Transforming work

Sachs, Patricia

doi:10.1145/223248.223258

Cited by 193 publications

(112 citation statements)

References 6 publications

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“…This view fails to acknowledge the more tacit aspects of work processes-those activities carried out in everyday practice, which rely on human ingenuity and depend on rules of thumb or individual judgment for synthesis and completion. 20 As a result, rote implementation of policy or procedure can highlight pronounced differences between organizational intention and provider practice, leading to the adoption of system workarounds by clinicians struggling to use a system that does not fully support their work. 26 Any implementation of organizational rules or directives should be undertaken only after careful assessment of the impact of such changes on actual clinical work, to determine whether or not these rules can be practically integrated into workflow.…”

Section: Cpoe Can Highlight Ineffective or Incomplete Implementation mentioning

confidence: 99%

“…1,[14][15][16][17] Regardless of the study focus, one theme consistently emerges: embedding CPOE in healthcare fundamentally changes the way clinicians coordinate their work activities and collaborate to deliver care. [18][19][20][21] Indeed, in our prior work we identified nine broad categories of unintended adverse consequences related to CPOE, negative impact on workflow emerged as the most frequently occurring theme. 18,22 The purpose of this current study was to explore these workflow issues in greater detail.…”

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confidence: 96%

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Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

et al. 2008

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OBJECTIVE: To identify and describe unintended adverse consequences related to clinical workflow when implementing or using computerized provider order entry (CPOE) systems. METHODS:We analyzed qualitative data from field observations and formal interviews gathered over a three-year period at five hospitals in three organizations. Five multidisciplinary researchers worked together to identify themes related to the impacts of CPOE systems on clinical workflow.RESULTS: CPOE systems can affect clinical work by 1) introducing or exposing human/computer interaction problems, 2) altering the pace, sequencing, and dynamics of clinical activities, 3) providing only partial support for the work activities of all types of clinical personnel, 4) reducing clinical situation awareness, and 5) poorly reflecting organizational policy and procedure. CONCLUSIONS:As CPOE systems evolve, those involved must take care to mitigate the many unintended adverse effects these systems have on clinical workflow. Workflow issues resulting from CPOE can be mitigated by iteratively altering both clinical workflow and the CPOE system until a satisfactory fit is achieved. INTRODUCTIONHealth care providers use computerized provider order entry (CPOE) systems to place orders for medications, laboratory tests and other ancillary services. 1 CPOE has been shown to decrease medication ordering errors and redundant test ordering, promote practice standardization, and reduce overall healthcare costs. 2-4 Despite these benefits, CPOE systems have yet to be widely adopted for several reasons, including the high cost of implementation, clinician resistance to technology, worry regarding practice disruption and loss of productivity, fear of technology failure, and the inability of some CPOE implementations to integrate with existing healthcare systems. [5][6][7] Furthermore, there is evidence that unintended adverse consequences can surround the implementation and ongoing maintenance of these systems. [8][9][10] Recent, conflicting reports about the role of CPOE in the reduction of medication errors and associated costs have cast some doubt on the actual scale of improvements to be gained as CPOE systems have generated new kinds of medical errors, negatively affected patient outcomes, and resulted in higher overall medical costs for those institutions implementing them. 9,11-13 Thus, there remains a need for ongoing analysis of CPOE to understand the causes of these issues and help find solutions.A growing body of research explores the impact of integrating clinical information systems, including CPOE, within healthcare. 1,[14][15][16][17] Regardless of the study focus, one theme consistently emerges: embedding CPOE in healthcare fundamentally changes the way clinicians coordinate their work activities and collaborate to deliver care. [18][19][20][21] Indeed, in our prior work we identified nine broad categories of unintended adverse consequences related to CPOE, negative impact on workflow emerged as the most frequently occurring theme. 18,22 The purpo...

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Section: Cpoe Can Highlight Ineffective or Incomplete Implementation mentioning

confidence: 99%

mentioning

confidence: 96%

Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

et al. 2008

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“…We believe, and argue in this paper, that user participation is a key success factor for designing for usability (see also Standish Group 1995, Gould et al, 1997, andISO 13407 1999) and that software development needs to move towards a user-centred approach rather than away from it. Computer systems (in particular in a work context) must support not only the official rules and version of the work practices but also the particularities in each situation (Sachs 1995, Beyer and Holtzblatt 1998, Harris and Henderson 1999, which required a deep understanding of the context of use. Few development teams have that understanding, and we believe that writing requirements documents or creating abstract models is simply not enough to create that kind of understanding.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Key Principles for User-Centred Systems Design

Gulliksen

Göransson

Boivie

et al. 2005

Human-Computer Interaction Series

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Abstract. The concept of user-centred systems design (UCSD) has no agreed upon definition. Consequently, there is a great variety in the ways it is applied, which may lead to poor quality and poor usability in the resulting systems, as well as misconceptions about the effectiveness of UCSD. The purpose of this paper is to propose a definition of UCSD. We have identified 12 key principles for the adoption of a user-centred development process, principles that are based on existing theory, as well as research in and experiences from a large number of software development projects. The initial set of principles were applied and evaluated in a case study and modified accordingly. These principles can be used to communicate the nature of UCSD, evaluate a development process or develop systems development processes that support a usercentred approach. We also suggest activity lists and some tools for applying UCSD. Purpose and justificationThis paper describes the results of our current research on UCSD and our experiences of applying UCSD in software development projects. Our purpose has been to compile knowledge and experiences of UCSD, in order to give the concept a more precise meaning and to increase its power. The main point in our paper is that applying UCSD requires a profound shift of attitudes in systems development, and our main goal is to promote that attitude shift.

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“…Even though these frameworks differ from each other, they share some key concerns. All of them are trying to provide an alternative to purely rational, explicit, normative, and pragmatic approach to understanding work and other types of human activities (e.g., Sachs, 1995). Numerous studies (e.g.…”

Section: Theoretical Foundations and Research Objectivesmentioning

confidence: 99%