors (n=40), ward doctors (n=57) and ward nurses (n=104). The rates of task-switching (pausing a task to handle an incoming task) and multitasking (adding a task in parallel to an existing task) were compared in each group. Random intercepts logistic regression was used to determine factors significantly associated with clinicians’ use of task-switching over multitasking and to quantify variation between individual clinicians.

Results Task-switching rates were higher among ED doctors (6.0 per hour) than ward staff (2.2 and 1.8 per hour for doctors and nurses, respectively) and vice versa for multitasking rates (9.2 vs 17.3 and 14.1 per hour). Clinicians’ strategy use was significantly related to the nature and complexity of work and to the person they were working with. In some settings, time of day, day of the week or previous chosen strategy affected a clinician's strategy. Independent of these factors, there was significant variation between individual clinicians in their use of strategies in a given situation (ED doctors p=0.04, ward staff p=0.03).

Conclusions Despite differences in factors associated with work management strategy use among ED doctors, ward doctors and ward nurses, clinicians in all settings appeared to prioritise certain types of tasks over others. Documentation was generally given low priority in all groups, while the arrival of direct care tasks tended to be treated with high priority. These findings suggest that considerations of safety may be implicit in task-switching and multitasking decisions. Although these strategies have been cast in a negative light, future research should consider their role in optimising competing quality and efficiency demands.

  • Interruptions
  • Human factors
  • Health services research

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