Abstract
‘A counter-intuitive, clunky, absolutely rubbish system that, you think, “nobody who’s worked on a front door service who’s had to do this would have done it like that, so why didn’t you involve them?”’. These recent words from an experienced emergency nurse practitioner (ref: https://vimeo.com/368059130) struggling to work with a poorly designed computer system underline the need for health-service design work that engages substantively with those who will make use of processes and products. As such, the reviewed paper is timely in proposing a process and related framework that may enable this with digital developments involving nurses.
Looking at the user-story template presented in the paper, it seems that the authors’ development processes have led to a specific tool which could help address the practitioner’s needs by eliciting highly relevant, individual perceptions in a succinct way. This could have benefits both for nurse and design practitioners in that pressures of time are so often a factor in health-service contexts. Indeed, this factor has recently led to more accelerated processes of engagement in well-established user-centred approaches such as Experience-Based Co-Design.
A strength of this paper is its clarity that digital ‘solutions’ are not always appropriate which, in effect, suggests a process of initial engagement with potential users that precedes the six-step framework. While the framework is extensively described, a clinically contextualised worked example of its use with nurses would have helped this reader better understand its application and the relationship of Interpretive Description to the resultant tools.
Another strong point is made when explaining that the final stage, testing of effectiveness, must have a wider ambit to understand integration with existing processes and systems. This is about understanding digital developments in context and in an ongoing way. The way that the user-story template incorporates open categories early in the six-stage process gives some scope for participants to explain important aspects of baseline contexts. Accordingly, it is not hard to imagine that the template could be adapted for later elicitation of not only the effectiveness of the digital development, but also its meaningfulness, appropriateness and feasibility for users (context-related attributes usefully developed by the Joanna Briggs Institute).
The latter considerations bring the reader full circle to the need for particular digital innovations and the politics of their creation and implementation. The authors pointedly highlight how health service users of such systems are liable to get ‘done to’ if they don’t engage more proactively with their design. The current paper is valuable in positing a framework that may make such engagement around a particular digital innovation more inclusive and systematic. However, more widespread uptake and change is likely to be contingent on a number of associated developments such as (i) integration of nursing informatics more substantively into nurse education and practice cultures, (ii) more integration of nurses into hospital and primary-care decision-making process so that they know who procures, commissions and designs their systems and can engage meaningfully in these processes, and (iii) fostering nurses’ understanding of why implementations tend to happen as they do, for example through explanation of basic elements of Normalisation Process Theory which itself initially developed through evaluations of digital/e-health developments. Thus there is much work to do, and this paper gives timely stimulus for its further advancement.