The implementation of information systems in organizational settings is a protracted process that includes the mutual adaptation of system and organization to each other after the system has gone live. We investigate a design-in-use approach to this implementation process. Rather than a centrally run implementation process with preset goals, the management in the studied hospital tasked the individual departments with exploring and embracing the possibilities afforded by a network of interconnected electronic whiteboards. The responsibility for driving this process was assigned to local super users in the departments. On the basis of interviews with 17 clinicians we find that (a) they perceive the design-in-use approach in conflicting ways, (b) the super users are more positive about the approach than the end-users, (c) standardization across departments conflicts with design in use within departments, (d) intradepartmental change is perceived more positively, (e) the design-in-use process is inextricably sociotechnical, and (f) the clinicians' perception of design in use is more about implementing change than about preparing it or about training and support. The conflicting perceptions of the design-in-use approach, for example, include whether it gained momentum, met local needs, and made for an engaging process. We discuss the implications of our findings for a design-in-use approach to implementation.
Studies have shown that whiteboards support much cooperative work by for example strengthening awareness, improving communication, and reducing mental workload. In line with these predominantly positive findings, an emergency department (ED) turned to its whiteboard to improve the coordination of its work with blood tests. We investigate this use of the whiteboard through observations and informal interviews in the ED and analyze the ability of the whiteboard to support coordination and awareness in the work with blood tests. Our findings show limitations in the ability of the whiteboard to support awareness in a setting where the users are (locally) mobile, specifically in regard to information that requires continuous monitoring. We do however also find that the whiteboard safeguarded the work with blood tests against some risks by making blood-test information socially visible.
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