Workarounds in the Shadow System: An Ethnographic Study of Requirements for Documentation and Cooperation in a Clinical Advisory Center.

OBJECTIVE

Hospital information systems (HIS) are meant to manage complex work processes across healthcare organizations. We describe limitations of HIS to address local information requirements and how they are circumvented at different organizational levels. Results can be used to better support collaboration in socio-technical systems.

BACKGROUND

describe a mismatch between a technology's purpose and its actual use, whereas are unofficial IT systems circumventing limitations of official systems to support workflows. are conceptualized as the entirety of all (in)formal digital and analog systems connecting different communities of practice in a socio-technical system.

METHODS

An ethnographic study with observations and semi-structured interviews was conducted and analyzed through categorization and iterative coding.

RESULTS

Several digital-analog workarounds are employed for documentation and a shared server functions as a shadow system to support workflows in ways the HIS cannot. For collaborative documentation, all (official and informal) information sources were used simultaneously as part of an interconnected boundary infrastructure.

CONCLUSION

Formal and informal IT systems are interconnected across different organizational levels and provide insights into unmet information requirements, effective and problematic work practices, and how to address them to improve system functioning. An integrated perspective on boundary infrastructures, workarounds, and shadow systems may advance system analysis, providing a more comprehensive picture of IT requirements than any concept alone.

APPLICATION

Workarounds and shadow systems highlight that HIS should support systemic local needs. Customized interfaces in HIS to support search, access, and exchange of relevant data might help to mitigate current shortcomings.