British Computer Society:Nurses prove it pays to seek user involvement

The impact of ignoring end-users when designing IT systems - generating resistance that can remove much of a system's value - has...

The impact of ignoring end-users when designing IT systems - generating resistance that can remove much of a system's value - has been underlined in a study of two nursing applications, writes John Kavanagh.

The study, reported to the BCS Nursing Specialist Group, says poor user involvement led to issues ranging from out-of-date patient information to concerns that managers could monitor nurses' work.

Lessons for IT projects beyond the National Health Service are revealed by researchers Stephen Timmons, a lecturer at Nottingham University's School of Nursing, and Sally Miller, community nursing services team leader at Mansfield Primary Care Trust.

One part of the study focused on three hospitals using a care planning system. Nurses are supposed to write and do at least daily updates of care plans for every patient.

"Outright refusal to use the systems was uncommon," the researchers say. "Much more common was a variety of ways the use of the system was adapted or delayed."

Care plans were not created and updated fully. Regular updates were neglected. Many staff hand-wrote reports and did not have time to enter the information on the system. Updates were delayed, often being left to the night shift staff because of health care priorities during the day.

"The various manifestations of not using the system, and the delays, could be considered as examples of working round the system," the researchers say. "On the whole, nurses had little choice but to use the systems. What was less susceptible to management control, however, was how and when they did so. This had the effect of changing what the systems became through the processes of implementation and use."

The second system studied is used by community nurses on their rounds. They use handheld devices to record details of visits. They are supposed to update the system after every visit but tend to do so at the end of the day or even the end of the week.

"The community nurses tended to record the bare minimum of data, and this, with the delays, led to a very high error rate," the researchers say.

Nurses are concerned about managers using the system to monitor their visits and change their working practices.

The researches have lessons for other fields from this study. "The community nurses' main justification for not fully engaging with the system was that they didn't get anything back from it," they say.

"It was perceived as being entirely an administrative system. This was due, in part, to problems with the system: it was slow, and support staff were often not available.

"Other technical and managerial issues were that it was largely imposed, with little user involvement in design and implementation, and there were some problems with the initial levels of IT literacy of the users."

The researchers say both groups of users "complied where they had to and resisted where they could".

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