Path Coherence and Disruption in Routine Dynamics

Abstract

We use evidence from a disruption of clinical documentation routines to propose a novel, predictive mechanism for routine dynamics based on path coherence. Path coherence refers to the continuity of situational attributes from one event to the next along a path, for example, a set of activities conducted by the same person has high actor coherence. Situational attributes include classic descriptors such as who, what, when, where, and why. To be recognized as a path, a minimal level of coherence is required, but path coherence can vary along a path. For example, in a medical clinic, typical paths flow from place to place (e.g., reception, waiting room, exam room) and involve different clinical staff (e.g., receptionist, nurse, physician). Using latent factor network models, we compare clinical documentation routines in five outpatient clinics before and after a technological disruption (an upgrade to the electronic health record system). We show that coherent paths are up to 14 times more likely to persist and up to 40 times more likely to form than less coherent paths. We use these findings to theorize about the role of path coherence in routine dynamics. Path coherence in narrative networks is like homophily in social networks, but with a completely different underlying mechanism. We discuss the implications of our findings for organizational path dependence, resilience, and inertia. Funding: This research was supported by the National Science Foundation [Grants SES-1734237 and BCS-2120530]. This research was also supported in part by the University of Rochester CTSA [Grant UL1 TR002001] from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH).