Challenges of Digital Commons: A Qualitative Study of an Automated Dispensing Cabinet in a Paediatric Intensive Care Unit

Missed medication doses can affect patient safety in hospitals. The use of automated dispensing cabinets (ADC) in clinical areas may reduce the occurrence of medications being unavailable at the time of need by alerting pharmacy to replenish stock. However, workarounds in ADC use can affect this capability. We studied nurses' use of an ADC in a paediatric intensive care unit with  54 hours of observation, semi-structure interviews (19 nurses; 4 pharmacy/management staff) and review of reported incidents. We found running out of medication a recurrent problem despite the ADC. Contributing factors affecting data entry in the ADC, and therefore replenishment alerts to pharmacy, included: the organisation of medication activities in the ward, nurses' information needs, patients' medication needs, and ADC design. Running out of medications was a 'tragedy of the commons'. Effective solutions may require going beyond user training and directives for accurate data entry, to work process redesign

WORKAROUNDS IN INFORMATION SYSTEMS RESEARCH: A FIVE-YEAR UPDATE

This paper complements an earlier (2019) literature review on workarounds in information systems research by including research that has influenced or been published in core IS outlets during the last five years (2018–2022). Our study captures research that strengthened, widened, and challenged theoretical insights from the previous review. It also provides additional insights and develops seven themes of theoretical insight. The 31 new papers and our updated analysis are most evident in the three themes: Workarounds and power, Temporality of workarounds, and Managing workarounds. We also found additional studies using the term ‘workaround’ differently to the extent that they have not applied the term to the same empirical phenomena, which questions the validity of some theoretical claims. We also found significantly more studies that used quantitative data-collection methods than the previous review

Breaking BAD to bridge the reality/rhetoric chasm

The reality of using digital technologies to enhance learning and teaching has a history of falling short of the rhetoric. Past attempts at bridging this chasm have tried: increasing the perceived value of teaching; improving the pedagogical and technological knowledge of academics; redesigning organisational policies, processes and support structures; and, designing and deploying better pedagogical techniques and technologies. Few appear to have had any significant, widespread impact, perhaps because of the limitations of the (often implicit) theoretical foundations of the institutional implementation of e-learning. Using a design-based research approach, this paper develops an alternate theoretical framework (the BAD framework) for institutional e-learning and uses that framework to analyse the development, evolution, and very different applications of the Moodle Activity Viewer (MAV) at two separate universities. Based on this experience it is argued that the reality/rhetoric chasm is more likely to be bridged by interweaving the BAD framework into existing practice

Conceptualizing Workarounds: Meanings and Manifestations in Information Systems Research

We reviewed papers in core IS outlets that defined the term workaround or presented an example of a workaround. In the analysis, we used Ogden and Richard’s triangle of reference as a theoretical framework to analyze the relationship between 1) the term workaround; 2) theories, definitions, and use of the term; and 3) their empirical basis and empirical workaround behavior that the papers describe. First, we summarize the existing theoretical insights regarding workarounds and investigate their validity. Second, we show that studies have defined and used the term workaround differently to the extent that they have not always applied it to the same empirical phenomena, which raises questions about some theoretical insights’ validity. Third, we suggest a definition for workarounds that we inductively derived from empirical accounts of workaround behavior and, therefore, that adequately describes how researchers commonly use the term and makes it possible to distinguish workarounds from other similar phenomena

The Role of Workarounds in Benefits Realisation: Evidence from a Field Study in Saudi Arabia

Recent studies show that more than half of Saudi Arabian (SA) organisations fail to realise business benefits from their IS investments. This has been largely attributed to the contextual misalignment between information technologies and the needs of developing countries. In the IS literature on benefits realisation, the application of benefits dependency networks (BDN), have been established as being helpful in improving IS projects outcomes. This research investigates current IT development practice in SMEs in Saudi Arabia and reports on some of the challenges that these businesses need to overcome to achieve benefits from their IT investments. Evidence from the literature and a field study suggests that workarounds are widely used when implementing new IT, particularly to facilitate the continuation of embedded cultural practices. The paper argues that integrating the Theory of Workarounds into frameworks for benefits realisation would offer a useful conceptualisation of IT implementation practice to support businesses in developing countries such as Saudi Arabia to improve outcomes when investing in IT

THE ROLE OF WORKAROUNDS DURING AN OPENSOURCE ELECTRONIC MEDICAL RECORD SYSTEM IMPLEMENTATION

A significant degree of customization of medical information technology is required to effectively integrate the promise of IT with the diversity and complexity of medical work. In the absence of such customizations, dissatisfaction and resistance toward the system arise. Indeed, the complexity of the medical work and the inability of software to tailor to the diverse medical practices may explain the limited diffusion of health information systems especially in North America. We study the role of workarounds during an open-source Electronic Medical Record System (EMR) implementation at a medium-size urgent care clinic in a major Canadian city. We found that the technology appropriation process involved the evolving of number of non-trivial workarounds in order to match the EMR to medical work. The emergence of workarounds is conceptualized as a knowledge creation and integration process. This perspective allows us to look at the antecedents and the change dynamics of workarounds in the clinic. Furthermore diverging from the negative view toward workarounds, we discuss the importance of incorporating workarounds during and following system development. The workaround perspective shed the light on how users’ behavior can be channeled into a constructive development effort. This paper contributes by examining the workaround of medical practitioners using an open-source electronic medical record system as well as offering a knowledge perspective for the study of EMR appropriation

Regulating Vendor-Client Workarounds: An Information Brokering Approach

Under pressure to deliver value, whilst driving down costs, shared service units (SSUs) themselves are turning to outsourcing. Despite efforts to manage both relationships, it can be the case that the SSU’s internal clients communicate directly with an external vendor, exchanging information which bypasses the SSU. The use of such illegitimate communication channels lead to what we refer to in this paper as Vendor-Client (V-C) workarounds. How units cope with V-C workarounds to limit detrimental impacts, whilst encouraging or accommodating those of potential benefit, has been largely understudied. This working paper draws on preliminary data, from the shared finance unit of a global logistics organization, to answer our main research question: How do SSUs regulate existing Vendor-Client workarounds to benefit information flow? In answering the question, we take an Information Brokering perspective to help explain the how SSUs leverage their position as intermediaries and manage information interfaces to regulate workarounds

EXPLAINING THE INFLUENCE OF WORKAROUNDS ON EFFECTIVE USE – THE CASE OF A SUPPLY CHAIN MANAGEMENT SYSTEM

The stage of post-adoption of an enterprise system (ES) implementation has been in the focus of recent information systems research. However, a thorough understanding of how users effectively use an enterprise system to complete their tasks is still missing. Prior research has implied that adaptive use is of great importance to facilitate effective use of a system. We investigate adaptive use solutions, which are outside the original system. This behavior is known as workaround. We conduct an interpretive case study to investigate the impact of workarounds and explain why workarounds can lead to an advance in effective use of a standard ES. We expand the theory of effective use with an explanation why workarounds can improve transparent interaction, representation fidelity and informed action via alleviating users’ issues with the surface structure and the faithfulness in representations of an implemented standard ES