Field research to improve patient care software in hospitals.

1. Providence Site Visit
Site Visit Overview......................................................................................................................... 2
Goal............................................................................................................................................. 2
Objectives ................................................................................................................................... 2
Participants.................................................................................................................................. 3
Locations..................................................................................................................................... 3
Subjects....................................................................................................................................... 4
Schedule...................................................................................................................................... 4
Before visit (questions/tasks):..................................................................................................... 5
Materials ..................................................................................................................................... 6
Notes ........................................................................................................................................... 6
Letter of Introduction.................................................................................................................. 7
Photography Release Form......................................................................................................... 8
Observation Notebook .................................................................................................................... 9
Clinician Questionnaire ............................................................................................................ 10
Clinician Interview Outline....................................................................................................... 12
Physical Inventory of the Unit (AEIOU).................................................................................. 14

2. Site Visit Overview
Goal
How is information gathered, stored, and transferred in the patient environment?
Objectives
• Gather data needed to construct common clinical personas and scenarios, specifically
Assistant Head Nurse, Nurse Specialist, Nurse Manager, RN, Respiratory Therapist, and
Physician
• Document workflow for common clinical tasks, specifically shift changes/reports and
patient admission, transfer, and discharge
• Give analysts insights into current hospital operations
We will seek a broad understanding of the clinicians and their day-to-day activities. Major
activities that will be observed will include:
- Shift change
- Patient admission
- Patient transfer into unit
- Patient transfer out of unit
- Patient discharge
- Task management
- Plan-of-care method
- Communication methods
- New orders
- Pre-op
- Post-op
If time allows, we will also observe:
- Covering for another clinician
- Patient education
- Charting vitals

3. Participants
Client
(names removed)
Name, title, location, phone, email, availability
McKesson
Team 1:
(name removed), Clinical Analyst
(name removed), System Administrator
Team 2:
John Milanski, User Research Expert
(name removed), Product Manager (Wed-Fri)
Team 3 (Floaters):
(name removed), Clinical Analyst
(name removed), Clinical Analyst (Tue-Fri)
Locations
We intend to visit three sites in the Providence Medical Center (pmc, cust #5165) network:
- Providence Portland
(483 beds, 262 avg daily census, 985 clinical staff, 21K admissions/yr)
- Providence St. Vincent
(451 beds, 370 avg daily census, 1647 clinical staff, 31K admissions/yr)
- Providence Milwaukie
(77 acute beds, 29 avg daily census, 445 clinical staff, 3K admissions/yr)
These sites were chosen because of the different facility sizes, specializations, and computerized
systems installed. At each site will observe activities in two (2) high-turnover units:
- Med/Surgery
- ICU
- NICU (if time allows)
- Pediatrics (if time allows)

4. Subjects
At each of these 3 sites, we will observe and interview:
- Nurse Manager
- Assistant Head Nurse
- Nurse Specialist
- RN
- Respiratory Therapist
If time allows, we will also interview:
- PT
- OT
- RN Case manager
- Nutritionist
- Physician
- Hospitalist
Schedule
Monday: 1p: Meet with (name removed) @ Providence-St Vincent, orient to facility,
get department assignments
2p-6p: Observations (including 3p shift change)
Tuesday: 6:30a: Meet at Providence-St Vincent
6:30a-12p: Observations (including 7a shift change and when? physician
rounds)
1p: Meet with (name removed) @ Providence-Portland, orient to facility, get
department assignments,
2p-6p: Observations (including 3p shift change)
Wednesday: 6:30a: Meet at Providence-Portland
6:30a-3:30p: Observations (including 7a shift change, 10a physician rounds,
and 3p shift change)
Thursday: 8:30a: Meet with (name removed) @ Providence-Milwaukie, orient to
facility, get department assignments
9a-4p: Observations (including 9a physician rounds and 3p shift change).
Friday: 8a-10a: Debrief Meeting, Providence-Portland

5. Before visit (questions/tasks):
- Collect existing clinical forms and staff evaluation forms
- Collect documentation on existing workflow
- List of installed SW applications
- Site demographics, market segmentation
- Find Mark A.’s SharePoint Folder
- What is the shift schedule at the facilities we will be visiting?
- About when does activity on the night shift usually stop?
- What is the difference in activity between shifts and between units?
- To whom can we send clinician questionnaires in advance of our visit?
- Copy of materials from those who attended Cooper Persona training.
Before the site visit, the McKesson team will be briefed on the sites. This site review will include
details about the facility (history, size, specialties, units, location, staff, competition, community,
issues facility is facing), the software applications currently installed and planned for installation,
and any current logged software issues (although fixing them is not the purpose of the visit).
Also in advance of the site visits, likely subjects will be asked to fill out a clinician
questionnaire. The questionnaire was developed using former clinicians working for McKesson.
The information will help us focus on the most interesting locations, units, and subjects.
At each facility, a team of two will observe one unit over an entire 8-hr shift, beginning 30
minutes before the shift change. Team 1 will observe the ICU, Team 2 will observe the
Med/Surgery unit, and Team 3 (‘floaters’) will follow particular clinicians between units, likely
an Acute Care Manager, a Respiratory Therapist, or a Physical Therapist. Each team member
will perform three tasks during their visit: document whatever tasks are happening on the unit,
interview clinicians, and record environment data in five major categories (AEIOU: activities,
environment, interactions, objects, users). Each team will debrief at regular intervals during the
shift. At the end of each observation session, the teams will leave the units to debrief. After one
shift has been observed, the teams will move to a new facility, covering three facilities over three
days (Tue, Wed, Thu).
On the last day (Fri), the teams will have a debrief session with some of the clinicians and
informatics staff. The analysts will display their sketches and pictures of the units, their
understanding of the tasks, and their understanding of the clinical roles. The clinicians and staff
will then have a chance to correct and flesh out these understandings.

6. Materials
6- Field Notebooks (1 per person)
3- Digital cameras (1 per team) + charger, USB cord, memory cards
3- Audio tape recorders (1 per team) + blank tapes, extra batteries
Notes
Providence currently has the following CRs:
31% 08/23/2006 168983 New HED: A result is not available in Add Selection when it
appears in two class cfgs with different security on the
same CRv
46% 08/16/2006 162427 New Keep changes to result names synchronized between
FS_RES and FS_RES_CFG
48% 08/09/2006 161643 New HED ER 9176 SP2: When refresh is clicked in chart
mode the first label in the first class disappears from
the CRV
70% 07/27/2006 160732 Pending HED AdminRX: Need a way to require clinical users
enter a valid override reason.
27% 07/21/2006 160291 Assigned Support Esc: Webforms is prompting login screen at
humility
The addresses for the hospitals are:
Providence Portland Medical Center
4805 NE Glisan Street
Portland, OR 97213
Providence St. Vincent Medical Center
9205 SW Barnes Road
Portland, OR 97225
Providence Milwaukie Hospital
10150 SE 32nd Avenue
Milwaukie, OR 97222

7. Letter of Introduction
To the clinicians at Providence-Portland, Milwaukie, and St. Vincent,
Six analysts from McKesson Provider Technologies will be visiting the Medical/Surgical and
ICU units during the week of Monday, September 18. Our goal is to understand you and the jobs
you do better so that we can improve the plan of care, patient record, and charting software that
you use.
We hope to spend one shift (7a-3p) in each unit at each facility with no more than three people in
any one unit. While there, we hope to observe these tasks:
- shift changes
- patient admissions
- patient transfers into/out of the unit
- patient discharges
- task management
- plan-of-care method
While on unit, we will be observing the tasks being done, asking occasional questions, and
conducting 15-minute interviews with clinicians to learn more who you are and what you care
about. We may take pictures of things and staff in the unit, but the images will only be used for
research and not for any promotional purposes. No patients or patient data will be recorded. We
will bring release forms for anyone who is photographed.
It is especially important that we meet with Assistant Head Nurses, Nurse Specialists, and Nurse
Managers to understand how tasks are expected to be done and how they are done. We would
also like to meet with a Respiratory Therapist and an Acute Care Manager/Social Worker to
understand tasks across units. We will bring a small token gift for every unit we visit.
Thank you so much for your help. Please feel free to call me at 303-926-2464 or Terri Barylak-
Roge at 303-926-2459 if you have any other questions.
Sincerely,
McKesson Provider Technologies, Site visit team

8. Photography Release Form
If permitted, analysts from McKesson Provider Technologies will photograph your work area.
The photographs will help us analyze your work environment and make recommendations for
improving your McKesson Horizon Clinical software applications.
McKesson will use these photographs for internal research and internal presenta purposes only;
the images will not be used for any external purpose such as advertising. Internally, McKesson
will not disclose the names of participants seen in any photographs.
Please read the following statements and ask the analysts any questions you may have. Indicate
that you understand and agree to the conditions stated in this form by checking the boxes and
signing and dating below.
I give McKesson Provider Technologies permission to photograph me and my workspace
during the site visit. I understand that the photographs will be used in McKesson’s analysis
and recommendations and that my name will not be associated with my comments or
discussion of company affairs.
At the completion of the site visit, all photographs will remain in McKesson’s possession.
McKesson may use the photographs for future analysis with no obligation to me. The
photographs will not be used for commercial advertising.
I have been given the opportunity to ask questions and have had my questions answered to
my satisfaction.
Participant’s Signature
Participant’s Printed Name
McKesson Representative
Date

9. Observation Notebook
Observer Name
Facility (circle) Providence-Portland Providence-St. Vincent Providence-Milwaukie
Unit in Facility
Date/Time am / pm
Check off these tasks as you do them:
Overview (fill out observation form):
Begin by asking for a tour of the unit.
- record in observation notebook (e.g. # beds, # and type of staff, hours, location of
computers, SW apps installed)
Interview (fill out Clinician Interview form):
Required: If time allows:
Department Manager PT
RN OT
Respiratory Therapist RN Case manager
Nutritionist
Physician
Observe tasks (fill out observation form):
Required: If time allows:
Shift change (including shift report) Covering for another clinician
Shift change Med administration
Patient admission Med not on floor
Patient transfer into unit Med late
Patient transfer out of unit New orders
Patient discharge Patient education
Task management Pre-op
Plan-of-care method Post-op
Charting vitals
After each observation, review your notes and fill in anything else you remember.

10. Clinician Questionnaire
Thanks for your help with this survey. There are no ‘right’ or ‘wrong’ answers, and your
responses will be kept confidential.
Demographics
Name
Age
Email (to be used only if we need to clarify)
Gender Female Male
Education High school Bachelor’s Graduate degree Post grad
Degrees
Certifications
Current occupation
Specialties
Current employer Location # of beds
How many hours per week do you work (on average)? hours/week
How long have you been with this employer? years
What are your job responsibilities?
How many years have you been in this occupation? years
Other occupations and clinical roles you’ve had:
Circle any devices that you use regularly:
- PDA (e.g. Palm, iPaq) - Cell phone
- Music/MP3 player - Video games
How many hours per week do you use a computer: At work: hours/week
At home: hours/week

11. Circle what do you use your computer for?
Work: Charting Home: Personal financial management
Clinical data review Internet
Accessing on line resources Office type applications
Internet access Other
Office type applications (word processing, etc)
Other
What computer training has been given at work? Mouse/keyboard Standard Windows
Specific Application training Other
How many hours of training? _________________
How do you rate your computer skills? (1 = beginner and 10 = expert) 1 2 3 4 5 6 7 8 9 10
How often do you use the internet? Never Daily Weekly Monthly
Do you wear glasses or contacts? Yes No
What is your corrected eyesight (e.g. 20/30)?
Do you have any trouble seeing colors? Yes No
If ‘yes’, describe
Tasks
List some of the tasks you do at work and how often:
Care planning : Never Weekly Once/Shift Multiple times/shift
Shift report : Never Weekly Once/Shift Multiple times/shift
Direct patient care : Never Weekly Once/Shift Multiple times/shift
Discharge planning : Never Weekly Once/Shift Multiple times/shift
Bed control : Never Weekly Once/Shift Multiple times/shift
Admission : Never Weekly Once/Shift Multiple times/shift
Discharge : Never Weekly Once/Shift Multiple times/shift
Assigning Tasks : Never Weekly Once/Shift Multiple times/shift
Coordinate Patient Care: Never Weekly Once/Shift Multiple times/shift
: Never Weekly Once/Shift Multiple times/shift
: Never Weekly Once/Shift Multiple times/shift
: Never Weekly Once/Shift Multiple times/shift
Thank you so much for your help!

12. Clinician Interview Outline
(perform the interview ‘on the unit’ in a semi-private place)
Goals
- To understand a day-in-your-life as a clinician on this unit
- To understand you as a person outside of your clinical role (what you like t do, what your
goals are)
1) Could you please fill out this Clinical Questionnaire (if you haven’t already done it)?
2) Do you mind if I record this so I don’t forget anything you tell me? I’d like to transcribe it
later.
3) Can I ask you a few questions about your Questionnaire? (fill in anything they left blank or
that you don’t understand)
4) May I take a nice picture of you for the file?
5) Now I’d like to ask you a few general questions about you and your job, ok?
List of questions:
(This is a conversation – not a survey. Use the questions as a guide, but let the clinician guide
the discussion.)
(background questions)
Where are you from?
Do you have any children? Are you married?
How did you get started doing this?
(their history)
(their job)
What’s a normal day / week?
How are patient charges handled? (esp. ask Respiratory and PT)
How do you receive orders and requisitions?
Where do you do your documentation?
How do you communicate cor status, scheduling of patients (esp. for off unit things)?
Differences between shifts, days, units
What activities do you do away from work (for fun)?
What words might others use to describe you?

13. What are the most common activities on the unit?
What are your goals at work? At home?
What things motivate you at work? At home?
What things scare you or frustrate you at work? At home?
What things do you look forward to?
(wrap-up)
Let me make sure I understand:
here is what I think your job is…
here is what problems you have
Thank you so very much for your help.

14. Observer _____________________ Hospital _____________________ Unit_________ Date__________ Time________ am/pm
Physical Inventory of the Unit (AEIOU)
• Take pictures of all information sources, esp. informal ones (binders, whiteboards, sticky notes, notebooks, PDAs, books).
• Get copies of all paper forms in use.
• Examine computer station in detail. Look for physical signs of workarounds: sticky notes, worn keys, fingerprints, hardware modifications.
• Sketch the unit. Include location of information sources, pics of areas, places where time is spent, frequently traveled routes.
Activities (tasks people are doing) Sketch of unit
Environments
Interactions (people-people, people-objects)
Objects (and how they relate to activities)
Users (people, roles, relationships)

15. Person observed ____________________ Page
Observer _____________________ Hospital _____________________ Unit_________ Date__________ Time________ am/pm
GOAL: How is information gathered, stored, and transferred in the patient environment?
Time Task or Observation
(what you saw or “quotes”)
Pic # Comments
(why it was interesting – workaround, idea, sketch)
:
:
:
:
:
:
:
Hints: Take pics of all paper (notes, binders, etc) • Ask person to ‘think aloud’ during tasks • Look for workarounds • Let them talk