JMIR Publications

ABSTRACT

Background:

Emergency department (ED) crowding is a global healthcare issue. E-health systems have the potential to reduce crowding; however, the true benefits are seldom realized because the systems are not integrated within the clinicians’ work. We seek a deeper understanding of how an e-health system implementation can be structured to truly integrate the system into clinicians’ workflow.

Objective:

The specific objectives of this study were to: (1) examine whether work system theory (WST) is a good approach to structure the implementation of an e-health system by incorporating the entire work system, and not just the e-health system, in the implementation framework; (2) identify the role that specific elements of WST’s static framework and dynamic work system lifecycle (WSLC) model play in the implementation, and; (3) demonstrate how WST can be applied in the health care setting to guide the implementation of an e-health system.

Methods:

Through a case study of an ED in a rural hospital, we used a mixed-methods approach to examine the implementation of a surge-management system (SMS) through the lens of WST. We conducted 14 hours of observation in the ED, 18 interviews with clinicians and management, a survey of 23 clinicians, and reviewed related documentation. We used template analysis based on WST to structure our analysis of the qualitative data and used descriptive statistics for our quantitative data.

Results:

The SMS helped to reduce crowding in the ED and staff was satisfied with the implementation. Even though study participants indicated changes to their workflow, 72% of survey participants were satisfied with their use of the system and 82% indicated that it was indeed integrated with their workflow. We found that examining the implementation through the lens of WST enabled us to identify the aspects of the implementation that made it so successful. Applying the static framework we saw how the implementation team incorporated the 9 elements of the ED work system, assessed their alignment, and designed interventions to address areas of misalignment. The dynamic WSLC model captured how planned and unplanned changes were managed throughout an iterative implementation cycle - 83% of participants indicated that there was sufficient management support for the changes, while 82% were committed to the change.

Conclusions:

The broad scope and holistic approach of WST is well suited to guide e-health systems implementations as it focuses efforts on the entire work system and not just the IT artifact. Researchers have adapted and used WST in different areas over several decades; however, it has had limited application to health care. Therefore, we broaden the focus of WST by applying it to the implementation of an ED SMS. These findings will guide further research and implementations of e-health systems using WST.