This is a very interesting little qualitative observational study, which paints a believable (bad) picture of the reality on the floor of an ED ‘across the ditch’ after the implementation of a fancy new SSO system.
On a deeper reading of it, it sounds like the solution/implementation didn’t have much clinical informatics input - and therefore wasn’t very well crafted for the ED / ward environment.
As is often the case, it isn’t the product that is the problem - rather the way it is configured and implemented.
It does sound like the problems identified in this study could be mitigated relatively easily if there was ongoing investment and support for a constructive and iterative approach.
Thank you for this article. When implementing digital systems, it is essential to bring together all stakeholders and clearly understand what the actual problem is, and how a proposed solution will address it.
For example, the clinical nursing team may say: “We do not have time to keep logging in to a PC. It takes too long, and we need a faster solution.”
The IT team might respond: “A tap‑on, tap‑off system could help. You tap your ID card to the PC to log in, and tap again to log out.”
The clinical team agrees: “Yes, fantastic — let’s do it.”
However, would this actually resolve the issue? In this case, no. The problem is not only remembering passwords. The underlying issue is outdated and underperforming hardware. Even after entering credentials, it takes a long time for the PC to load the user profile, start applications, and complete antivirus scans.
IT may then advise: “Before implementing a tap‑on, tap‑off system, the hardware needs to be upgraded.”
Management responds: “There is no budget for that.”
The point I want to make is that when engaging with different stakeholders, it is critical to clearly identify and articulate the real problem and the intended outcome, discuss to the point to ensure none IT user actually understood, what solution offer. In this scenario, the issue is not primarily a login process problem, but the overall time required for the system to become usable after login. Without addressing that root cause, changes to authentication alone will not deliver the expected benefits.
I wonder how much our fascination with (and therefore, focus on) the widget interferes with understanding the context of the problem being experienced. We don’t only need the people affected by the problem to provide input. We need to understand the problem in its context. Delays in logging in don’t affect managers in the same way they affect ED staff who are working on the trot all the time in a time-desert when information is core to their response to urgent issues being presented to them in a space of ambiguity, uncertainty and diminished ability to capture information from patients and those who accompany them.
Do we always need a clinical informatician for this? No, but we do need clinical informations to train the IT solution-makers to learn how to understand context (IT infrastructure and hardware effects, problem solving value, users and their differences relating to roles, who to talk to for more insight to solve a problem, more…)