Future Directions in Evaluation Research: People, Organizational, and Social Issues

Kaplan, Bonnie; Shaw, Nicola

doi:10.1055/s-0038-1633862

Cited by 91 publications

(13 citation statements)

References 221 publications

(333 reference statements)

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“…We chose qualitative techniques because they excel at answering "why" questions, can help us understand problem list utilization from the user's perspective, and can identify contextual and cultural factors that might affect attitudes and utilization [13-16]. In order to better understand clinician attitudes toward, and use of, electronic problem lists, we observed and interviewed a variety of clinicians.…”

Section: Introductionmentioning

confidence: 99%

Clinician attitudes toward and use of electronic problem lists: a thematic analysis

Wright

Maloney

Feblowitz

2011

BMC Med Inform Decis Mak

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BackgroundThe clinical problem list is an important tool for clinical decision making, quality measurement and clinical decision support; however, problem lists are often incomplete and provider attitudes towards the problem list are poorly understood.MethodsAn ethnographic study of healthcare providers conducted from April 2009 to January 2010 was carried out among academic and community outpatient medical practices in the Greater Boston area across a wide range of medical and surgical specialties. Attitudes towards the problem list were then analyzed using grounded theory methods.ResultsAttitudes were variable, and dimensions of variations fit into nine themes: workflow, ownership and responsibility, relevance, uses, content, presentation, accuracy, alternatives, support/education and one cross-cutting theme of culture.ConclusionsSignificant variation was observed in clinician attitudes towards and use of the electronic patient problem list. Clearer guidance and best practices for problem list utilization are needed.

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Section: Introductionmentioning

confidence: 99%

Clinician attitudes toward and use of electronic problem lists: a thematic analysis

Wright

Maloney

Feblowitz

2011

BMC Med Inform Decis Mak

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“…Thus, we were able to tell a more complete story of the process by which the new policy of the 4 hour wait target and an emergency department adapted to each other at the local organisational and professional context [62,63]. We paid particular attention to unintended consequences as they revealed the strength of mutual dependencies between the social and technical elements that hold this new way of working together [64] and, provided an opportunity to investigate their role in shaping the outcomes of this organisational change [65].…”

Section: Discussionmentioning

confidence: 99%

National targets, process transformation and local consequences in an NHS emergency department (ED): a qualitative study

Vezyridis

Timmons

2014

BMC Emerg Med

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BackgroundIn the attempt to reduce waiting times in emergency departments, various national health services have used benchmarking and the optimisation of patient flows. The aim of this study was to examine staff attitudes and experience of providing emergency care following the introduction of a 4 hour wait target, focusing on clinical, organisational and spatial issues.MethodsA qualitative research design was used and semi-structured interviews were conducted with 28 clinical, managerial and administrative staff members working in an inner-city emergency department. A thematic analysis method was employed and NVivo 8 qualitative data analysis software was used to code and manage the emerging themes.ResultsThe wait target came to regulate the individual and collective timescales of healthcare work. It has compartmentalised the previous unitary network of emergency department clinicians and their workspace. It has also speeded up clinical performance and patient throughput. It has disturbed professional hierarchies and facilitated the development of new professional roles. A new clinical information system complemented these reconfigurations by supporting advanced patient tracking, better awareness of time, and continuous, real-time management of emergency department staff. The interviewees had concerns that this target-oriented way of working forces them to have a less personal relationship with their patients.ConclusionsThe imposition of a wait-target in response to a perceived “crisis” of patients’ dissatisfaction led to the development of a new and sophisticated way of working in the emergency department, but with deep and unintended consequences. We show that there is a dynamic interrelation of the social and the technical in the complex environment of the ED. While the 4 hour wait target raised the profile of the emergency department in the hospital, the added pressure on clinicians has caused some concerns over the future of their relationships with their patients and colleagues. To improve the sustainability of such sudden changes in policy direction, it is important to address clinicians’ experience and satisfaction.

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“…Evaluation research is, in ‘Methods of Information in Medicine’, considered “a key in identifying how people, organizational, and social issues—all crucial to system design, development and implementation, and use—interplay with informatics projects” [14 p.215]. Further, “the study of failures, partial successes, and changes in project definition or outcome” are recommended for future research [ibid].…”

Section: Methodsmentioning

confidence: 99%

Attending unintended transformations of health care infrastructure

Wentzer

Bygholm²

2007

Int J Integr Care

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IntroductionWestern health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure.Theory and methodsAgainst a background of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure. These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices.ResultsThis paper develops a conceptual framework for addressing transformations of communication and workflow in health care as a result of implementing IT.Conclusion and discussionThe purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences of IT implementation into health care practices and outcomes.

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Future Directions in Evaluation Research: People, Organizational, and Social Issues

Cited by 91 publications

References 221 publications

Clinician attitudes toward and use of electronic problem lists: a thematic analysis

Clinician attitudes toward and use of electronic problem lists: a thematic analysis

National targets, process transformation and local consequences in an NHS emergency department (ED): a qualitative study

Attending unintended transformations of health care infrastructure

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