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Research project: Same technology, different settings

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CDSS (clinical/computer decision support systems) are computer programmes which link medical knowledge and rules (or ‘algorithms') to support decision making. They are widely used, for example, helping doctors/nurses prescribe medicines, in ambulance services and NHS Direct. CDSS may allow staff to work more efficiently or faster, or allow staff to do tasks previously done by other staff (such as replacing a doctor with non-medical staff).

Previous research has looked at CDSS design or compared CDSS with other technologies but we do not understand how CDSS impact on workforce planning and management. We need to know how people work with CDSS, how this affects the way CDSS develop and, crucially, how to manage these technologies (e.g. the skills/training needed, level/experience of staff required, how many staff are needed).

To answer these questions we will study how different staff use the same CDSS technology in different ways in different healthcare settings.Clinical/computer decision support systems have diffused rapidly in the NHS to support triage, diagnosis, prescribing and treatment (e.g. in NHS Direct, Walk-in Centres, Ambulance Service and General Practice).

CDSS can improve decision-making, making it faster, more accurate or efficient, safer, and/or more evidence-based, whilst offering opportunities to change workflow and workforce configuration.

Such improvements depend heavily on the interplay between the technologies and the workforce that use them but the consequences of CDSS for workforce planning, management and training are not fully understood.

This two-year study will examine how a single CDSS is used by different types of staff in different healthcare contexts in order to:

  1. understand the impact of new technology on everyday work and service delivery;
  2. identify education and training needs for staff engaging with new technologies;
  3. examine the implications of new technology for workforce reconfiguration and management planning.

We will conduct a comparative study using ethnography and survey approaches to describe the design, development, management and use of a CDSS in three environments where it is used by different types of staff. The focus of this study is a CDSS which is used by clinical and non-clinical staff to support emergency (ambulance) and urgent (GP out-of-hours) care. Some 150 staff currently deal with approximately 450,000 calls from patients annually in the three chosen sites. The study will use the following methods :

  • Documentary analysis to trace development
  • Semi-structured interviews with key stakeholders to explore implementation and consequences; and with CDSS users exploring use, roles, expertise, team-working, boundaries, barriers and facilitators.
  • Non-participant observation at each site to capture interactions, networks, and work activity
  • On-line skills audit to describe skills, training and experience,
  • Survey of knowledge sharing and trust in teams related to new technology.
  • Qualitative and quantitative methods will be integrated developmentally to inform the study design and analysis, and by comparing data to explore convergence and contradiction.

This study is theoretically informed by sociology and psychology and will develop a robust conceptual model to understand the use of CDSS. It is underpinned by the ‘Normalization Process Model' (NPM) - a model for understanding the social shaping of interventions - which is designed precisely to enable systematic analysis across different settings. NPM explores

  • How work is enacted by the people doing it (interactional workability)
  • How work is understood within networks (relational integration)
  • The place of work in the division of labour (skills set workability)
  • Organizational sponsorship and control of work (contextual integration)

By using NPM we will analyse our findings in a theoretically generalizable way, so that they can be applied to other contexts and technologies. This will be valuable to workforce planners and educators, managers, commissioners and professionals.

The findings of the study will be disseminated summative through reports, journal papers and web technologies, and formatively to current and future user groups to maximise the impact of our findings for the future planning and development of the NHS workforce.

Project team

Professor Catherine Pope

Jo Turnbull Senior Research Fellow

Project funder

NIHR SDO Programme

Associated research themes

Health technologies – computer decision support system; urgent and emergency care; ambulance service; out-of-hours services; workforce configuration; workforce training; normalization process theory

Related research groups

Health Work and Systems
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