From expert-driven to user-oriented communication of infection control guidelines
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Abstract
Background: Currently, infection control protocols are more expert-driven than user-centered. In order to become more usable, protocols should externalize healthcare workers’ (HCWs) tacit knowledge, which is context-dependent and made up of practical and experiential wisdom of individual HCWs.
Objective:Based on a user-centered design process, we developed a web-based tool that facilitates HCWs with applicable infection control guidelines that enable them to deliver safe health care.
Methods: We used a one-group pretest-posttest design. During the pretest, 28 HCWs together performed 141 ‘what if’ scenarios simulating actual use of the paper-based, expert-driven protocol. HCWs’ knowledge and skills were detected using the thinking-aloud technique. Based on the findings, we developed a web-based guideline tool and assessed its usability in the posttest.
Results: The pretest demonstrated that HCWs faced 293 usability problems while working with expert-driven protocols, due to structure (40), a mismatch between HCWs’ and experts’ semantics (77), and information quality (176). Qualitative information problems could be attributed to actions or consequences that HCWs knew from daily practice but were not incorporated in the protocol, or information that was too concise to base a safe decision upon. These information problems produced 165 practical key questions that we used to restructure the existing expert-driven guidelines around. To overcome matching and structural problems we communicated the guidelines, comprising both expert-driven and practical information, via a web-based tool equipped with a search engine and index representing HCWs’ terminology, and inserted multimedia features to enhance adequate guideline application and prevent incomprehensibility problems (see Figure). The posttest revealed that HCWs encountered fewer matching (66) and information quality (143) problems. However, the amount of structural problems increased (86), caused by the advent of sophisticated electronic healthcare applications that make HCWs nowadays expect to obtain information instantly and dynamically. E.g., our respondents required more hyperlinks to additional sources and more precise results of the search engine.
The user-centered guideline-tool significantly outperformed the expert-driven protocol in both effectiveness (successful scenario-completion increased from 47.5 to 87.9%, p<.001) and efficiency criteria (time spent with scenario dropped from 359 to 134 seconds, p<.001).
Conclusions: The user-centered approach provided insights in HCWs’ practical thinking and acting which helped to fully adapt the tool to HCWs’ needs. This generated a more efficient and effective guideline-tool compared to expert-driven protocols. Moreover, we found that involving HCWs is important to create ownership and to foster the tool’s applicability, which eventually might encourage compliance and reduce healthcare-associated infections.
Objective:Based on a user-centered design process, we developed a web-based tool that facilitates HCWs with applicable infection control guidelines that enable them to deliver safe health care.
Methods: We used a one-group pretest-posttest design. During the pretest, 28 HCWs together performed 141 ‘what if’ scenarios simulating actual use of the paper-based, expert-driven protocol. HCWs’ knowledge and skills were detected using the thinking-aloud technique. Based on the findings, we developed a web-based guideline tool and assessed its usability in the posttest.
Results: The pretest demonstrated that HCWs faced 293 usability problems while working with expert-driven protocols, due to structure (40), a mismatch between HCWs’ and experts’ semantics (77), and information quality (176). Qualitative information problems could be attributed to actions or consequences that HCWs knew from daily practice but were not incorporated in the protocol, or information that was too concise to base a safe decision upon. These information problems produced 165 practical key questions that we used to restructure the existing expert-driven guidelines around. To overcome matching and structural problems we communicated the guidelines, comprising both expert-driven and practical information, via a web-based tool equipped with a search engine and index representing HCWs’ terminology, and inserted multimedia features to enhance adequate guideline application and prevent incomprehensibility problems (see Figure). The posttest revealed that HCWs encountered fewer matching (66) and information quality (143) problems. However, the amount of structural problems increased (86), caused by the advent of sophisticated electronic healthcare applications that make HCWs nowadays expect to obtain information instantly and dynamically. E.g., our respondents required more hyperlinks to additional sources and more precise results of the search engine.
The user-centered guideline-tool significantly outperformed the expert-driven protocol in both effectiveness (successful scenario-completion increased from 47.5 to 87.9%, p<.001) and efficiency criteria (time spent with scenario dropped from 359 to 134 seconds, p<.001).
Conclusions: The user-centered approach provided insights in HCWs’ practical thinking and acting which helped to fully adapt the tool to HCWs’ needs. This generated a more efficient and effective guideline-tool compared to expert-driven protocols. Moreover, we found that involving HCWs is important to create ownership and to foster the tool’s applicability, which eventually might encourage compliance and reduce healthcare-associated infections.
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