Available via license: CC BY-NC-ND 4.0
Content may be subject to copyright.
Proceedings of the 18th International Symposium on Health Information
Management Research
Communication Breakdowns between Nurses
and IT Department: Why Hospitals Fail at
Improving the Usability of Health Information
Technology
Diane Golay1, Åsa Cajander1, Deman Hussein1, Ali Azeez2, and
Stefano Bonacina2
1Division for Visual Information and Interaction, Department of Information Technology,
Uppsala University, Uppsala, Sweden
2Health Informatics Centre (HIC), Department of Learning, Informatics, Management and
Ethics, Karolinska Institutet, Stockholm, Sweden
Often, Health Information Technology (HIT) in hospitals consists of off the shelf systems that are
configured and implemented by IT department workers. This means that these employees have a
significant impact of the usability of HIT systems. Nonetheless, we currently do not know how IT
department workers work. This prevents us from formulating educated recommendations aimed at
improving HIT usability, known to be poor, especially from nurses’ perspective. In this paper, we
hence present the results from an interview study, shedding light on 1) the communication channels
that exist between nurses and IT department at a large public hospital in Sweden, and 2) the problems
that undermine system-related communication between these two groups. Our findings stress the
need for successful two-way communication between nurses and IT department in order to improve
the usability of HIT in use.
Keywords
end user involvement, health information technology, IT department, nurses, user-centred design
1. Introduction
Health Information Technology (HIT) plays an important role in today’s health care. The way
information is handled, stored, and shared influences how effectively and efficiently care can be
provided. By enabling clinicians to make better use of information, HIT has the potential to support
them in taking the right decisions and actions, thereby improving patient outcomes. However, HIT is
often plagued by usability issues [1, 2], which has been associated with negative outcomes for both
patients and healthcare professionals [3]. Nurses, as the largest group of HIT users [4], have been
particularly affected by the issues emerging from its use. Examples of reported problems related to
HIT use by hospital nurses include additional work, stress, and errors [2, 5, 6].
Improving the usability of HIT systems will require efforts from both HIT vendors and healthcare
organizations [3, 5]. Indeed, HIT systems used in hospitals often are off the shelf systems developed
by HIT vendors and configured, implemented, and maintained by the health care organizations
themselves [3, 5], and more specifically by employees from these organizations’ dedicated Information
Technology (IT) department. These employees, many of which have no formal background in
computing, are key agents before, during and after the implementation of the main HIT systems used
in hospitals, including the electronic health record (EHR). In consequence, it is indisputable that IT
department workers play a significant role in the usability of HIT systems, through their influence on
the systems’ interface and functionality on the one hand, and through their role in shaping the
systems’ implementation and maintenance processes on the other [3, 5].
In spite of IT department workers’ importance in the usability of HIT in use, we currently lack
knowledge on how they work [3]. As a result, we currently are unable to formulate effective
recommendations as to what healthcare organizations can (should) do to achieve higher HIT usability
© 2020 Author/s. This is an Open Access article distributed under the terms of the Creative Commons Attribution
NonCommercial NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/),
ISBN: 978-91-89081-09-3
DOI: https://doi.org/10.15626/ishimr.2020.01
Diane Golay, Åsa Cajander, Deman Hussein, Ali Azeez, and Stefano Bonacina
Proceedings of the 18th International
Symposium on Health Information
Management Research
[3]. A recent literature review on the topic has concluded that the “improvement [of HIT usability] will
require that we more clearly identify where and when usability gets created or breaks down, [...] and
how usability methods are used (and not used)” by IT department workers in healthcare organizations
[3].
Following this call for more research, this paper investigates the perspective of IT department workers
on system-related communication between nurses and IT department. Previous research indeed
suggests that nurses’ involvement in the design and evaluation of HIT is beneficial to its usability [4].
On the basis of two interview studies conducted with IT department workers at a large University
Hospital in Sweden, we therefore address two main research questions:
•What communication channels currently support system-related communication between nurses
and IT department?
•What breakdowns in these communication channels undermine (from IT department workers’
perspective) system-related communication between nurses and IT department, thus negatively
affecting the usability of HIT in use?
2. Related Research
2.1 Usability of Health Information Technology
Usability is defined in ISO 9241-210 as “the extent to which a system [...] can be used by specified
users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of
use” [7]. Usability is hence an assessment of 1) whether users can perform their work tasks with the
system (e.g., marking a drug prescription as administered), 2) how quickly these work tasks can be
carried out in the system (e.g., how long it takes to mark a drug prescription as administered), and 3)
users’ subjective assessment of how well a system fulfils their use needs.
The lacking usability of HIT has been widely acknowledged in the literature [1–3], including in the
specific context of hospital nursing. In their recent examination of nurses’ usability problems with HIT,
Staggers et al. [6] found a wide range of issues, including mismatches between nurses’ work practice
and system design (e.g., single patient views while nurses care for groups of patients, individual work
view while nurses work as part of an interdisciplinary team), fragmentation of patient information within
and across systems, and lack of internal and external system interoperability. Additional problems
include excessive documentation requirements (without compensation in other areas of nurses’ work),
as well as inadequate training and education [6]. Consequences of these usability issues for nurses
include work inefficiencies, reductions in productivity, frustrations, increases in cognitive burden and
stress, as well as threats to patient safety and gaps and errors in the care provided [6]. These findings
coincide with other studies making a connection between poor HIT usability and multiple negative
outcomes for patients as well as for clinicians [3].
It is therefore essential to improve HIT usability in order to ensure high quality of care and healthy
working conditions for healthcare professionals. As made visible by the list of usability issues
mentioned above, this requires work on the level of both HIT vendors (designers of HIT [3]) and
healthcare organizations (implementers of HIT [3]), as both contribute to shaping HIT usability [3, 5, 6].
For instance, decisions about configuration, customization, and user training, all of which can have a
significant impact on the usability of HIT in use, are made by healthcare organizations [3, 5], and more
specifically by these organizations’ IT department workers. As a consequence, for researchers, the
“improvement [of HIT usability] will require that we more clearly identify where and when usability gets
created or breaks down, [...] and how usability methods are used (and not used)” by IT department
workers in healthcare organizations [3]. However, a major issue is that we still lack knowledge about
how these implementers of HIT work [3], and thus cannot make effective recommendations as to what
they should change and improve in their current work processes in order to achieve higher system
usability.
2.2 End Users’ Involvement in the Development Life Cycle and Usability
Usability is closely connected to user-centred design methods [8], which consist in taking into
consideration the user and the physical, social and organizational context of use by involving end
users in all phases of the system development life cycle [9, 10]. Ideally, a user-centred design process
is iterative and has a continuous focus on the user [9], as user requirements affect all aspects of
Communication Breakdowns between Nurses and IT Department:
Why Hospitals Fail at Improving the Usability of Health Information Technology
Editors: Peter Bath,
Päivi Jokela, Laura Sbaffi
system development [10]. Common methods used in user-centred design include personas, think
aloud evaluations and workshop with users [11]. However, previous research has shown that user-
centred principles are not systematically integrated and followed by HIT vendors [3, 8], even though
there have been attempts at achieving such an integration [12]. There are for instance efforts in
adapting user-centred design methods to public organizations in general [13], as well as more
specifically to health care organizations, where these efforts have for example resulted in use
scenarios [14] and multidisciplinary thematic seminars [15]. Nonetheless, the most popular user-
centred methods used when developing systems (independent of the work domain) remain usability
tests, interviews and questionnaire surveys [11]. In addition, the problem is that when user-centred
methods are resorted to, they are often used too late in the design process [8], which limits the
benefits they can provide.
Nowadays, agile system development is the prevalent model in both development and maintenance of
IT systems at large [16]. Resorting to agile methodology has an impact on the degree of end user
involvement in the development process. For instance, previous research has pointed to the fact that,
in agile system development processes, feedback is often informal, and that lack of time leads to the
(even more) limited use of user-centred design methods [17, 18]. Some researchers are therefore
working on integrating user-centred design methods in agile development [16, 19, 20], while others
work towards a new software development methodology that includes more time for user involvement,
e.g. [21].
It is important to point out that the vast majority of the research looking into the involvement of end
users (including nurses) in HIT development (e.g. the works we have referenced above) focuses on
HIT vendors, and not on HIT implementers, i.e., IT department workers in hospitals [3]. There is very
little research on user-centred design methods and user involvement in internal design,
implementation and maintenance processes within healthcare organizations.
2.3 Nurses’ Involvement in the Development Life Cycle of Health Information
Technology
Nurses are the largest group of healthcare professionals [4] and the primary providers of patient care
in hospital settings [22]. They are thus required to interact daily with HIT to ’track, organize, and
update patient information’ [22], and as such a key user group of HIT, whose ability to deliver high
quality care can be hindered by poor HIT usability [6].
HIT usability issues in nursing can be associated with nurses’ lack of involvement in this process, as
“corporate decisions about health IT purchases are often made without adequate nursing input” [6].
However, research suggests that this lack of involvement of nurses throughout the design process of
HIT is not solely due to HIT vendors’ and/or implementers’ disregard for nurses’ needs. Nurses also
seem reluctant to take an active role in the design, implementation and evaluation of HIT. Procter et
al. [23] stress that “nurses at all levels have a choice, to continue to shy away from involvement in the
development, implementation and evaluation of [HIT] systems, or take a leadership role and add
[system-related] wisdom to their professional knowledge”.
In conclusion, existing research on the (lacking) usability of HIT suggests that, if higher HIT usability is
to be achieved, adequate input from nurses should be collected throughout the whole system
development lifecycle, “from selection to tailoring/customization to implementation, evaluation, and
optimization” [6].
3. Method
This paper reports on the results of an interview study carried out at the IT department of a university
hospital in Sweden. Altogether 15 IT department workers were asked about their perspective on
nurses’ involvement in the design and implementation of HIT systems in their organization, as well as
their perspective on the usability of these systems. Informed consent was obtained from the
interviewees before each interview.
Participants were all involved in the configuration, customization and/or maintenance of the big HIT
systems in use at the hospital, including an electronic health record, an operation planning system,
and a patient vitals monitoring system. The participants’ roles varied and their distribution across roles
is presented in Table 1. The job titles given in the table are those used by the interviewees
themselves.
Diane Golay, Åsa Cajander, Deman Hussein, Ali Azeez, and Stefano Bonacina
Proceedings of the 18th International
Symposium on Health Information
Management Research
The audio recordings of the interviews were transcribed verbatim, and the data were compiled and
grouped into themes. We then extracted the findings related to these common themes and brought
them into a coherent structure. The interview study has previously resulted in one bachelor thesis [24]
and one master thesis [25].
Table 1 Participants’ distribution across roles.
Role
Number of Participants
Care coordinator
1
Project leader/manager
5
Support staff member
4
IT technician
1
Application manager
4
Total
15
4. Results
Our participants, IT department workers at a large public hospital in Sweden, stressed the need for
successful, two-way communication between nurses and IT department in order to achieve high HIT
usability. This means that they saw both 1) getting information and feedback from nurses (i.e., nurses
communicating their system-related needs and issues to the IT department) and 2) getting system-
related information through to nurses (i.e., nurses assimilating system-related information from the IT
department) as essential components of HIT usability. In other words, the IT department workers we
talked to felt it was not enough for them to listen to nurses and take their needs into consideration in
order to achieve high usability; nurses also needed to listen to (and learn from) them.
In accordance with this perspective on HIT usability, our findings address two main themes - always
from the perspective of IT department workers at a large public hospital in Sweden:
•Communication channels between nurses and IT department;
•Breakdowns in these communication channels (i.e. in the communication between nurses and IT
department).
4.1 Communication channels between nurses and IT department
Our participants mentioned several communication channels (or modes/means of communication)
between IT department and nurses. These communication channels are presented in table 2, taking
into consideration the direction of the communication for each channel (i.e., whether from nurses to
the IT department or from the IT department to nurses or, in cases of two-way communication
channels, both). In the remainder of this section, we describe each communication channel in some
more detail.
Table 2 Communication channels between nurses and IT department.
Direction
Communication Channels
Nurses à IT dept.
Electronic error reporting
system
Meetings between IT
department and nurse
representatives
Two-way
communication
Instructor-led training
workshops
IT dept. à Nurses
Nurse managers
Intranet
Communication Breakdowns between Nurses and IT Department:
Why Hospitals Fail at Improving the Usability of Health Information Technology
Editors: Peter Bath,
Päivi Jokela, Laura Sbaffi
Electronic Error Reporting System
When, or after, encountering a problem during an interaction with a system, nurses can report (i.e.,
describe) the issue in a structured way via an electronic reporting system.
The system error reports thus created in the system by nurses are then scanned by a care
coordinator, who performs an evaluation of the relative significance of each reported issue, assigning
different priority rankings to different error reports.
Finally, the high-priority error reports are forwarded to the IT department. IT department workers can
then on this basis identify the HIT-related aspects nurses struggle with as well as the system
components in need of improvement.
Meetings between IT department and nurse representatives
One of the application managers we talked to indicated meeting with nurse representatives four to six
times a year to discuss system-related issues. More specifically, the interviewee mentioned asking
nurses about their “thoughts and needs” regarding the continuous development (improvement) of
systems already in use. However, no details were provided as to the composition, form and goals of
these sessions.
Instructor-led training workshops
Instructor-led training sessions are provided to different user groups when (often shortly before) new
systems managed by the IT department are implemented or going through a significant update (e.g.,
when new features are being implemented). These workshops are primarily aimed at teaching the
system’s end users how to interact with the system and/or its new features, i.e., supporting
communication from the IT department to the nurses (and other medical staff). Nonetheless,
interviewees also described them as good opportunities to gather staff’s (including nurses’) opinions
on system functionality, i.e., supporting communication from the nurses to the IT department, allowing
IT department workers to identify changes to be made even before the full implementation of the new
system or features. In consequence, instructor-led workshops appear to be the only two-way
communication channel between nurses and IT department (in the investigated research setting).
Nurse managers
Participants stressed nurse managers’ function as intermediaries between IT department and nurses.
According to our participants, nurse managers are one of two channels through which IT department
workers in our research setting can communicate system-related information to nurses (the second
one being the intranet, see below). Nurse managers have daily, face-to-face meetings with their staff
and, according to our participants, using these meetings to rely messages from the IT department is
part of nurse managers’ duties. In that sense, nurse managers are, from nurses’ perspective, a “push”
medium, i.e., a way for nurses to get system-related information without actively looking for it.
Intranet
The intranet is the second channel through which the IT department can communicate system-related
information to nurses. In contrast to the first channel (i.e., nurse managers, see above), the intranet is
a “pull” medium, meaning that nurses actively need to go and fetch the information in order to receive
it.
4.2 Communication breakdowns between IT department and nurses
Our participants mentioned breakdowns (problems) in several of the communication channels
between the IT department and nurses. The mentioned breakdowns affected both the communication
from nurses to the IT department (i.e., nurses’ feedback on system-related issues) and the
communication from the IT department to the nurses (i.e., information about the systems and their
use).
With the exception of the higher-level issue of lack of time, channel-specific problems were mentioned
in relation to three of the identified communication channels:
•Low quality and low-level filtering of reports in relation to the electronic error reporting system;
•Non-attendance of nurses in relation to the instructor-led training workshops;
•Misalignment between nurse managers’ and IT department workers’ priorities in relation to nurse
managers (and, indirectly, instructor-led training workshops and the intranet).
Diane Golay, Åsa Cajander, Deman Hussein, Ali Azeez, and Stefano Bonacina
Proceedings of the 18th International
Symposium on Health Information
Management Research
In the remainder of this section, we take a closer look at what our participants said about each one of
these issues they identified as hindering the communication between nurses and IT department.
Lack of time
Lack of time was mentioned by our participants as an obstacle to effective communication between IT
department workers and nurses in multiple ways, affecting both the IT department’s and nurses’ ability
to receive system-related information from each other.
For IT department workers, lack of time is a factor hindering them from carrying out continuous user
surveying over the long term. This is something our participants expressed some frustration about, as
they indicated that having the time resources to investigate end users’, and more particularly nurses’,
needs more in depth would help them to better understand their needs as well as diagnose and solve
system-related issues more effectively.
For nurses, lack of time was mentioned by our interviewees as one of the reasons why they did not
attend the instructor-led training workshops provided by the IT department as well as why they did not
access the hospital’s intranet to read system-related information placed there by the IT department.
Low quality and low-level filtering of electronic error reports
Several of the IT department workers we talked to felt that nurses lacked the technical knowledge
required in order to describe system-related breakdowns in an appropriate way when filling in an
electronic error report. In their experience, the low quality of the problem descriptions provided in the
reports submitted by nurses did not allow them to understand what had gone wrong in the interaction
between the end user and the system, what had caused the issue, and how it could be fixed.
Participants attributed this issue to nurses’ lack of IT skills, and connected this lack of IT skills to
nurses’ non-attendance to the instructor-led workshops proposed by the IT department (see below). It
is also worth adding that participants felt that nurses’ lack of system know-how resulted in a significant
amount of, from their perspective, unnecessary error reports - reports of problems not caused by
technical issues or bugs in the systems, but by the users’ ignorance as to how to carry out a task
“properly” in the system.
Beside the (assessed) low quality of the error reports, another problem participants saw in electronic
error reporting in its current form in their organization was the low-level filtering of reports carried out
by care co-ordinators. As described in the previous section, electronic error reports filled out by nurses
(and other end users) are first sorted by a care coordinator, and only the issues ranked as high priority
(by that co-ordinator) are forwarded to the IT department. Therefore, not all system-related issues
reported by nurses reach the IT department. For some interviewees, this created a risk for potentially
significant issues to remain unnoticed by the IT department and thus being left unresolved.
Participants described the lack of shared priority-setting guidelines between care coordinators and IT
department workers as being at the core of this problem.
In short, not only are electronic error reports badly formulated (making it hard for the IT department
workers to understand what the problems are), not all of them reach the IT department.
Nurses’ non-attendance to the instructor-led training workshops
The IT department workers we talked to mentioned nurses’ non-attendance to the instructor-led
training workshops provided by the IT department as a significant issue, with multiple causes and
consequences.
In regard to causes of nurses’ non-attendance to the training workshops, our participants mentioned
two main factors: 1) the limited capacity of the workshops (i.e., not all nurses in the interviewees’
organization could take part in these instructor-led training sessions), and 2) nurse managers’ lack of
cooperation (i.e., not sending their staff to training). Indeed, nurses are dependent on their manager(s)
to be given time to attend an instructor-led training workshop; in other words, their attendance needs
to be added to their schedule by their manager(s). If nurse managers do not take that step, nurses are
left unable to attend the training sessions (even if free spots are available). Our participants
experienced a lack of cooperation from nurse managers in this regard, finding that nurse managers
were not giving nurses’ system training the importance it deserved (see below).
As these instructor-led training workshops were described as the only opportunity for two-way
communication between IT department and nurses, nurses’ non-attendance was considered a
particularly serious issue by our participants. In their view, it results into 1) nurses learning how to use
systems by imitating their colleagues, which means “mistakes” in the interaction with systems are
passed along, leading nurses to experience low usability and, potentially, to generate technical issues
Communication Breakdowns between Nurses and IT Department:
Why Hospitals Fail at Improving the Usability of Health Information Technology
Editors: Peter Bath,
Päivi Jokela, Laura Sbaffi
through “wrong” manipulations, and 2) nurses not discussing their needs with the IT department
workers.
Misalignment between nurse managers’ and IT department workers’ priorities
As mentioned above, the IT department workers we talked to felt that nurse managers were not giving
nurses’ system training the importance it deserved. As a result, they are not scheduling instructor-led
training workshops for their nurses and not (always) communicating all the system-related information
they receive from the IT department to their staff, or are not doing it quickly enough (in our
participants’ view).
Our interviewees connected this issue - the lack of importance given by nurse managers to system-
related information and training provided by the IT department - to the current shortage of nurses in
their organization as well as to the time-intensive nature of nursing work (e.g., long working hours). In
the specific case of system-related information from the IT department, which nurse managers are,
according to our participants, expected to communicate to their staff, another reason for nurse
managers’ perceived lack of cooperation was the availability of that information on the organization’s
intranet. In other words, our interviewees’ statements suggest that nurse managers expect nurses to
actively go and seek out system-related information from the IT department, and thus refuse to take
responsibility for “pushing” that information onto their staff. However, as already mentioned, nurses
often seem to not have (or take) the time to go and check the system-related information the IT
department places on their intranet.
5. Discussion and Conclusion
This paper contributes to existing research by investigating the different ways in which IT department
workers and nurses communicate with each other about HIT-related issues, both before
implementation (e.g. about nurses’ needs), during implementation (e.g. system training and
configuration), and after implementation (e.g. system errors). It thus sheds light on an important part of
IT department workers’ practices, something that has been identified as a research gap [3].
More specifically, this study identifies five different communication channels supporting
communication either from nurses to IT department, from IT department to nurses, or both (two-way
communication). Electronic error reports and meetings between IT department and nurse
representatives are the two channels found to enable nurses to communicate their system-related
needs and problems to the IT department. In other words, these two communication channels support
nurses’ involvement in the design, implementation and improvement of HIT systems. Previous
research, e.g., [8, 10], has stressed the importance of end users’ involvement throughout the system
development life cycle in achieving high system usability. Instructor-led training workshops was found
to be the only communication channel supporting two-way communication between nurses and IT
department, allowing IT department workers to teach nurses how the systems work and allowing
nurses to tell IT department workers about their system-related needs and problems. Finally, nurse
managers and intranet were found to be the two communication channels supporting the transfer of
system-related information from the IT department to nurses. The need for nurses (or end users in
general) to receive system-related information from the implementers of HIT in order to experience
higher system usability is a key finding of this paper, as the importance of successful two-way
communication between IT department and nurses (as opposed to “just” considering nurses’ needs in
the system development life cycle) in “creating” usability has not been stressed in the existing
literature in the topic.
Our study also identifies four main breakdowns negatively affecting communication between IT
department and nurses. Beside the more general issue of lack of time, these breakdowns were
(directly or indirectly) connected to specific communication channels. For instance, low quality and
low-level filtering of error reports were found to hinder effective action-taking based on electronic error
reports submitted by nurses to the IT department; nurses’ non-attendance was found to reduce the
potential positive impact of instructor-led training workshops on nurses’ system-related know-how, as
well as on IT department workers’ awareness of nurses’ system-related needs; and misalignment
between nurse managers’ and IT department workers’ priorities was found to hinder the
communication of system-related information from IT department to nurses through nurse managers,
as well as to contribute to nurses’ non-attendance to training workshops.
If we now take a closer look at the communication channels supporting nurses’ communication of their
system-related needs and problems to the IT department (i.e. electronic error reports, meetings
between IT department and nurse representatives and instructor-led training workshops), we see that
Diane Golay, Åsa Cajander, Deman Hussein, Ali Azeez, and Stefano Bonacina
Proceedings of the 18th International
Symposium on Health Information
Management Research
16
our findings concur with previous research pointing to the insufficient involvement of nurses into HIT
design [18]. Indeed, it is obvious that nurses are not continuously involved in the system development
life cycle, and that the identified communication breakdowns in these nurses-to-IT-department
channels (i.e. low quality and low-level filtering of electronic error reports and nurses’ non-attendance
to training workshops) undermine nurses’ already limited involvement in system design,
implementation and improvement.
As user involvement in all phases of the system design life cycle is associated with greater usability [3,
9, 10], it is urgent for healthcare organizations to fix these breakdowns. When it comes to the low-level
filtering of electronic error reports, our study stresses the need for care coordinators and IT
department workers to have a common set of guidelines on how to prioritize reported system-related
issues to reduce the risk of significant issues not being transferred to the IT department. An alternative
solution could be to have all error reports transferred directly to the IT department, without the
involvement of a third party. When it comes to the low quality of electronic error reports, our results
suggest that instructor-led training workshops need to be 1) extended to all nurses in the organization,
and 2) aim not only at allowing nurses to interact with the systems, but also at enabling them to
describe the issues they encounter in terms IT department workers can understand. Indeed, others
have shown that the competence needed to participate in software development (or improvement)
does not come naturally to nurses [14]. Ultimately, this is also about integrating computer literacy in
nursing education [26]. In addition, our findings point to the need to provide nurses with the time to
report system-related errors and to attend instructor-led training workshops. Our findings suggest that
nurse managers have the ability to make a difference here, and that they need to assign a higher
priority to nurses’ exchanges with the IT department.
Lack of time was however found to not only be a problem for nurses (preventing them from giving and
receiving system-related information), but also for IT department workers. In particular, IT department
workers need to be given the time to collect end user feedback continuously and over the long term.
Time restrictions limiting the ability to collect information about end users’ system-related needs and
problems is a problem that HIT vendors also experience [17]. This problem is closely connected to
agile software development processes being dominant, as speed and agility are core values in the
agile development model. We hence need to work more with the integration of user centred design
methods in agile development [16, 19, 20], or work towards a software development methodology
where there is more time for user involvement, such as for example [21], and which can be used in
health care.
Interestingly, participants did not note any breakdown in relation to meetings between IT department
and nurse representatives. However, it is also unclear exactly what impact these meetings have on
the configuration, customization and improvement of HIT systems. More research is needed in order
to identify the exact benefits and breakdowns connected to this way for IT department workers to
collect information about nurses’ system-related needs and problems.
5.1 Limitations
This paper reports on the perspective of IT department workers from one single IT department of a
large hospital in one Swedish county. Our findings are therefore not generalizable, but we believe that
readers doing research in a similar setting (i.e., large hospital using off the shelf systems managed by
a dedicated IT department simultaneously acting as the third line of support) may find these findings
transferrable to their particular setting. More research with a similar focus but in different settings is
needed in order to understand IT departments’ work with nurses’ involvement into HIT design more
fully. In addition, we want to point out that this study solely reflects IT department workers’ perspective
on communication between IT department and nurses. Studies examining the perspectives of other
roles part of the communication channel(s) between nurses and IT department, such as nurse
managers and nurses, are needed in order to gain a more complete understanding of the
phenomenon.
Acknowledgements
This work was partly supported by FORTE and the project “Digitalization and its effects on nurses’
work environment” (grant number 2016-07153). We would like to give a warm thank you to all
interview study participants.
Communication Breakdowns between Nurses and IT Department:
Why Hospitals Fail at Improving the Usability of Health Information Technology
Editors: Peter Bath,
Päivi Jokela, Laura Sbaffi
References
[1] Scandurra I, Hägglund M, Persson A, et al. Disturbing or Facilitating?-On the Usability of Swedish
eHealth Systems 2013. In: MIE. 2014, pp. 221–225.
[2]Wass S, Vimarlunda V. I got 99 problems, and eHealth is one. In: MEDINFO 2017: Precision
Healthcare Through Informatics: Proceedings of the 16th World Congress on Medical and Health
Informatics. IOS Press, 2018, p. 258.
[3]Carayon P, Hoonakker P. Human factors and usability for health information technology: old and
new challenges. Yearb Med Inform 2019; 28: 071–077.
[4]Strudwick G, McGillis Hall L. Nurse acceptance of electronic health record technology: a literature
review. J Res Nurs 2015; 20: 596–607.
[5]Ratwani RM, Savage E, Will A, et al. A usability and safety analysis of electronic health records: a
multi-center study. J Am Med Inform Assoc 2018; 25: 1197–1201.
[6]Staggers N, Elias BL, Makar E, et al. The imperative of solving nurses’ usability problems with
health information technology. JONA J Nurs Adm 2018; 48: 191–196.
[7] ISO 9241-11. Ergonomic requirements for office work with visual display terminals.
[8]Pollack AH, Simon TD, Snyder J, et al. Creating synthetic patient data to support the design and
evaluation of novel health information technology. J Biomed Inform 2019; 95: 103201.
[9]Vossebeld DM, Puik EC, Jaspers JE, et al. Development process of a mobile electronic medical
record for nurses: a single case study. BMC Med Inform Decis Mak 2019; 19: 1–12.
[10] Shah SGS, Robinson I. User involvement in healthcare technology development and assessment.
Int J Health Care Qual Assur.
[11] Jia Y, Larusdottir MK, Cajander \AAsa. The usage of usability techniques in scrum projects. In:
International Conference on Human-Centred Software Engineering. Springer, 2012, pp. 331–341.
[12] Kashfi H. Applying a user centered design methodology in a clinical context. In: MedInfo. 2010, pp.
927–931.
[13] Cajander \AAsa. Usability–who cares?: the introduction of user-centred systems design in
organisations. PhD Thesis, Acta Universitatis Upsaliensis, 2010.
[14] Hägglund M, Scandurra I, Koch S. Scenarios to capture work processes in shared homecare—
From analysis to application. Int J Med Inf 2010; 79: e126–e134.
[15] Scandurra I, Hägglund M, Koch S. From user needs to system specifications: Multi-disciplinary
thematic seminars as a collaborative design method for development of health information
systems. J Biomed Inform 2008; 41: 557–569.
[16] Cockton G, Lárusdóttir M, Gregory P, et al. Integrating User-Centred Design in Agile Development.
In: Integrating User-Centred Design in Agile Development. Springer, 2016, pp. 1–46.
[17] Cajander \AAsa, Larusdottir M, Gulliksen J. Existing but not explicit-the user perspective in scrum
projects in practice. In: IFIP Conference on Human-Computer Interaction. Springer, 2013, pp. 762–
779.
[18] Holgersson J, Söderström E. Experiences from and Attitudes towards Applying User Participation
in Public e-Service Development. In: WEBIST (1). 2014, pp. 269–275.
[19] Kuusinen K. Integrating UX work in agile enterprise software development. PhD Thesis, Doctoral
thesis, Publication 1339, Tampere University of Technology, 2015.
[20] Kashfi P, Nilsson A, Feldt R. Integrating User eXperience Practices into Software Development
Processes: Implications of Subjectivity and Emergent Nature of UX. ArXiv Prepr ArXiv160503783.
[21] Larusdottir MK, Gulliksen J, Hallberg N. RAMES–Framework supporting user centred evaluation in
research and practice. Behav Inf Technol 2019; 38: 132–149.
[22] Bergey MR, Goldsack JC, Robinson EJ. Invisible work and changing roles: Health information
technology implementation and reorganization of work practices for the inpatient nursing team. Soc
Sci Med 2019; 235: 112387.
[23] Procter P, Woodburn I. Encouraging nurses to develop effective electronic documentation. Nurs
Manag 2013 2012; 19: 22.
[24] Hussein D. eHealth-System Usability Improvement: Bridging the Gap Between Stakeholders and
Nurses. 2019.
[25] Azeez A. Perspectives of a Health IT Service Team regarding Nurses’ Needs and Application
Usability during the Implementation Process of Health IT Applications at Uppsala University
Hospital. Karolinska Institutet, 2019.
[26] Saranto K, Leino-Kilpi H. Computer literacy in nursing; developing the information technology
syllabus in nursing education. J Adv Nurs 1997; 25: 377–385.
