Beyond usability: Designing effective technology implementation systems to promote patient safety
Open accessAbstract
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.
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Problematic system design can undermine otherwise appealing and effective products.
“problematic system design can easily undermine otherwise appealing and effective products (Littlejohns, Wyatt, & Garvican, 2003; Karsh, 2004)”
From User‐centered design for psychosocial intervention development and implementation. (2016) · cites this paper as Karsh, 2004
The specific context of HIT design and implementation can strongly affect its effectiveness, safety, and true cost.
“the details of HIT design and implementation 100 in a specific context can make a huge difference to its effectiveness, safety, and real cost”
From Health information technology: fallacies and sober realities (2010) · cites this paper as [100]
The health care literature shows that EHRs can contribute to safety incidents and patient harm.
“Complicating matters, the health care literature documents the potential of EHRs to contribute to safety incidents and patient harm.1,23,30 -33”
From EHR Safety: The Way Forward to Safe and Effective Systems (2008) · cites this paper as [30]
Initial broad classifications of safety incidents have come from published accounts of CPOE-related errors.
“Published reports of CPOE-related errors have provided initial, high-level typologies of safety incidents.30,44,45”
From EHR Safety: The Way Forward to Safe and Effective Systems (2008) · cites this paper as [30]
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- Authors
- Karsh, B.-T.
- Affiliations
- University of Wisconsin–Madison (US)
- Corresponding author
- Karsh, B-T
- Venue
- Quality and Safety in Health Care
- Publisher
- BMJ
- Published
- 2004-10-01
- Volume
- 13
- Issue
- 5
- Pages
- 388-394
- ISSN
- 1475-3898 (ISSN-L)
- 1475-3901
- PMC
- PMC1743880
- OpenAlex
- W2150337999
- Cited by
- 414
- References
- 123
- Citations by year
- 2026: 7 · 2025: 16 · 2024: 23 · 2023: 21 · 2022: 26 · 2021: 29 · 2020: 26 · 2019: 32 · 2018: 14 · 2017: 25 · 2016: 26 · 2015: 17 · 2014: 20 · 2013: 15 · 2012: 20
- FWCI
- 15.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ Quality & Safety (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (1r01hs013610-01)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Social Sciences › Sociology and Political Science › Information Systems Theories and Implementation
- Keywords
- technology implementation, patient safety, human factors engineering, computerized physician order entry, medical errors, diffusion of innovations, technology acceptance, organizational justice, participative decision-making, organizational change, health technology adoption, usability
- MeSH terms
- Diffusion of Innovation, Humans, Ergonomics, Systems Analysis, Technology Assessment, Biomedical, Safety Management, Medical Errors
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