Search

No description supplied

Additional file 1. Data collection form.

The organisational culture of a health facility has been identified as a significant factor for successful implementation of clinical information systems. There have been no reported studies exploring the link between sub-cultures and the use of information systems. This study utilises cross sectional surveys to measure doctors' and nurses' perceptions of organisational culture and relate this to their use of a hospital-wide mandatory computerised pathology order entry (CPOE) system. Data were collected by administering an organisational culture survey (Organisational Culture Inventory, OCI) along with a user-satisfaction survey to a population of 103 doctors and nurses from two clinical units in an Australian metropolitan teaching hospital. We identified subcultures based on professional divisions where doctors perceived an aggressive/defensive culture (mean percentile score = 43.8) whereas nurses perceived a constructive culture (mean percentile score = 61.5). There were significant differences between doctors and nurses on three of the attitude variables with nurses expressing more positive views towards CPOE than doctors. The manifestation of subcultures within hospitals and the impact this has on attitudes towards clinical information systems should be recognized and addressed when planning for system implementation.

This research is supported under Australian Research Council's Linkage Projects scheme (project LP100200586). Human Research Ethics Committee approval for its conduct was granted by the University of New South Wales (HREC 10274). We acknowledge the staff of the industry partners (ACHS, AGPAL, ACSAA) and the quality improvement agencies (ACSQHC, CEC) who provided support for the project. We appreciate Ms Danielle Marks' valuable research assistance in the development of this paper. Background: Service accreditation is a structured process of recognising and promoting performance and adherence to standards. Typically, accreditation agencies either receive standards from an authorized body or develop new and upgrade existing standards through research and expert views. They then apply standards, criteria and performance indicators, testing their effects, and monitoring compliance with them. The accreditation process has been widely adopted. The international investments in accreditation are considerable. However, reliable evidence of its efficiency or effectiveness in achieving organizational improvements is sparse and the value of accreditation in cost-benefit terms has yet to be demonstrated. Although some evidence suggests that accreditation promotes the improvement and standardization of care, there have been calls to strengthen its research base. In response, the ACCREDIT (Accreditation Collaborative for the Conduct of Research, Evaluation and Designated Investigations through Teamwork) project has been established to evaluate the effectiveness of Australian accreditation in achieving its goals. ACCREDIT is a partnership of key researchers, policymakers and agencies. Findings. We present the framework for our studies in accreditation. Four specific aims of the ACCREDIT project, which will direct our findings, are to: (i) evaluate current accreditation processes; (ii) analyse the costs and benefits of accreditation; (iii) improve future accreditation via evidence; and (iv) develop and apply new standards of consumer involvement in accreditation. These will be addressed through 12 interrelated studies designed to examine specific issues identified as a high priority. Novel techniques, a mix of qualitative and quantitative methods, and randomized designs relevant for health-care research have been developed. These methods allow us to circumvent the fragmented and incommensurate findings that can be generated in small-scale, project-based studies. The overall approach for our research is a multi-level, multi-study design. Discussion. The ACCREDIT project will examine the utility, reliability, relevance and cost effectiveness of differing forms of accreditation, focused on general practice, aged care and acute care settings in Australia. Empirically, there are potential research gains to be made by understanding accreditation and extending existing knowledge; theoretically, this design will facilitate a systems view of accreditation of benefit to the partnership, international research communities, and future accreditation designers. "Accreditation of health-care organisations is a multimillion dollar industry which shapes care in many countries. Recent reviews of research show little evidence that accreditation increases safety or improves quality. It's time we knew about the cost and value of accreditation and about its future direction." [Professor John vretveit, Karolinska Institute, Sweden, 7 October 2009]. © 2011 Braithwaite et al; licensee BioMed Central Ltd.

Prior to developing and implementing health informatics systems it is essential to acquire information about the work practice. Interviews are often used but they don't always capture important details. In this project we used video cameras to observe the work practice of two medical secretaries at Department of Urology at Arhus University Hospital, Skejby. The project was carried out with a clear user influence in all phases of the project. The observation and the analysis focused on interruptions of the work processes, of which we found numerous that we categorized in three different types. The use of video and audio proved to be powerful tools for analysis of work practice, although it is very labor intensive method.

We report from a longitudinal laboratory-based usability evaluation of a health care information system. The purpose of the study was to inquire into the nature of usability problems experienced by novice and expert users, and to see to what extend usability problems of a health care information system may or may not disappear over time, as the nurses get more familiar with it—if time heals poor design? As our method for studying this, we conducted a longitudinal study with two key studies. A usability evaluation was conducted with novice users when an electronic patient record system was being deployed in a large hospital. After the nurses had used the system in their daily work for 15 months, we repeated the evaluation. Our results show that time does not heal. Although some problems were not experiences as severe, they still remained after 1 year of extensive use. On the basis of our findings, we discuss implications for evaluating usability in health care.