A Design for Organizing the Domino’s Farms Cardiology Clinic Shared Drive

Final Report

Submitted to:Ms. Samantha Fink, Administrative Manager, Domino’s Farms Cardiology Clinic1

Project CoordinatorsMr. David Hyatt, Senior Continuous Improvement Specialist, Continuous Improvement1

Mr. Ian Perry, Senior Continuous Improvement Specialist, Continuous Improvement1

Mr. Arnold Yin, Continuous Improvement Specialist, Continuous Improvement1

IOE 481 Course InstructorsDr. Mark Van Oyen, Professor, Industrial & Operations Engineering2

Ms. Mary Duck, Senior Administrative Manager, Continuous Improvement1

Mr. David Hyatt, Intermittent Lecturer, Industrial & Operations Engineering2

Dr. Elaine Wisniewski, Lecturer IV, Undergraduate Education2

Submitted by:Team 20F6

Ms. Imani CarsonMr. Ricardo Cummings

Ms. Jiaqi LeiMr. Christopher Schemanske

Department of Industrial & Operations Engineering2

Date Submitted:December 8, 2020

IOE481/20F6-FinalReport1Michigan Medicine, University of Michigan

2College of Engineering, University of Michigan

TABLE OF CONTENTS

Executive Summary 4

1. INTRODUCTION 7

2. BACKGROUND AND KEY ISSUES 7

3. GOALS, OBJECTIVES, and EXPECTED IMPACT 93.1. Goals 93.2. Objectives 93.3. Expected Impact 9

4. PROJECT SCOPE 10

5. DESIGN PROCESS 105.1. Engineering Challenges 105.2. Literature Search 115.3. Deliverables and Design Tasks 125.4. Design Constraints 135.5. Design Requirements 135.6. Design Standards 13

6. ALTERNATIVES CONSIDERED 146.1. Criteria for Evaluation 146.2. Decision Matrix 15

7. DATA COLLECTION and ANALYSIS METHODS 157.1 File Usage Data - Rough 157.2 File Usage Survey - Rough 157.3 Cognitive Task Analysis - Current State 157.4 Cognitive Task Analysis - Alternatives 167.5 Literature Search - File Naming 167.6 Literature Search - File Duplication/Removal Process 17

8. FINDINGS 178.1 File Usage Data 178.2 File Usage Survey 178.3 Cognitive Task Analysis - Original 178.4 Cognitive Task Analysis - Alternatives 188.5 Literature Search - File Naming 198.6 Literature Search - File Duplication/Removal Process 19

9. CONCLUSIONS 19

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9.1 File Usage 199.2 Task Analysis 199.3 Literature Search - File Naming 209.4 Literature Search - File Duplication/Reorganization Process 20

10. RECOMMENDATIONS 2010.1 File Hierarchy and Policy Handling 2010.2 File Naming 2010.3 Reorganization Process 20

11. FUTURE WORK 21

REFERENCES 22

APPENDIX I. Constraints & Standards Matrix 24

APPENDIX II. Decision Matrix 25

APPENDIX III. File Usage Survey 26

APPENDIX IV. File Naming Rules 27

List of Figures and TablesFigure I: Representative hierarchy of the initial state of the shared drive at the Domino’s Farms Preventative Cardiology Clinic. 9Figure II: Functional, divisional, and hybrid approaches for organizing the top level of the shared file drive. 15

Table I: Tasks in Cognitive Task Analysis with Corresponding SRK Purpose 17Table II: Averages Times and Accurate Completion Rates of CTA Results by Task 18Table III: Averages Times of CTA Results by Structure Alternative 19

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Executive Summary

BackgroundStaff at the Domino’s Farms Cardiology Clinic have reported difficulties using the clinic’s shared file drive. For example, users have trouble finding the latest versions of files, encounter duplication in files and archives, and struggle with ambiguity in determining proper locations for saving new files. As a result of these user reports, the organization sought to develop a strategy for reorganizing the drive. In the past, the clinic has attempted to reorganize the drive, but efforts have encountered various pitfalls.

As a result, the IOE 481 Team 6 was tasked with developing a framework for improving the state of the shared drive. The project’s primary goal was to increase file search efficiency in the Domino’s Farms shared drive. This was to be achieved by reorganizing the structure of the drive, reducing duplicated files and folders, and naming files consistently.

Scope & DeliverablesWhile the team originally envisioned performing the reorganization itself, this was not possible. Due to restrictions associated with the COVID-19 pandemic, the team was unable to work directly alongside clinic staff. This made it impossible to employ methods, such as embedded study, that would have been most useful for achieving the reorganization. COVID-19 pandemic-related regulations also made it difficult for the team to access technology resources needed to securely access files in the shared drive while complying with Michigan Medicine data protection regulations.

Accordingly, the final project task was designing a protocol for clinic employees in each respective area to reorganize their portion of shared drive on their own. This protocol includes:

- A folder structure.- Best practices for file naming.- Best practices for archiving/deleting existing duplicates and preventing future

duplication.- Best practices for handling policy/procedure documents.

Data CollectionThe team utilized literature review, survey, and cognitive task analysis as its primary data collection methods. The team used literature review to inform its recommendations on the folder hierarchy, file naming conventions, and implementing the reorganization. Cognitive task analysis results informed policy/procedure handling and the folder structure. Survey results informed recommendations for implementing the reorganization.

Task Analysis Findings & Conclusions

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After initial cognitive task analysis (n = 3) study, the team developed three alternatives for structuring the shared drive. The first alternative was to organize the files primarily by their function (patient education, clinic form, etc.). The second alternative was to organize files primarily by their division of the clinic (exercise physiology, nursing, etc.). The third alternative was a hybrid of these two approaches; a divisional ordering with some exceptions for important folders. The team conducted additional cognitive task analyses (n = 3) on the alternatives, and subjects unanimously agreed that the second, divisional, option was generally the best, but that certain, rare exceptions for important types of folders could be appropriate (in the form of the hybrid option). Policy and procedure documents were often highlighted as an appropriate exception, deserving a top-level folder.

Literature Review Findings & ConclusionsMeanwhile, the team searched the literature for guidance on constructing an ideal file structure, and uncovered that experience is the most important factor for determining a user’s ideal breadth/depth. The literature was also consulted for guidance on naming files, and the team developed standard naming procedures from its findings. The team also conducted literature search to better understand how reorganization should be conducted, and found that teams are an important part of successful implementations of this type.

File Usage Findings & ConclusionsFinally, the team distributed a survey assessing the most-used files in the exercise physiology portion of the drive to get a sense of the relationship between folder size and importance in the drive. This survey showed that folder size was a very poor predictor of folder importance.

RecommendationsThis led to the team’s recommendations. The team recommends:

- Folder Structure- Adopting a top-level folder structure based on divisional areas of the clinic.- Minimizing folder depth in high-use areas; increasing folder depth in low-use

areas.- Keeping policy and procedure documents in a top-level folder of their own.

- File Naming- Standardizing the use of names, dates, etc. to create consistency across the drive.

See Appendix IV for full details.- Reorganization Management

- Appointing a person to be in charge of each area of the drive with the following responsibilities:

- Perform any changes to the folder or file locations that need to be made- Perform the initial archive process

- Archive all files that have not been modified for 4 years or longer

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- Determine what in the archive can be moved into the live folder- Perform the annual archive review process

- Remaining files from the last archive cleanup should be deleted- Archive files that are no longer used or current- If something in the archive has been accessed, move it to the live

folder.- Facilitating teamwork between people in charge of different areas, such that

clinic-wide decisions about organization can be made by a variety of employees.

Future WorkThe team notes that future work will inherently be required here, as the drive is not yet organized, but believes that this framework would allow for an effective reorganization. The team does not believe that further design work would be fruitful at this time, but believes that the project could be worth revisiting from an engineering perspective after restrictions related to the COVID-19 pandemic have ended. It may also be useful to reconsider repeating the methods from this project with greater sample size.

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1. INTRODUCTION

Staff at the Domino’s Farms Cardiology Clinic have reported difficulties using the clinic’s shared file drive. For example, users have trouble finding the latest versions of files, encounter duplication in files and archives, and struggle with ambiguity in determining proper locations for saving new files. As a result of these user reports, the organization sought to develop a strategy for reorganizing the drive. In the past, the clinic has attempted to reorganize the drive, but efforts have encountered various pitfalls. To help address this problem, the IOE 481 Team 6 was tasked with developing a framework to clean up and organize the clinic’s shared drive. The primary goal of the project was to develop tools and strategies to achieve a better working environment in the shared drive for the cardiology clinic staff. This report documents the team’s design process, data collection, findings and recommendations.

2. BACKGROUND AND KEY ISSUES

The Cardiology Clinic at Domino’s Farms maintains a shared file drive for storing files that are used across the clinic and at some of the satellite preventative cardiology offices. This project originated from observations during a cardiac patient readmission project done by Michigan Medicine’s Continuous Improvement organization. The state of the shared drive was a known issue during that project in early 2020, but was not within the scope of that project.

The shared drive’s initial folder hierarchy is partially outlined in Figure I:

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Figure I: Representative hierarchy of the initial state of the shared drive at the Domino’s Farms Preventative Cardiology Clinic.

Two main types of top-level folders are (1) clinic-wide resources and (2) specific medical specialty resources. Within each specialty’s folder, the level of organization varies, but in general, each has resources related to that specialty’s functions. Different specialties use the shared drive with different frequencies; exercise physiology is the most frequent user of the shared drive.

Policy documents are one easily identifiable example of inconsistency in the drive. A top-level folder exists for policy, but there are also additional policy folders under each specialty area. This inconsistency was one major consideration in the project. Within a specialty’s folder, there are varying degrees of specialty-specific files and subfolders. In some cases, there are duplicate/old files, folders, or folder archives. Across specialties, naming conventions (ex. dates in filenames) vary. This combination resulted in frustration and lost time among employees using the shared drive.

Employees of the clinic have unsuccessfully attempted to reorganize the shared drive a few times in recent years. Some of the folder structures and duplications that particularly frustrate

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employees today are a result of those aborted prior efforts. Accordingly, this project was commissioned to get an engineering perspective on the state of the shared drive.

Initially, this project’s definition included a full reorganization of the shared drive by the team. Due to the COVID-19 pandemic, the team was unable to interact as closely with clinic staff as would have been ideal; an embedded study would have been very useful for achieving the project’s original aim. Unfortunately, the team lacked the necessary medical expertise on its own to competently deliver the full reorganization and determined that digital collaboration would not be sufficient to achieve that goal. Additionally, the team became aware of the presence of protected health information (PHI) very late into the project, and due to the COVID-19 pandemic, did not have access to technological resources needed to assess those documents while complying with Michigan Medicine Data Protection regulations.

As a result, the project focused more specifically on the human factors considerations of organizing a file drive, and the methods used reflect a cognitive ergonomics/user experience lens.

3. GOALS, OBJECTIVES, and EXPECTED IMPACT

3.1. GoalsThe primary goal of this project is to increase file search efficiency in the Domino’s Farms shared drive by providing the clinic a protocol to reorganize the shared drive. To achieve this, the project deliverables will include a file structure and best practices for file naming and other details of the drive organization process. The new structure will increase usability, as measured through reduced time and frustration.

3.2. ObjectivesTo achieve these goals, the following objectives were set:

- Reduce wasted time searching for files.- Reduce confusion & frustration while searching for files.- Reduce version control issues on the drive.

While the team did not explicitly achieve these objectives through an implementation, the team has delivered a protocol that, if followed, it expects would achieve the goals.

3.3. Expected ImpactFrom initial discussions, employees currently report wasted time, confusion, and frustration due to the shared drive’s current format. Creating and implementing a new strategy for fileorganization will reduce these problems by removing waste and providing a more efficient, streamlined way to access files. In order to maintain the progress achieved by reorganization, it

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will be important to train employees (both existing and new) on the new approach, sustaining the success of this process. The team anticipates that adopting its recommendations will contribute to reduced frustration, reduced file search time, and reduced version control issues.

4. PROJECT SCOPE

Originally, the scope of this project was the entire Domino’s Farms Cardiology Clinic shared drive. Specifically, the team was going to work with employees (surveys, interviews, cognitive task analysis) to create a design framework to be employed by the major employee groups in the clinic to reorganize their shared folders. The team was going to work with employees in exercise physiology (EP) to pilot implementation of the team’s design framework. As a result of the COVID-19 pandemic, the team was unable to work in-person with the clinic staff and could not employ a number of methods that would have made the original scope practically attainable.

The final scope of the project included designing a protocol for clinic employees in each respective area to reorganize their portion of shared drive on their own. This protocol includes:

- A folder structure.- Best practices for file naming.- Best practices for archiving/deleting existing duplicates and preventing future

duplication.- Protocol for handling policy/procedure documents.

Examining the use of alternative file storage options, such as MBox, was not within the scope of the project.

5. DESIGN PROCESS

5.1. Engineering Challenges

The project’s primary engineering design task was creating a folder hierarchy for use in the shared drive. The most important detail is that different staff at the clinic have different needs in the shared drive—some staff use it as part of their day-to-day job, and some use it rarely. The shared drive needs to be accessible to all staff, but more than that, it needs to be efficient, too. Frequent users should not have to struggle through levels of folders to find the same file every day; infrequent users need sufficient structure to be able to find what they need.

Thus, there are two primary design considerations: how the drive’s folders should be sorted and how to balance breadth and depth of the folder hierarchy. The drive could be primarily sorted by divisional area (exercise physiology, administration, etc.), functional area (policies & procedures, patient education, etc.), or a mix thereof. The breadth/depth balance is also

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essential: too many files at one level make visual search hard; too few result in a user needing to click through many levels to find their target file.

The team also considered engineering challenges in file naming and change management, but the primary focus of this section is the key design challenge of the folder hierarchy.

5.2. Literature Search

Past IOE 481 Projects

The team did consider past IOE 481 projects to understand whether there may be better ways to address the project that we had not considered. A search of the archives of IOE 481 project reports yielded no relevant results for “shared drive,” “file organization,” “file management,” “cardiology clinic,” or permutations thereof. There are, further, no recorded past applications of 5S or lean principles to a digital environment. The project appears to be without direct precedent in IOE 481.

Broadening horizons to consider files as a form of “digital inventory,” the team examined reports that sought to apply 5S methods to inventory management situations. While there are examples of such reports (ex. Francis, Hinton, and Lee 2006; Dobbie, Ercius, Grenier 2008), all seem to largely cover management of spatial constraints and logistics, which are not salient to this project, nor this design challenge. There are no past reports discussing file system design (or the relevant human factors issues in any broader context either).

Human Factors - File HierarchyThe team sought to understand more about the role of hierarchy breadth and depth on visual search performance. There are minimal surveys of this sort directly applicable in the literature [8][9], and the team was unsuccessful in its attempts to search other domains for additional relevant information. Additionally, the team sought to further understand the cognition literature to accommodate designing for various types of users, as outlined in frameworks like Rasmussen’s skill-rule-knowledge hierarchy [6][7]. Rasmussen’s framework generally proposes that users interact with systems differently depending on how much experience they have with the specific system or genre of work the system supports. In this case, there are users who work at a skill-based level (the exercise physiologists, who use the drive daily), and also users who need to work at a lower level as a result of using the drive less.

Minimal study on the design of file systems exists in the human factors literature discussing, the literature is somewhat old. A research study performed in 1984 determined that hierarchical folder structures are often better expanded in breadth than in depth, but noted some conflicting signals depending on the user’s level of experience [8]. More recently, a paper discussing a simulation experiment explored dependency on search speed and file access frequency on

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hierarchy efficiency and determined that optimal breadth of a hierarchy level depended primarily on the user’s ability to search the list of files quickly (which is somewhat related to a user’s experience with the hierarchy) [9]. Together, these studies help inform the team’s recommendations for an ideal file hierarchy structure.

Unfortunately, further search of the literature was unproductive. Algorithmic search by computers—which is where most current research is in this field—is not analogous to human visual search, making that literature inapplicable. There is simply not significant academic literature on file system design (at least, not without the added context of automated aids or other disqualifying complication).

Lean Implementation - Change Management

Accordingly, the team turned to the academic literature on applied lean techniques. The University of Michigan library holdings were searched for terms such as “shared files,” “lean file system,” “medical file organization,” and “file system organization.” A search yielded no examples of lean techniques applied to a digital file system in either healthcare or manufacturing. There is a wealth of literature in healthcare about the application of lean principles in general, but nothing that quite relates to this task. Still, that literature speaks to the nature of lean in healthcare. One frequently-cited paper details application of lean principles to a healthcare environment and emphasizes the need for employee buy-in and an overall culture of continuous improvement—without employees feeling like they have stake and ownership in the shared space, any effort to change the workspace is not going to be successful [3]. This emphasizes the importance of engaging employees as affected stakeholders in the process.

The importance of engaging employees is underscored outside of healthcare as well. In manufacturing, there is some understanding that changes to lean-based systems are only functionally successful when they correspond with an overarching culture change in the organization [4]. Organizations whose members have a sense of shared purpose and collective responsibility as an institution, have a mindset oriented toward the future and are willing to compromise with each other stand a much greater success of long-term sustainment of lean techniques than those who don’t [4]. It is expected that this principle would apply to healthcare as well, furthermore emphasizing the relevance of employee consultation.

5.3. Deliverables and Design Tasks

The team’s deliverables were:

- A folder structure.- Best practices for file naming.

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- Best practices for archiving/deleting existing duplicates, and preventing future duplication.

- Protocol for handling policy/procedure documents.

This primarily corresponds to design tasks:

- Design a folder structure.- Design a file naming convention.- Assess how the clinic should go about reorganizing files.

The folder structure is the primary technical design task and is accordingly the subject of the remainder of this section.

5.4. Design ConstraintsThere are few constraints in this project. The team’s design was restricted to working within Windows File Explorer, and could not use MBox or other alternative storage solutions. The team was also unable to work in-person with the clinic’s staff as a result of the COVID-19 pandemic, which limited the methods the team could employ for analyzing the situation. For example, ethnographic analysis (embedded study analyzing users’ thought patterns and needs) would have been a useful technique, but wasn’t something the team could pursue. See Appendix I for a full breakdown of the Constraints & Standards Matrix.

5.5. Design RequirementsThe team has identified a few key design requirements. Foremost, the design should result in easy access to documents. “Easy access” will primarily be measured by search time, but will also be evaluated by surveying employee frustration. The other major requirement is that the design make policy and procedure documents, of interest to staff across Michigan Medicine, clear. While implementation is in progress, it is also strongly preferred that staff’s ongoing work is undisrupted, as has occurred during a past attempt to fix this problem.

5.6. Design StandardsFor most of the team’s work, the only applicable standards were laid out by the University of Michigan’s Standard Practice Guide (SPG). SPG 601.12 outlines the university’s overall standards for the housing of “institutional data,” which applies to the contents of the shared drive. SPG 601.27 outlines information security standards, and SPG 601.07 requires all personnel to use data only as needed, in a responsible manner. However, in the last stages of the project, the team discovered that the drive did contain files with personal health information (PHI), which meant HIPAA became a concern. These placed constraints on the team’s operations, particularly during the COVID-19 pandemic, where it was more difficult to access the technology needed to view sensitive information while being compliant with Michigan Medicine data protection regulations. Despite a thorough review of the web and the extensive

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UM library resources of engineering standards, the team could not locate additional applicable standards.

The team was also unable to work in-person with the clinic’s staff due to state and university orders resulting from the COVID-19 pandemic, which limited the methods the team could employ for analyzing the situation.

6. ALTERNATIVES CONSIDERED

The team developed 3 possible layout alternatives based on discussions with clinic staff and its literature review. The three alternative layouts the team considered are displayed in Figure II.

Functional Divisional Hybrid

Figure II: Functional, divisional, and hybrid approaches for organizing the top level of the shared file drive.

In option 1, files are primarily grouped by function: for example, patient education, clinic marketing, or staff schedule. Under each of those, the relevant clinic specialties would have their own subfolders. For example, a cardiac stress testing calculator, used in exercise physiology, could be stored under Tools -> Exercise Physiology.

In option 2, the order is reversed: files are primarily grouped by division of the clinic, and then by their function. The stress testing calculator would be stored under Exercise Physiology -> Stress Testing.

In option 3, a hybrid of the two are employed. Option 3 is essentially the same as option 2, but with certain file types, such as policy documents, receiving an additional top-level folder for easy access. This is the closest option to the current state (as outlined in Figure 1), but the current state has no consistent standards for what is included at the first level and what is not.

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6.1. Criteria for EvaluationThe team evaluated alternatives based on:

- Clear display of policies: visibility of policy and procedure documents for users of different experience levels.

- Visual search time: the amount of time needed to click through folders to locate a desired file.

- Clicks required for experts: how many clicks are required for a high-experience user to find a given file. This is reflective of the number of folders in the hierarchy’s depth (interviews with stakeholders suggested 5 clicks as a reasonable upper bound goal).

- Information provided for novices: the amount of context given, through folder structure, for a low-experience user to find the appropriate files.

6.2. Decision MatrixThe team created a decision matrix to compare the alternatives, which can be found in Appendix II. In summary, a hybrid of divisional and functional organization—option 3—is the most effective, but causes some slowness in visual search. It is otherwise the best choice according to the criteria the team outlined.

7. DATA COLLECTION and ANALYSIS METHODS

7.1 File Usage Data - Rough The team obtained file usage data from Health Information Technology and Services (HITS). This data includes the pathname for each file, the percentage of the drive that file makes up, and the last time the file was accessed and modified. The team originally planned to use this data to determine what files were not regularly accessed or changed to gauge what could be archived or deleted from the drive. Because of automated scripts run in the shared drive “accessing” files, this data was unreliable, so this was not possible. Instead, the team used the file usage data to determine the five largest files within the Exercise Physiologists’ subfolders. This information was then used to create a survey designed to determine the commonly used folders.

7.2 File Usage Survey - Rough The team designed a 16 questions survey to ascertain the most commonly used files within the EP folder. The purpose of this survey was to determine if there were any particular trends or problems that could inform the team on how to design the deletion and archive procedures. The survey is in Appendix III.

7.3 Cognitive Task Analysis - Current State The team employed a Cognitive Task Analysis (CTA) to determine the initial state and usability of the drive. Tasks were designed to test users’ performance across a range of experience levels in alignment with Rasmussen’s skill-rule-knowledge (SRK) framework [6]; some tasks were

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intentionally difficult to simulate an inexperienced user’s experience in the drive. All tasks were go-find-seek tasks, where participants were asked to locate specific items in the drive. Due to duplication in the drive, it was possible for participants to find items somewhere other than where the team expected, which was noted. The team’s CTA tasks are summarized in Table I:

Table I: Tasks in Cognitive Task Analysis with Corresponding SRK Purpose

Item to Find Scope CTA Purpose

Clinic Emergency Plan Clinic Semi-Familiar File — Rule-Based

Cardiac Stress Testing Calculators EP Familiar File — Skill-Based

Clinic Phone List Clinic Semi-Familiar File — Rule-Based

Sleep Hygiene Tips EP Familiar File — Skill-Based

Physician Coverage Schedule Other Unfamiliar File — Knowledge-Based

Three exercise physiologists completed the CTA and provided comments on their own personal experience using the drives. The team analyzed both the qualitative outcomes (success/partial success/failure) and quantitative results (time to completion), but the most important element of this was the commentary from the clinic staff, which helped the team determine how to progress through the project.

7.4 Cognitive Task Analysis - Alternatives The team designed a set of testing environments on the shared drive and ran a second set of task analyses in these environments. The test environments were medium-fidelity, skeleton representations of the actual shared drive, with the general shape of the folder structure built out, but less files/folders than exist in the actual shared drive. The same three exercise physiologists as before performed the same 5 tasks in each of the 3 alternative environments (functional, divisional, and hybrid top-level structure). The team varied the order subjects were exposed to the 3 alternatives, and the 5 tasks within each alternative, to minimize any bias resulting from order effect. The team analyzed the time it took to complete tasks and the qualitative evaluations provided by the subjects.

7.5 Literature Search - File Naming The team performed a literature review to understand best practices for naming files. The team synthesized the findings from the literature and reviewed the current naming convention of the shared folder based on the determined best practices. The team found several shortcomings with the current naming convention. Then, the team used the results of the literature review to provide recommendations on how to standardize and improve the file naming.

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7.6 Literature Search - File Duplication/Removal Process After gathering feedback from the CTA, the team was interested in exploring the idea of delegating the responsibility of organizing and maintaining the shared drive to one person rather than training the whole department. In this scenario one person/a group of people would have authority over the shared drive. This violates the notion of decentralized authority, which is a key principle throughout lean methodology. The team performed a literature search to determine how to implement lean methodologies within the healthcare hierarchy.

8. FINDINGS

8.1 File Usage Data The team found that there were multiple files that have not been modified in over four years. There seems to be a multitude of small and few folders that contain the majority of the files. These folders were used for survey data to determine how often they are used.

8.2 File Usage Survey The biggest takeaway from this survey was that the biggest files were not used very often. This trend combined with the knowledge that many of these folders contained files older than 4 years, helped provide a way to develop the procedure for archive and deleting files.

8.3 Cognitive Task Analysis - Original SystemThe CTA yielded useful information. Staff difficulty locating desired files in the drive is one of the main issues with the drive. Many folders exist at each level of the file hierarchy, which makes a visual search challenging; therefore, the staff often resort to using the search engine. However, the search engine is still problematic because staff has difficulty determining the necessary keywords to find a file. Additionally, searching takes a long time if there are many files in the search pool, as is often the case.

Another recurring problem is the presence of duplicate folders and files. On several occasions during the CTA, subjects found the requested information from different files in different locations within the drive. This implies that duplicate files play a significant impact on the disorganization of the drive. Furthermore, it is often unclear which of the different versions of a file is the most recent. The team tracked completion time for later comparison to our alternative systems. Table II summarizes this data.

Table II: Averages Times and Accurate Completion Rates of CTA Results by Task

Task #Average time to

Completion% Accurate Completion

1 2:43 100%

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2 0:20 100%

3 1:11 0%

4 1:41 0%

5 1:02 66%

It is notable that tasks 3 and 4 were usually completed by the subject finding a file that conveyed similar, if not exact, information to what the team intended—just not the exact file. This supported comments from staff that the drive contains multiple duplicated folders and sections.

During the CTA, the exercise physiologists described a previous plan for managing the drive that their unit had discussed. This plan would have designated internal responsibility for making updates to the content of shared drive in different drive areas to certain unit members. Due to COVID-19 complications and personnel changes, this plan was not implemented. The team will consider this option when creating the new structure. Additionally, staff reported a personality assessment that had identified people within the clinic who might be the best-fit for “organization” tasks like this one.

This analysis was weakened by its relatively low sample size and the reality that all three interviewees were members of the EP staff. This reduces the generalizability of the results to the clinic at large. However, since the EPs use the drive the most, this is reasonable, and this analysis was intentionally structured to generate simulated data for infrequent users (non-EPs).

8.4 Cognitive Task Analysis - Alternatives Table III displays the average result time for each alternative across the three participants and five tasks. There were two tasks in which the respondents became confused due to apparently illogical choices made in developing the test environment; those averages are reported in the rightmost column.

Table III: Averages Times of CTA Results by Structure Alternative

Alternative Average Time Adjusted for Outliers

Functional 0:15 0:13

Divisional 0:16 0:14

Hybrid 0:11 0:11

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Critically, while Hybrid performed the best here, the differences are not especially significant. More importantly, these results did not match the qualitative reporting from the subjects, who all reported a strong preference for a Divisional top-level structure and felt that the Hybrid structure introduced additional ambiguity that might scale poorly to the full drive.

8.5 Literature Search - File Naming The team consulted the literature to understand how to best name files. Naming conventions are rules to order files and records in a consistent and logical way. This ensures that the correct records can be located, identified and retrieved from a filing system in a timely and accurate fashion [10].

8.6 Literature Search - File Duplication/Removal Process For our specific process, we want to appoint employees to be “in charge” of the shared drive without creating a centralized authority over the shared drive. To achieve this the team suggests appointing a group of authorities, rather than one person, as a result of research’s conclusion “Teamwork on improvements weakened the hierarchical structure, since every member of the team had the same position and role and was expected to contribute to improvements[3].” This authority would be further decentralized if the same process was implemented clinic wide. There would be a cross functional team of EP’s, clinical, and admin team that are all overseeing the organization of the shared drive.

9. CONCLUSIONS

9.1 File Usage Based on the survey and file usage data, many of the biggest folders are not utilized and contain many old files. An archival and reorganization process was developed to address this problem.

9.2 Task Analysis The primary conclusions from the task analysis were:

- There is significant duplication of files/folders in the drive, which contributes significantly to time loss and frustration.

- The staff believe it would be helpful to designate certain point-people to handle the drive’s reorganization and ongoing maintenance.

- Staff believe that the primary top-level folder scheme should be by division, with a rare exception for an especially key area (such as policy and procedure).

- File shortcuts, linking to file from a different location, could be a good way to handle the inherent risk of duplication.

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9.3 Literature Search - File Naming According to the literature review, the basic best practices of file naming are brevity, uniqueness, meaningfulness, and standardization. To make sure the files’ names are generated in the same way, the team developed rules to name files based on the literature’s guidance.

9.4 Literature Search - File Duplication/Reorganization Process Based on the literature, the team determined that the best way to carry out the reorganization process was to organize a cross functional team of people who are tasked with organizing and maintaining the drive.

10. RECOMMENDATIONS

10.1 File Hierarchy and Policy Handling As a result of the task analysis and study of the literature, the team recommends that the clinic employ a file scheme that starts with a divisional area folder split at the top level, then gets into specific functions within an area. In very limited cases, it may be appropriate to split certain high-importance or high-use file types into an additional top-level folder. Policy & Procedure documents are one example of a file type that the team recommends be given a dedicated top-level folder. Schedules were another file type that may warrant this exception. A fuller breakdown of how the team envisions the drive should look is included in Appendix V.

In situations where it is appropriate to reference the same file in more than one place, the team proposes designating one clinic area to “own” the file and placing a shortcut in the alternate location. This will minimize the current version control problem.

According to the literature, the ideal breadth/depth balance of a folder structure depends on the knowledge of its users. Accordingly, for areas of the shared drive that are used frequently, the team recommends that the folder hierarchy be broader, with more folders at each level and less granular division into subfolders. For areas that are used rarely, the team recommends more frequent use of subfolders to help users navigate the drive.

10.2 File Naming The team has developed recommended protocols for naming files, prioritizing consistent date formats, version control, and meaningfulness. These recommendations are included in Appendix IV in their totality.

10.3 Reorganization Process In order to reorganize the drive, each functional area will appoint one person, or a group of people depending on the size of the divisional area, as the division expert of the folder. The responsibility of the division expert is to uphold the rules and maintain the order of the drive. These responsibilities are as follows:

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- Recommend designating one person for each sub-division folder - This person will be tasked in reorganizing the drive - Perform any changes to the folder or file locations that need to be made- This person will also perform the archive process

Part of the reorganization process is the deletion of old files. There will be an initial archive process to organize the file and then a second process that will be continuously repeated to maintain the drive. These two processes are described below:

Initial archive process- Archive all files that have not been modified for 4 years or longer - The division expert then determines what in the archive can be

moved into the live folder- The remaining files can be left in the archive until the next cleanup

process- If folders in the archive are accessed or needed at any point

then they should be removed from the archiveMaintaining Archive clean up process (Performed once a year)

- Remaining files from the last archive cleanup should be deleted- Division expert imports files that are no longer used or current

11. FUTURE WORK

The team notes that future work will be required here, as the drive is not yet organized, but believes that this framework will allow for an effective reorganization. The clinic is well-equipped to organize the shared drive and maintain it into the future. The team does not believe that further design work would be fruitful at this time. In the event that the drive has not made substantial progress in a year or so, the team believes that the project could be worth revisiting from an engineering perspective after restrictions related to the COVID-19 pandemic have ended. Until COVID-19-related restrictions are removed, methods that would be best for studying this problem will be inaccessible. Future expansion of this team’s work, including additional cognitive task analysis, could also be useful.

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REFERENCES

[1] R. Gapp, R. Fisher, and K. Kobayashi, “Implementing 5S within a Japanese context: an integrated management system,” Management Decision, vol. 46, no. 4, pp. 565–579, May 2008.

[2] D. V. D. Malagatti, “Value Stream Mapping to Identify the Impact of Waste in the Process,” Sumedha Journal of Management, vol. 7, no. 2, pp. 38-44, 2018.

[3] E. Drotz and B. Poksinska, “Lean in healthcare from employees’ perspectives,” Journal of Health Organization and Management, vol. 28, no. 2, pp. 177–195, May 2014.

[4] T. Bortolotti, S. Boscari, and P. Danese, “Successful lean implementation: Organizational culture and soft lean practices,” International Journal of Production Economics, vol. 160, pp. 182–201, Feb. 2015.

[5] J. Nielsen and R. Molich, “Heuristic evaluation of user interfaces,” in Proceedings of the SIGCHI conference on Human factors in computing systems Empowering people - CHI ’90, Seattle, Washington, United States, 1990, pp. 249–256.

[6] J. Rasmussen, “Skills, rules, and knowledge; signals, signs, and symbols, and other distinctions in human performance models,” IEEE Trans. Syst., Man, Cybern., vol. SMC-13, no. 3, pp. 257–266, May 1983.

[7] K. J. Vicente, “Ecological Interface Design: Progress and Challenges,” Human Factors, vol. 44, no. 1, pp. 62–78, Mar. 2002.

[8] T. M. Spine, J. A. Whiteside, and R. C. Williges, “Evaluation of Strategies of File Management Behavior,” Proceedings of the Human Factors Society Annual Meeting, Seattle, Washington, United States, 1984, pp. 643-647.

[9] C. T. Stanley, M. D. Byrne, and K. R. Ramos, “Effects of Frequency Sorting Towards Finding Optimal Organizations of Hierarchal File Structures,” Proceedings of the Human Factors Society Annual Meeting, New York, New York, 2008, pp. 945-949.

[10]D. Krewer and M. Wahl. "What’s in a Name? On ‘Meaningfulness’ and Best Practices in Filenaming within the LAM Community." Code4Lib Journal 40, 2018.

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[11]D. Schober, et al. "Survey-based naming conventions for use in OBO Foundry ontology development." BMC bioinformatics 10.1, 2009, pp. 125.

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APPENDIX I. Constraints & Standards Matrix

Requirements Operational Ethical Health & Safety

Ease for Clinic

(R-1) Provide easy access to files. X X

(R-2) Avoid work interference X X X

(R-3) Clear display of policies X X X

Hard Constraints Operational Ethical Health & Safety

Ease for Clinic

(H-1) Remain in Windows Explorer

X

Standards Operational Ethical Health & Safety

Ease for Clinic

(S-1) Compliant with SPG X X

(S-2) Compliant with HIPAA X X X

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APPENDIX II. Decision Matrix Alternatives

Criteria

Baseline = Current

state

Functional Grouping

Divisional Grouping

Hybrid of the Two

Totals

Clear Display of Policies

Datum

+ − + 1

Visual Search Time 0 0 − -1

Clicks required for experts − − + -1

Information provided for novices

− + 0 0

Totals -1 -1 1

Rank 2 2 1

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APPENDIX III. File Usage Survey 1. How often do you use the following folders?

● MFP● Active EP● Stress Testing ● Cardiac Rehab● Fitness Center ● Exercise Consults

Answer Options:a. A great dealb. A lotc. A moderate amountd. A littlee. None at all

2. These are the 5 biggest subfolders. Rank them from most to least used.Answer Options: 5 top folders can be ranked

3.What other files are frequently used in this folder?Open Ended Answer

2.

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APPENDIX IV. File Naming Rules

● Standardized date○ Add dates as yyyymmdd at the end when the edited or created date is an

important factor to the file. e.g 20201121 means Nov 21 st, 2020● Version indicator

○ Add V1, V2, etc at the end of the file name when there are several versions of the file and each version should be tracked.

● Reduction of redundancy○ Avoid redundancy in file names and file paths as this can increase their length

● No special characters○ Avoid using special characters. Expand special symbols to words if necessary. e.g

using ‘and’ instead of ‘&’● Meaningfulness

○ Apply names that are self-explanatory and understandable.○ Avoid truncated names and colloquialisms. ○ Expand abbreviations and acronyms.

● Proper word usage○ Prefer singular nominal form○ Consistently use same word

● Consistent format○ Prefer lower case beginnings.○ Using space between the words.

APPENDIX V. Proposed Layout of File Hierarchy

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First Level

Example Second LevelsExercise Physiology

Clinic Clerical and Administration Work

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Medical Assistants

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