Adaptation as design

Abstract

We conducted an observational study in an Emergency Department (ED) to examine the adaptation process after deploying an Electronic Medical Records (EMR) system. We investigated how EMR was adapted to the complex clinical work environment and how doctors and nurses engaged in the adaptation process. In this paper, we present three cases in which ED clinicians designed workarounds in order to adapt to the new work practice. Our findings reveal a rich picture of ED clinicians' active reinterpretation and modification of their work practice through their engagement with the system-in-use and its organizational and physical context. These findings call for the adaptation period in designing a socio-technical system in healthcare settings to be critically considered as an active end-user design process, a negotiating process, and a re-routinized process.

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