A Usability Perspective on Clinical Handover Improvement- CHIPS with Everything ?


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David Kaufmann
School of Computing and Mathematical Sciences, Auckland University of Technology
(Friday, 3.00, Science 2)

Support for clinical handover remains a challenge for Health Informatics. Obstetric Handover is an important multi-disciplinary activity that can have important consequences for patient safety. Although IT systems can be used to support handover, the improvement of handover is not a purely IT-based problem. This project took place in the context of a clinical improvement process designed to formalise and improve handover in a busy delivery unit. This study used investigative tools from the usability domain in order to understand the usability requirements of a complete socio-technical system - the handover process. This work demonstrated the feasibility of using such tools and illustrated potential usability problems and solutions in the clinical handover process. Changes were made in IT systems, the organisation of the handover and the physical environment. Evaluation of the modified approach is being conducted, in the light of some usability issues already discovered.

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A Usability Perspective on Clinical Handover Improvement- CHIPS with Everything ?

  1. 1. HINZ Conference and Exhibition 2011 A usability perspective on clinical handover improvement – CHIPS with everything? David Kaufmann, Philip Carter, David Parry Auckland University of TechnologyVictoria Carlsen, Katie Groom, Lucy Westbrooke, Lisa Cunningham, Emma Parry National Women’s Health, Auckland City Hospital 25 November 2011 / david.kaufmann1@gmail.com
  2. 2. Agenda- Introduction- Setting (CHIP Project)- Setting (CHIPS Study)- Applied Methods (Framework)- Applied Methods (Usability Evaluation Methods)- Findings (Clinical Handover & System)- Findings (Usability Evaluation Methods & Triangulation)- Conclusion & Future Work
  3. 3. Setting (CHIP Project)• Handover at Women’s Health Department atAuckland City Hospital.• Current Handover Environment, Process & System tobe improved based on Literature Review & Best Practice.• Success of improvements (mainly data transfer)measured through two Evaluations, applying UserObservation and Survey.
  4. 4. Setting (CHIP Project)CHIP – Improvement of the Handover EnvironmentBefore After
  5. 5. Setting (CHIP Project)CHIP – Improvement of the Handover ProcessNew overall proforma for New proforma for handover ofhandover individual patient
  6. 6. Setting (CHIP Project)CHIP – Improvement of the Handover SystemNote: CHIP only applied minor changes to the system.(addition of columns, change of columns)
  7. 7. Setting (CHIPS Study)• Success of improvements measured through twoEvaluations, applying four usability evaluation methods.• Formulating Usability Design Requirements for futureClinical Handover System.• Assess practical application of these UsabilityEvaluation Methods in a Health Care Setting.• Assess practical application of the “Triangulation ofMethods” concept. Note: Study has not been completed yet.
  8. 8. Applied Methods (Framework)Project CHIP Literature Review & Best PracticeCHIP Project & CHIPS First Usability Second Usability Evaluation Evaluation Study User Observation Updated User Observation Initial Handover Future Handover Handover Environment, Environment, Environment, Process & Process & Survey Process & Survey System System System Stakeholder Stakeholder Interviews Interviews Heuristic Heuristic CHIPS Study Evaluation Evaluation List of Usability Updated List of Usability Design Aspects Usability Aspects Requirements Key Concept: Triangulation of Usability Evaluation Methods as Each Usability Evaluation Methods has particular strengths and weaknesses. (Tan, Liu & Bishu, 2009)
  9. 9. Applied Methods (Usability Evaluation Methods)• User ObservationApplication: Use of video recording / Observer took role of “onlooker”.Strength: Capture of actual user experience.• SurveyApplication: Use of Likert scale / 12 questions.Strength: Simple data collection, anonymous.• Stakeholder InterviewsApplication: Use of voice recording / 11 questions (1 system specific).Strength: Detailed stakeholder responses about specific problems.• Heuristic EvaluationApplication: Based on Nielson & Mack’s (1994) ten heuristic principles.Strength: Finding usability issues that are hard to describe by the users.
  10. 10. Findings (Clinical Handover & System)• Handover Environment - ImprovementsEvidence: The number of observation logs in regards to negativeenvironment related aspects decreased from 60 to 15.• Handover Process - ImprovementsEvidence: The survey showed that participants assessment of handoverefficiency increased from 5.1 to 7.9 (means values on a scale from 1-10).• Handover System - Minor ImprovementsFinding: Due to the larger screen, the data is more visible. However, thesystem does still not store all the handed over data, is not aligned withthe handover process and lacks of some best practice user interfacedesign. For instance, it is not possible to enlarge the information for oneparticular patient.
  11. 11. Findings(Usability Evaluation Methods & Triangulation)• Methods: Medical domain knowledge is NOT requiredin order to discover a large number of usability aspects.In fact, domain knowledge could be unhelpful.• Methods (Observation): Presence of Camera / Observerhad only minor impact on participants.• Triangulation of Methods: Empirical evidence thatdifferent methods highlight different usability relatedaspects. Triangulation allows for effective working in a“Real World” Environment.
  12. 12. Conclusion & Future Work• IT Systems used for handover must further evolve,especially to address the issue of data loss.• Usability assessment for Handover systems mustacknowledge the handover process in order to meet keyusability aspects of efficiency and user satisfaction.• “Journey” to future Handover System. People / Handover System Handover System Handover System not Process used as auxiliary used as primary used. Journey working surface. working surface. Integration with Use of advanced Integration of Integration withTechnological Handover other Clinical IT data display Users Handheld Journey process into Systems. technology. Pocket PC’s. system.
  13. 13. QuestionsQuestions?