Unanticipated influence of coordination mechanisms on physician workstyles and ED operational efficiency

The coordination of activities in a work context has been examined by many disciplines and in recent years the role of information systems and other artifacts has become increasingly prominent. The emergency department (ED) of a hospital in a large US city is used to study how information systems and other coordinating mechanisms affect how physicians choose to perform their work and how such choices can impact the ED’s overall operational performance. The study used direct observation of the work performed in the ED, interviews of physicians, nurses and other ED staff members, and the analysis of historical performance data. The key findings were that the existing coordination mechanisms are a mix of fixed and mobile, computer and paper-based information systems, and other artifacts. The workstyles adopted by physicians were shaped by incidental characteristics of these coordination mechanisms. Some workstyles appear to have adverse, albeit unintended, effects on aspects of the department’s operational performance

Noise Levels in Two Emergency Departments Before and After the Introduction of Electronic Whiteboards

Purpose: Hospital work generates noise. This article investigates the noise level in emergency department

Examining barriers to healthcare providers’ adoption of a hospital-wide electronic patient journey board

Background: The dynamic environment that characterizes patient care in hospitals requires extensive communication between staff. Electronic status board applications are used to improve the flow of communication in hospitals. To date there has been limited work exploring the adoption of these applications in general acute ward settings. Aim: This study aimed to identify barriers to the adoption of an electronic patient journey board (EPJB)1 application in acute wards of a hospital. Method: Data were collected at a large public teaching hospital in Sydney, Australia. The EPJB was implemented across all hospital wards with the aim of improving multidisciplinary communication in wards. Observations (29.5 h) and contextual interviews (n = 33) with hospital staff were conducted in two acute wards of the hospital. Results: Two manual whiteboards were used on wards, in addition to the EPJB, to compensate for information not being available or accessible on the EPJB. Despite the stated purpose of the EPJB, the tool did not appear to support team communication on wards. Barriers to adoption and optimal use of the EPJB included inappropriate location and configuration of the system, limitations in information timeliness, quality and lack of customisation (for different user groups), inconsistent information updates and the absence of a shared understanding of the purpose of the EPJB among the various user groups. Conclusion: Multiple socio-technical barriers influenced uptake and optimal use of the EPJB by healthcare providers. Engaging users early in the design and implementation of electronic status board applications is required to ensure effective use of these complex interventions on general wards