Clinical Documentation System Resistance and Workarounds: A Case Study of User Adoption Challenges in Pediatric Intensive Care
Overview
This case study examines the implementation failure of an electronic clinical documentation system at Garrison Children's Hospital, specifically analyzing nurse dissatisfaction and resistance in NICU and PICU units. The paper identifies inadequate end-user involvement, poor leadership communication, and insufficient training as key contributing factors, arguing that user-centered redesign and enhanced change management are essential to address system adoption and patient safety risks.
What this case study covers
- Problem identification: Nurse dissatisfaction with inadequate flowsheets and documentation inconsistencies
- Contributing factors: Lack of end-user involvement, poor communication, and insufficient training
- Discussion of broader EHR implementation literature and recommendations for improvement
Preview
Week 6 Info Tech for Healthcare Org Module 3
What is the major problem in this case? What factors seem to have contributed to the current situation?
The major problem in Case #7, “Concerns and Workarounds with a Clinical Documentation System,” at Garrison Children’s Hospital is the significant dissatisfaction and resistance among nurses, particularly in the NICU and PICU, with the newly implemented electronic clinical documentation system. Nurses report that the system’s flowsheets are grossly inadequate, leading to inconsistencies in documentation, lack of standardization, slow information retrieval, and potential risks to patient safety (Wager et al., 2022). This has prompted formal complaints to nurse managers and even direct escalation to the chief nursing officer, highlighting a breakdown in user adoption and system effectiveness that could compromise care quality in a pediatric setting.
Several factors have contributed to this situation. First, inadequate involvement of end-users (especially frontline nurses) during the planning and design phases likely resulted in a system that fails to align with the unique workflows of pediatric and intensive care units, where documentation needs differ markedly from adult settings due to factors like rapid physiological changes, weight-based dosing, growth tracking, and specialized flowsheets (Wager et al., 2022). Second, poor communication from leadership about the goals of automating clinical documentation has left nurses unclear on the organization’s objectives, fostering resentment and resistance rather than buy-in.
Third, insufficient training and support appear evident, as nurses struggle with usability issues and resort to workarounds that may introduce errors (Wager et al., 2022).