Richard Holden | Vanderbilt University (original) (raw)
Papers by Richard Holden
International journal of industrial ergonomics, Jan 1, 2011
Health information technology (IT) is widely endorsed as a way to improve key health care outcome... more Health information technology (IT) is widely endorsed as a way to improve key health care outcomes, particularly patient safety. Applying a human factors approach, this paper models more explicitly how health IT might improve or worsen outcomes. The human factors model specifies that health IT transforms the work system, which transforms the process of care, which in turn transforms the outcome of care. This study reports on transformations of the medication administration process that resulted from the implementation of one type of IT: bar coded medication administration (BCMA). Registered nurses at two large pediatric hospitals in the US participated in a survey administered before and after one of the hospitals implemented BCMA. Nurses’ perceptions of the administration process changed at the hospital that implemented BCMA, whereas perceptions of nurses at the control hospital did not. BCMA appeared to improve the safety of the processes of matching medications to the medication administration record and checking patient identification. The accuracy, usefulness, and consistency of checking patient identification improved as well. In contrast, nurses’ perceptions of the usefulness, time efficiency, and ease of the documentation process decreased post-BCMA. Discussion of survey findings is supplemented by observations and interviews at the hospital that implemented BCMA.By considering the way that IT transforms the work system and the work process a practitioner can better predict the kind of outcomes that the IT might produce. More importantly, the practitioner can achieve or prevent outcomes of interest by using design and redesign aimed at controlling work system and process transformations.
Journal of patient safety, Jan 1, 2011
The British journal of general practice : the journal of the Royal College of General Practitioners, Jan 1, 2011
BMC health services research, Jan 1, 2012
Research in social & administrative pharmacy : RSAP, Jan 1, 2012
BACKGROUND: The safety benefits of bar-coded medication-dispensing and administration (BCMA) tech... more BACKGROUND: The safety benefits of bar-coded medication-dispensing and administration (BCMA) technology depend on its intended users favorably perceiving, accepting, and ultimately using the technology. OBJECTIVES: (1) To describe pharmacy workers' perceptions and acceptance of a recently implemented BCMA system and (2) to model the relationship between perceptions and acceptance of BCMA. METHODS: Pharmacists and pharmacy technicians at a Midwest U.S. pediatric hospital were surveyed following the hospital's implementation of a BCMA system. Twenty-nine pharmacists' and 10 technicians' self-reported perceptions and acceptance of the BCMA system were analyzed, supplemented by qualitative observational and free-response survey data. Perception-acceptance associations were analyzed using structural models. RESULTS: The BCMA system's perceived ease of use was rated low by pharmacists and moderate by pharmacy technicians. Both pharmacists and technicians perceived that the BCMA system was not useful for improving either personal job performance or patient care. Pharmacy workers perceived that individuals important to them encouraged BMCA use. Pharmacy workers generally intended to use BCMA but reported low satisfaction with the system. Perceptions explained 72% of the variance in intention to use BCMA and 79% of variance in satisfaction with BCMA. CONCLUSIONS: To promote their acceptance and use, BCMA and other technologies must be better designed and integrated into the clinical work system. Key steps to achieving better design and integration include measuring clinicians' acceptance and elucidating perceptions and other factors that shape acceptance.
BMJ quality & safety, Jan 1, 2012
Violations of safety protocols are paths to adverse outcomes that have been poorly addressed by e... more Violations of safety protocols are paths to adverse outcomes that have been poorly addressed by existing safety efforts. This study reports on nurses' self-reported violations in the medication administration process.
Research in Social and …, Jan 1, 2010
BMJ Quality & …, Jan 1, 2011
Proceedings of the 2nd …, Jan 1, 2008
Annals of Emergency Medicine, Jan 1, 2010
Applied Ergonomics, Jan 1, 2006
Human Factors: The Journal of the Human …, Jan 1, 2007
International journal of medical informatics, Jan 1, 2010
Cognition, Technology & Work, Jan 1, 2010
Quality and Safety in …, Jan 1, 2006
Applied Ergonomics, Jan 1, 2008
… Journal of Human- …, Jan 1, 2009
Journal of biomedical informatics, Jan 1, 2010
Behaviour & Information Technology, Jan 1, 2009
International journal of industrial ergonomics, Jan 1, 2011
Health information technology (IT) is widely endorsed as a way to improve key health care outcome... more Health information technology (IT) is widely endorsed as a way to improve key health care outcomes, particularly patient safety. Applying a human factors approach, this paper models more explicitly how health IT might improve or worsen outcomes. The human factors model specifies that health IT transforms the work system, which transforms the process of care, which in turn transforms the outcome of care. This study reports on transformations of the medication administration process that resulted from the implementation of one type of IT: bar coded medication administration (BCMA). Registered nurses at two large pediatric hospitals in the US participated in a survey administered before and after one of the hospitals implemented BCMA. Nurses’ perceptions of the administration process changed at the hospital that implemented BCMA, whereas perceptions of nurses at the control hospital did not. BCMA appeared to improve the safety of the processes of matching medications to the medication administration record and checking patient identification. The accuracy, usefulness, and consistency of checking patient identification improved as well. In contrast, nurses’ perceptions of the usefulness, time efficiency, and ease of the documentation process decreased post-BCMA. Discussion of survey findings is supplemented by observations and interviews at the hospital that implemented BCMA.By considering the way that IT transforms the work system and the work process a practitioner can better predict the kind of outcomes that the IT might produce. More importantly, the practitioner can achieve or prevent outcomes of interest by using design and redesign aimed at controlling work system and process transformations.
Journal of patient safety, Jan 1, 2011
The British journal of general practice : the journal of the Royal College of General Practitioners, Jan 1, 2011
BMC health services research, Jan 1, 2012
Research in social & administrative pharmacy : RSAP, Jan 1, 2012
BACKGROUND: The safety benefits of bar-coded medication-dispensing and administration (BCMA) tech... more BACKGROUND: The safety benefits of bar-coded medication-dispensing and administration (BCMA) technology depend on its intended users favorably perceiving, accepting, and ultimately using the technology. OBJECTIVES: (1) To describe pharmacy workers' perceptions and acceptance of a recently implemented BCMA system and (2) to model the relationship between perceptions and acceptance of BCMA. METHODS: Pharmacists and pharmacy technicians at a Midwest U.S. pediatric hospital were surveyed following the hospital's implementation of a BCMA system. Twenty-nine pharmacists' and 10 technicians' self-reported perceptions and acceptance of the BCMA system were analyzed, supplemented by qualitative observational and free-response survey data. Perception-acceptance associations were analyzed using structural models. RESULTS: The BCMA system's perceived ease of use was rated low by pharmacists and moderate by pharmacy technicians. Both pharmacists and technicians perceived that the BCMA system was not useful for improving either personal job performance or patient care. Pharmacy workers perceived that individuals important to them encouraged BMCA use. Pharmacy workers generally intended to use BCMA but reported low satisfaction with the system. Perceptions explained 72% of the variance in intention to use BCMA and 79% of variance in satisfaction with BCMA. CONCLUSIONS: To promote their acceptance and use, BCMA and other technologies must be better designed and integrated into the clinical work system. Key steps to achieving better design and integration include measuring clinicians' acceptance and elucidating perceptions and other factors that shape acceptance.
BMJ quality & safety, Jan 1, 2012
Violations of safety protocols are paths to adverse outcomes that have been poorly addressed by e... more Violations of safety protocols are paths to adverse outcomes that have been poorly addressed by existing safety efforts. This study reports on nurses' self-reported violations in the medication administration process.
Research in Social and …, Jan 1, 2010
BMJ Quality & …, Jan 1, 2011
Proceedings of the 2nd …, Jan 1, 2008
Annals of Emergency Medicine, Jan 1, 2010
Applied Ergonomics, Jan 1, 2006
Human Factors: The Journal of the Human …, Jan 1, 2007
International journal of medical informatics, Jan 1, 2010
Cognition, Technology & Work, Jan 1, 2010
Quality and Safety in …, Jan 1, 2006
Applied Ergonomics, Jan 1, 2008
… Journal of Human- …, Jan 1, 2009
Journal of biomedical informatics, Jan 1, 2010
Behaviour & Information Technology, Jan 1, 2009