Activity theory driven system analysis of complex healthcare processes

The patient discharge process is one of the most critical and complex healthcare processes as it involves several actors with a variety of skills and roles working towards the outcome of effective and efficient discharge of a patient from a hospital. This paper used a case study of the patient discharge process of two care units in a large urban hospital in which we analysed the process as an activity system using activity theory methodology. Through the case study we collected data from 63 non-participant observations interviews, 5 semi-structured interviews and document analysis. We analysed the data with the Activity-Oriented Design Method (AODM) and revealed eighteen contradictions in the discharge process activity system. The contradictions include information or documentation issues but also organizational and process issues, emphasizing that Hospital Information System (HIS) design for complex processes is a sociotechnical endeavor. Addressing these contradictions is an initial stage for systems analysis for the design of a health information system to improve the discharge planning process.