| The goal of Electronic Remote Blood Issue (ERBI) is to increase the safety and efficiency of blood issuing in surgery suites. Like many healthcare information technologies (HIT), there is limited evidence of the impact of ERBI on safety and efficiency, and relatively little information on factors affecting errors and adaptation of work practices during implementation. This dissertation describes a human factors approach, informed by socio-technical perspectives on HIT, to the study of ERBI in three hospital operating suites and (i) the impact of ERBI on safety and efficiency, (ii) learning, adaptation and use of ERBI, and (iii) staff perspectives on ERBI. Findings are that: nursing staff experience ERBI differently from other staff roles; staff develop adaptations in work practice in response to constraints imposed by the design of ERBI and task constraints; sites differ in areas (i and ii, above) except the time it took sites to adapt to ERBI (3-4 months); and, that there is evidence of efficiency gains for blood use with ERBI at one of three sites. In addressing the intended aims of ERBI systems to increase safety and efficiency of blood issue and delivery, this dissertation provides some evidence of efficiency and safety gains when ERBI is successfully implemented. It also highlights barriers and enablers to successful implementation, identifying areas where further study may be needed, including workload factors impacting nursing staff experiences and adaptation to new technology, factors impacting error recovery in critical safety situations such as blood issuing, and representing dimensions and dynamics of transactional processes such as blood issuing for inclusion in systems design. Reflecting on the approach taken for the study of ERBI in this dissertation, the research highlights adaptation behaviours and experiences of ERBI that suggest a resiliency approach to be appropriate for understanding and designing HIT for blood unit issue, and highlights the value of a socio-technical approach in providing proxy measures for error, revealing diversity of experiences of implementation, and providing actionable design recommendations for implementation and design of ERBI systems. |
