Communications systems are vital in the life and death dramas that take place in hospitals.
Perhaps the most used are the telephones that staff use to contact patients along with the call system that helps those in bed get help when they need it. Like your phone at home these call systems have gone wireless. But implementing them can be challenging. The story of how one system was introduced in a large hospital is told by Dr. Casper Bruun Jensen who was a postdoctoral fellow on the Action for Health project.
Jensen’s paper which was published in 2006 in Computer Supported Cooperative Work tells a fascinating tale of just how troublesome it can be to replace an older telephone system with something that is supposed to be modern, innovative and do far more. The Rauland Responder IV system was certainly state of the art, and part of Jensen’s role as both expert and researcher, was to help staff understand and incorporate the new system into their busy routines. That’s the whole point of computer supported cooperative work (CSCW) in which academics and users work together to understand each other’s activities and help individuals and groups (such as health care professionals) implement technology seamlessly.
Of course switching from one system to another was anything but seamless. To Jensen’s surprise, people working on the hospital ward where the new phone system was to be implemented couldn’t even agree on how the old system worked. No one had ever asked nurses what a “green” call with its distinctive ring meant. As it happens, it meant different things to different people. Even a little test demo didn’t quite solve the problem. It was a good thing that the ward was being used as a pilot study and that the whole hospital wasn’t going to adopt the confusing new telephones all at once.
So suddenly there were issues. How would a new system that did many more things be used, when it turns out that even the old system was not handled in the same way by everyone. In fact, there were certain alarms incorporated into the system that no one had ever used. Staff were thrilled to learn that they could finally do without these false alarms that meant nothing more than a nuisance, not a real emergency or even problem.
We have all encountered the problem of switching from one technology to another—who hasn’t had to upgrade their computer? It’s always supposed to be easier, better, faster. But often it’s also problematic. In health care systems the problems can be much more critical. If your word processor doesn’t work the way you expect that’s one thing. If a patient can’t get a nurse that can be far more serious.
This issue of dependability was an important one for Jensen and he analyzed it in multiple ways. Everyone plays a role in the implementation of new technology including those that make the product (the vendors), those that help install and get things up to speed (the researcher in this case along with information technology specialists) and the health care professionals (the users). How these people understand the telephones and how they expect to use them all factor into the mix. Jensen unraveled it all but the process was not always very satisfactory. But then again research can be a messy business.
The good news is that people like Jensen analyze processes while simultaneously helping implement them. That’s the nature of CSCW and part of the researcher’s special expertise. Hopefully then those people who need to implement new technologies in the future won’t have to reinvent the wheel, they can learn from experts like Jensen.
There is no doubt the new wireless telephone system offers advantages. A few of these pluses were even unanticipated (and not really approved); for example patients quickly found out they could use the new phones to call their families.
There might never be a really easy way to move from one system to another. But new technologies and the systems they replace are a fact of life. We can only hope that people like Jensen will ease us through the bumpy transitions.
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What is a pilot study?
When large ships come into harbor they are accompanied by smaller pilot boats that help navigate them safely into their berth. In a similar way, researchers often guide their research with a smaller study that will replicate the larger process but in a way that tests assumptions and techniques without the cost and time involved in the full-scale study. That’s what was done here as one ward was chosen to test phones that would eventually be used in the entire complex. Like the little ship, the pilot can guide a large research project to its final destination.