How Do Users Perceive a Design-in-Use Approach to Implementation? A Healthcare Case

The implementation of information systems in organizational settings is a protracted process that includes the mutual adaptation of system and organization to each other after the system has gone live. We investigate a design-in-use approach to this implementation process. Rather than a centrally run implementation process with preset goals, the management in the studied hospital tasked the individual departments with exploring and embracing the possibilities afforded by a network of interconnected electronic whiteboards. The responsibility for driving this process was assigned to local super users in the departments. On the basis of interviews with 17 clinicians we find that (a) they perceive the design-in-use approach in conflicting ways, (b) the super users are more positive about the approach than the end-users, (c) standardization across departments conflicts with design in use within departments, (d) intradepartmental change is perceived more positively, (e) the design-in-use process is inextricably sociotechnical, and (f) the clinicians’ perception of design in use is more about implementing change than about preparing it or about training and support. The conflicting perceptions of the design-in-use approach, for example, include whether it gained momentum, met local needs, and made for an engaging process. We discuss the implications of our findings for a design-in-use approach to implementation.