Skip to main content
NCBI home page
Quality & Safety in Health Care logoLink to Quality & Safety in Health Care
. 2004 Oct;13(5):388–394. doi: 10.1136/qshc.2004.010322

Beyond usability: designing effective technology implementation systems to promote patient safety

B Karsh 1
PMCID: PMC1743880  PMID: 15465944

Abstract



 Evidence is emerging that certain technologies such as computerized provider order entry may reduce the likelihood of patient harm. However, many technologies that should reduce medical errors have been abandoned because of problems with their design, their impact on workflow, and general dissatisfaction with them by end users. Patient safety researchers have therefore looked to human factors engineering for guidance on how to design technologies to be usable (easy to use) and useful (improving job performance, efficiency, and/or quality). While this is a necessary step towards improving the likelihood of end user satisfaction, it is still not sufficient. Human factors engineering research has shown that the manner in which technologies are implemented also needs to be designed carefully if benefits are to be realized. This paper reviews the theoretical knowledge on what leads to successful technology implementation and how this can be translated into specifically designed processes for successful technology change. The literature on diffusion of innovations, technology acceptance, organisational justice, participative decision making, and organisational change is reviewed and strategies for promoting successful implementation are provided. Given the rapid and ever increasing pace of technology implementation in health care, it is critical for the science of technology implementation to be understood and incorporated into efforts to improve patient safety.

Full Text

The Full Text of this article is available as a PDF (86.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker Laurence C., Phibbs Ciaran S. Managed care, technology adoption, and health care: the adoption of neonatal intensive care. Rand J Econ. 2002 Autumn;33(3):524–548. [PubMed] [Google Scholar]
  2. Bates David W., Evans R. Scott, Murff Harvey, Stetson Peter D., Pizziferri Lisa, Hripcsak George. Detecting adverse events using information technology. J Am Med Inform Assoc. 2003 Mar-Apr;10(2):115–128. doi: 10.1197/jamia.M1074. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bates David W., Gawande Atul A. Improving safety with information technology. N Engl J Med. 2003 Jun 19;348(25):2526–2534. doi: 10.1056/NEJMsa020847. [DOI] [PubMed] [Google Scholar]
  4. Bates David W. Using information technology to screen for adverse drug events. Am J Health Syst Pharm. 2002 Dec 1;59(23):2317–2319. doi: 10.1093/ajhp/59.23.2317. [DOI] [PubMed] [Google Scholar]
  5. Carroll J. S., Edmondson A. C. Leading organisational learning in health care. Qual Saf Health Care. 2002 Mar;11(1):51–56. doi: 10.1136/qhc.11.1.51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dixon D. R., Stewart M. Exploring information technology adoption by family physicians: survey instrument valuation. Proc AMIA Symp. 2000:185–189. [PMC free article] [PubMed] [Google Scholar]
  7. Donchin Y. Resuscitation trolleys: human factors engineering. Qual Saf Health Care. 2002 Dec;11(4):393–393. doi: 10.1136/qhc.11.4.393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gagnon Marie-Pierre, Godin Gaston, Gagné Camille, Fortin Jean-Paul, Lamothe Lise, Reinharz Daniel, Cloutier Alain. An adaptation of the theory of interpersonal behaviour to the study of telemedicine adoption by physicians. Int J Med Inform. 2003 Sep;71(2-3):103–115. doi: 10.1016/s1386-5056(03)00094-7. [DOI] [PubMed] [Google Scholar]
  9. Godin G., Kok G. The theory of planned behavior: a review of its applications to health-related behaviors. Am J Health Promot. 1996 Nov-Dec;11(2):87–98. doi: 10.4278/0890-1171-11.2.87. [DOI] [PubMed] [Google Scholar]
  10. Gosbee J. Human factors engineering and patient safety. Qual Saf Health Care. 2002 Dec;11(4):352–354. doi: 10.1136/qhc.11.4.352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kaushal R., Barker K. N., Bates D. W. How can information technology improve patient safety and reduce medication errors in children's health care? Arch Pediatr Adolesc Med. 2001 Sep;155(9):1002–1007. doi: 10.1001/archpedi.155.9.1002. [DOI] [PubMed] [Google Scholar]
  12. Kaushal R., Bates D. W. Information technology and medication safety: what is the benefit? Qual Saf Health Care. 2002 Sep;11(3):261–265. doi: 10.1136/qhc.11.3.261. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Korunka C., Huemer K. H., Litschauer B., Karetta B., Kafka-Lützow A. Working with new technologies: hormone excretion as an indicator for sustained arousal. A pilot study. Biol Psychol. 1996 Feb 5;42(3):439–452. doi: 10.1016/0301-0511(95)05172-4. [DOI] [PubMed] [Google Scholar]
  14. Kushniruk Andre. Evaluation in the design of health information systems: application of approaches emerging from usability engineering. Comput Biol Med. 2002 May;32(3):141–149. doi: 10.1016/s0010-4825(02)00011-2. [DOI] [PubMed] [Google Scholar]
  15. Layde Peter M., Cortes Leslie M., Teret Stephen P., Brasel Karen J., Kuhn Evelyn M., Mercy James A., Hargarten Stephen W., Maas Leslie A. Patient safety efforts should focus on medical injuries. JAMA. 2002 Apr 17;287(15):1993–1997. doi: 10.1001/jama.287.15.1993. [DOI] [PubMed] [Google Scholar]
  16. Leong F. J. W-M, Nicholson A. G., McGee J. O'D. Robotic telepathology: efficacy and usability in pulmonary pathology. J Pathol. 2002 Jun;197(2):211–217. doi: 10.1002/path.1112. [DOI] [PubMed] [Google Scholar]
  17. McNutt Robert A., Abrams Richard, Arons David C., Patient Safety Committee Patient safety efforts should focus on medical errors. JAMA. 2002 Apr 17;287(15):1997–2001. doi: 10.1001/jama.287.15.1997. [DOI] [PubMed] [Google Scholar]
  18. Melchior Maria, Berkman Lisa F., Niedhammer Isabelle, Chea Maline, Goldberg Marcel. Social relations and self-reported health: a prospective analysis of the French Gazel cohort. Soc Sci Med. 2003 Apr;56(8):1817–1830. doi: 10.1016/s0277-9536(02)00181-8. [DOI] [PubMed] [Google Scholar]
  19. Munro L., Rodwell J., Harding L. Assessing occupational stress in psychiatric nurses using the full job strain model: the value of social support to nurses. Int J Nurs Stud. 1998 Dec;35(6):339–345. doi: 10.1016/s0020-7489(98)00049-2. [DOI] [PubMed] [Google Scholar]
  20. Prochaska J. M., Prochaska J. O., Levesque D. A. A transtheoretical approach to changing organizations. Adm Policy Ment Health. 2001 Mar;28(4):247–261. doi: 10.1023/a:1011155212811. [DOI] [PubMed] [Google Scholar]
  21. Prochaska J. O., Velicer W. F. The transtheoretical model of health behavior change. Am J Health Promot. 1997 Sep-Oct;12(1):38–48. doi: 10.4278/0890-1171-12.1.38. [DOI] [PubMed] [Google Scholar]
  22. Rogoski Richard R. Opening the floodgates of usability. Clinical information systems allow free flow of patient data to clinicians when and where they need it. Health Manag Technol. 2003 Sep;24(9):12–17. [PubMed] [Google Scholar]
  23. Salas E., Cannon-Bowers J. A. The science of training: a decade of progress. Annu Rev Psychol. 2001;52:471–499. doi: 10.1146/annurev.psych.52.1.471. [DOI] [PubMed] [Google Scholar]
  24. Venkatesh V, V, Morris MG, Ackerman PL. A Longitudinal Field Investigation of Gender Differences in Individual Technology Adoption Decision-Making Processes. Organ Behav Hum Decis Process. 2000 Sep;83(1):33–60. doi: 10.1006/obhd.2000.2896. [DOI] [PubMed] [Google Scholar]
  25. Vicente K. J. From patients to politicians: a cognitive engineering view of patient safety. Qual Saf Health Care. 2002 Dec;11(4):302–304. doi: 10.1136/qhc.11.4.302. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Quality & safety in health care are provided here courtesy of BMJ Publishing Group

RESOURCES