David Kaufmann School of Computing and Mathematical Sciences, Auckland University of Technology (Friday, 3.00, Science 2) Support for clinical handover remains a challenge for Health Informatics. Obstetric Handover is an important multi-disciplinary activity that can have important consequences for patient safety. Although IT systems can be used to support handover, the improvement of handover is not a purely IT-based problem. This project took place in the context of a clinical improvement process designed to formalise and improve handover in a busy delivery unit. This study used investigative tools from the usability domain in order to understand the usability requirements of a complete socio-technical system - the handover process. This work demonstrated the feasibility of using such tools and illustrated potential usability problems and solutions in the clinical handover process. Changes were made in IT systems, the organisation of the handover and the physical environment. Evaluation of the modified approach is being conducted, in the light of some usability issues already discovered.

1. HINZ Conference and Exhibition 2011
A usability perspective on
clinical handover improvement –
CHIPS with everything?
David Kaufmann, Philip Carter, David Parry
Auckland University of Technology
Victoria Carlsen, Katie Groom, Lucy Westbrooke, Lisa Cunningham, Emma Parry
National Women’s Health, Auckland City Hospital
25 November 2011 / david.kaufmann1@gmail.com

2. Agenda
- Introduction
- Setting (CHIP Project)
- Setting (CHIPS Study)
- Applied Methods (Framework)
- Applied Methods (Usability Evaluation Methods)
- Findings (Clinical Handover & System)
- Findings (Usability Evaluation Methods & Triangulation)
- Conclusion & Future Work

3. Setting
(CHIP Project)
• Handover at Women’s Health Department at
Auckland City Hospital.
• Current Handover Environment, Process & System to
be improved based on Literature Review & Best Practice.
• Success of improvements (mainly data transfer)
measured through two Evaluations, applying User
Observation and Survey.

4. Setting
(CHIP Project)
CHIP – Improvement of the Handover Environment
Before After

5. Setting
(CHIP Project)
CHIP – Improvement of the Handover Process
New overall proforma for New proforma for handover of
handover individual patient

6. Setting
(CHIP Project)
CHIP – Improvement of the Handover System
Note: CHIP only applied minor changes to the system.
(addition of columns, change of columns)

7. Setting
(CHIPS Study)
• Success of improvements measured through two
Evaluations, applying four usability evaluation methods.
• Formulating Usability Design Requirements for future
Clinical Handover System.
• Assess practical application of these Usability
Evaluation Methods in a Health Care Setting.
• Assess practical application of the “Triangulation of
Methods” concept.
Note: Study has not been completed yet.

8. Applied Methods
(Framework)
Project
CHIP
Literature Review
& Best Practice
CHIP Project & CHIPS
First Usability Second Usability
Evaluation Evaluation
Study
User Observation Updated User Observation
Initial Handover Future Handover
Handover
Environment, Environment,
Environment,
Process & Process &
Survey Process & Survey
System System
System
Stakeholder Stakeholder
Interviews Interviews
Heuristic Heuristic
CHIPS Study
Evaluation Evaluation
List of Usability Updated List of Usability Design
Aspects Usability Aspects Requirements
Key Concept: Triangulation of Usability Evaluation
Methods as Each Usability Evaluation Methods has
particular strengths and weaknesses. (Tan, Liu & Bishu, 2009)

9. Applied Methods
(Usability Evaluation Methods)
• User Observation
Application: Use of video recording / Observer took role of “onlooker”.
Strength: Capture of actual user experience.
• Survey
Application: Use of Likert scale / 12 questions.
Strength: Simple data collection, anonymous.
• Stakeholder Interviews
Application: Use of voice recording / 11 questions (1 system specific).
Strength: Detailed stakeholder responses about specific problems.
• Heuristic Evaluation
Application: Based on Nielson & Mack’s (1994) ten heuristic principles.
Strength: Finding usability issues that are hard to describe by the users.

10. Findings
(Clinical Handover & System)
• Handover Environment - Improvements
Evidence: The number of observation logs in regards to negative
environment related aspects decreased from 60 to 15.
• Handover Process - Improvements
Evidence: The survey showed that participants assessment of handover
efficiency increased from 5.1 to 7.9 (means values on a scale from 1-10).
• Handover System - Minor Improvements
Finding: Due to the larger screen, the data is more visible. However, the
system does still not store all the handed over data, is not aligned with
the handover process and lacks of some best practice user interface
design. For instance, it is not possible to enlarge the information for one
particular patient.

11. Findings
(Usability Evaluation Methods & Triangulation)
• Methods: Medical domain knowledge is NOT required
in order to discover a large number of usability aspects.
In fact, domain knowledge could be unhelpful.
• Methods (Observation): Presence of Camera / Observer
had only minor impact on participants.
• Triangulation of Methods: Empirical evidence that
different methods highlight different usability related
aspects. Triangulation allows for effective working in a
“Real World” Environment.

12. Conclusion & Future Work
• IT Systems used for handover must further evolve,
especially to address the issue of data loss.
• Usability assessment for Handover systems must
acknowledge the handover process in order to meet key
usability aspects of efficiency and user satisfaction.
• “Journey” to future Handover System.
People / Handover System Handover System
Handover System not
Process used as auxiliary used as primary
used.
Journey working surface. working surface.
Integration with Use of advanced Integration of Integration with
Technological Handover
other Clinical IT data display Users Handheld
Journey process into
Systems. technology. Pocket PC’s.
system.

13. Questions
Questions?