Real-use evaluation of effects: Emergency departments aiming for 'Warm Hands'

Embracing real use in an iterative approach calls for systematic formative evaluation. Effects-driven IT Development has been suggested as a way of supporting a Participatory Design (PD) process involving implementations that expose mature prototypes to real work practices. This is followed by evaluations of how specified and desired effects are obtained. We present results from a project where high-level political goals ('More Warm Hands'; i.e., clinicians spending more time at the patient bedside) are aligned with the local clinical organization and practice. We demonstrate how to combine quantitative and qualitative methods to address various levels of 'use' from overall politics to actual practice. The project concerns the introduction and use of an electronic whiteboard system to support clinical overview and logistics at emergency departments (EDs). The nurses succeed in getting 'warmer hands' while the physicians have good reasons for not pursuing this aim after all. The study contributes to a growing bulk of literature on how to include PD in the later stages of iterative development.