Tinkering Around Healthcare Infrastructures: Nursing Practices and Junction Work

Introduction of healthcare infrastructures is often accompanied by workarounds, persistence of paper-based documents and of technologies that the innovation was intended to replace, raising the question as to whether they are by-products or intrinsic to infrastructure innovation processes. This work, through a longitudinal case study of a hospital information system long in use, investigates their origin, their role in enabling the system’s affirmation, and the difficulty of eliminating them. Through a qualitative methodology, semi-structured interviews and ethnography, we reconstruct the history of the system and the information management practices around it. Our analysis reveals that the effectiveness of the tool implemented derived largely from ‘junction work’ performed by the nurses, which ensured the flow of data among different electronic and paper-based information systems. Moreover, in carrying out their junction work the nurses intervened to modify, enrich and complete the information contained in the different systems.

[1]  Signe Vikkelsø,et al.  Subtle Redistribution of Work, Attention and Risks: Electronic Patient Records and Organisational Consequences , 2005, Scand. J. Inf. Syst..

[2]  Davide Nicolini,et al.  Organizational Knowledge: The Texture of Workplace Learning , 2006 .

[3]  Reinhold Haux,et al.  Health information systems - past, present, future , 2006, Int. J. Medical Informatics.

[4]  Markus A. Feufel,et al.  The impact of medical record technologies on collaboration in emergency medicine , 2011, Int. J. Medical Informatics.

[5]  Suzy Paisley,et al.  Factors associated with success in the implementation of information management and technology in the NHS , 1999 .

[6]  Geoffrey C. Bowker,et al.  Industrial Geophysics. (Book Reviews: Science on the Run. Information Management and Industrial Geophysics at Schlumberger, 1920-1940.) , 2003 .

[7]  Alissa L. Russ,et al.  Paper persistence, workarounds, and communication breakdowns in computerized consultation management , 2011, Int. J. Medical Informatics.

[8]  Karen Ruhleder,et al.  Steps Toward an Ecology of Infrastructure: Design and Access for Large Information Spaces , 1996, Inf. Syst. Res..

[9]  Heather Wharrad,et al.  Going paperless at the emergency department: A socio-technical study of an information system for patient tracking , 2011, Int. J. Medical Informatics.

[10]  Brit Ross Winthereik,et al.  ICT and Integrated Care: Some Dilemmas of Standardising Inter-Organisational Communication , 2005, Computer Supported Cooperative Work (CSCW).

[11]  Sampsa Hyysalo Health Technology Development and Use: From Practice-Bound Imagination to Evolving Impacts , 2010 .

[12]  M. Berg,et al.  ICT in health care: sociotechnical approaches. , 2003, Methods of Information in Medicine.

[13]  E. Piras,et al.  "Le infermiere sanno quello che i medici vogliono": il lavoro di congiunzione nei TDEs , 2014 .

[14]  S. L. Star,et al.  The Ethnography of Infrastructure , 1999 .

[15]  S. Gherardi,et al.  Through the practice lens: Where is the bandwagon of practice-based studies heading? , 2010 .

[16]  Richard Heeks,et al.  Health information systems: Failure, success and improvisation , 2006, Int. J. Medical Informatics.

[17]  Rob Procter,et al.  Making a Case in Medical Work: Implications for the Electronic Medical Record , 2003, Computer Supported Cooperative Work (CSCW).

[18]  M Berg,et al.  Integrating Quantitative and Qualitative Methods in Patient Care Information System Evaluation , 2003, Methods of Information in Medicine.

[19]  K. Baker,et al.  Toward Information Infrastructure Studies: Ways of Knowing in a Networked Environment , 2009 .

[20]  Susan Leigh Star,et al.  Sorting Things Out: Classification and Its Consequences , 1999 .

[21]  Carsten S. Østerlund Documents in Place: Demarcating Places for Collaboration in Healthcare Settings , 2008, Computer Supported Cooperative Work (CSCW).

[22]  C. Anandan,et al.  The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview , 2011, PLoS medicine.

[23]  R. Roine,et al.  Assessing telemedicine: a systematic review of the literature. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[24]  Marc Berg,et al.  Implementing information systems in health care organizations: myths and challenges , 2001, Int. J. Medical Informatics.