Order Description
\nDiscovery Question<\/p>\n
In a minimum of 400 words, compare and contrast the three major conceptual frameworks concerning technology and task: TTF, FITT, and ISTA.<\/p>\n
1.Fit between Individuals Task and Technology – FITT – Ammenwerth et al.<\/p>\n
2.Interactive Sociotechnical Analysis – ISTA – Harrison et al.<\/p>\n
3.Clinical Adoption Meta-Model – CAMM – Price & Lau<\/p>\n
BioMedCentral
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\nBMC Medical Informatics and
\nDecision Making
\nResearch article Open Access
\nIT-adoption and the interaction of task, technology and individuals:
\na fit framework and a case study
\nElske Ammenwerth*1, Carola Iller2 and Cornelia Mahler3
\nAddress: 1Institute for Health Information Systems, UMIT \u2013 University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol,
\nAustria, 2Institute for Educational Science, University of Heidelberg, Germany and 3Dept. of Psychiatry, University Hospitals of Heidelberg,
\nGermany
\nEmail: Elske Ammenwerth* – elske.ammenwerth@umit.at; Carola Iller – iller@ews.uni-heidelberg.de;
\nCornelia Mahler – cornelia_mahler@med.uni-heidelberg.de
\n* Corresponding author
\nAbstract
\nBackground: Factors of IT adoption have largely been discussed in the literature. However,
\nexisting frameworks (such as TAM or TTF) are failing to include one important aspect, the
\ninteraction between user and task.
\nMethod: Based on a literature study and a case study, we developed the FITT framework to help
\nanalyse the socio-organisational-technical factors that influence IT adoption in a health care setting.
\nResults: Our FITT framework (“Fit between Individuals, Task and Technology”) is based on the
\nidea that IT adoption in a clinical environment depends on the fit between the attributes of the
\nindividual users (e.g. computer anxiety, motivation), attributes of the technology (e.g. usability,
\nfunctionality, performance), and attributes of the clinical tasks and processes (e.g. organisation, task
\ncomplexity). We used this framework in the retrospective analysis of a three-year case study,
\ndescribing the adoption of a nursing documentation system in various departments in a German
\nUniversity Hospital. We will show how the FITT framework helped analyzing the process of IT
\nadoption during an IT implementation: we were able to describe every found IT adoption problem
\nwith regard to the three fit dimensions, and any intervention on the fit can be described with regard
\nto the three objects of the FITT framework (individual, task, technology). We also derive
\nfacilitators and barriers to IT adoption of clinical information systems.
\nConclusion: This work should support a better understanding of the reasons for IT adoption
\nfailures and therefore enable better prepared and more successful IT introduction project ( help with nursing paper writing from experts with MSN & DNP degrees)s. We
\nwill discuss, however, that from a more epistemological point of view, it may be difficult or even
\nimpossible to analyse the complex and interacting factors that predict success or failure of IT
\nproject ( help with nursing paper writing from experts with MSN & DNP degrees)s in a socio-technical environment.
\nBackground
\nIt is hard to imagine health care without Information and
\nCommunication Technology (ICT). Information technology
\nin health care has existed for about four decades, and
\nhas gained widespread usage. Electronic patient records
\noffer health care professionals access to vast amounts of
\npatient-related information; decision support systems
\nsupport clinical actions; and knowledge servers allow
\nPublished: 09 January 2006
\nBMC Medical Informatics and Decision Making 2006, 6:3 doi:10.1186\/1472-6947-6-3
\nReceived: 16 June 2005
\nAccepted: 09 January 2006
\nThis article is available from: https:\/\/monkessays.com\/write-my-essay\/biomedcentral.com\/1472-6947\/6\/3
\n\u00a9 2006 Ammenwerth et al; licensee BioMed Central Ltd.
\nThis is an Open Access article distributed under the terms of the Creative Commons Attribution License (http:\/\/creativecommons.org\/licenses\/by\/2.0),
\nwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
\nBMC Medical Informatics and Decision Making 2006, 6:3 https:\/\/monkessays.com\/write-my-essay\/biomedcentral.com\/1472-6947\/6\/3
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\ndirect access to state-of-the-art clinical knowledge to support
\nevidence-based medical practice [1].
\nIntroduction of ICT can radically affect health care organisation
\nand health care delivery and outcome. It is evident
\nthat the use of modern ICT offers tremendous opportunities
\nto support health care professionals and to increase
\nthe efficiency, effectiveness and appropriateness of care
\n[2,3].
\nHowever, not all project ( help with nursing paper writing from experts with MSN & DNP degrees)s introducing IT in health care are
\nsuccessful. It is estimated that up to 60 \u2013 70% of all software
\nproject ( help with nursing paper writing from experts with MSN & DNP degrees)s fail (e.g. [4]), leading to enormous loss of
\nmoney within healthcare and also to loss of confidence on
\nIT from the side of users and managers.
\nIt is interesting to recognize that the same IT system can be
\nseen as success by one department or professional group,
\nbut as a failure or at least as problematic by another
\ndepartment or professional group. Various interconnected
\nfactors seem to exist that influence success or failure. In
\nfact, the notion of success and failure has been largely discussed
\nin the literature in the last years. We will not try to
\nrepeat the overall discussion here, but just refer to some
\ngood references ([5-11]).
\nWhat we observe in any case is that the objective effects of
\nthe same IT system can largely differ in different settings.
\nThis is not surprising if we understand information systems
\nas technical systems embedded in a social-organizational
\nenvironment (see also [12]). The technology we are
\nintroducing in different clinical settings can be largely
\nequal (e.g. the same PACS software in various radiological
\ndepartments). But the socio-organizational setting may be
\nquite different (e.g. different organization of workflow,
\ndifferent patient profiles, different motivation of staff, different
\nmanagement support, different IT history etc.),
\nleading to different adoption processes of the same IT system,
\nand thus to different effects (e.g. increased efficiency
\non one ward, user boycott on the other ward).
\nWhat does this mean for a systematic IT management in
\nhospitals We argue that it would be helpful to know
\nmore about the factors influencing IT adoption, success
\nand failure, and to be able to predict the effects in a certain
\nsetting.
\nTherefore, at least two questions arise which should be
\nanswered by medical informatics research:
\n1. What are the “socio-organizational” factors that influence
\nadoption of an IT system in a given socio-organizational
\ncontext
\n2. Based on the answers to question 1: Is there any way to
\npredict the effects of an IT system in a certain context
\nThe aim of this paper
\nThe aim of this paper is to present an approach to answer
\nthe first question. Based on a literature study, we will
\npresent a framework (the FITT framework) to better analyse
\nthe socio-organisational-technical factors that influence
\nIT adoption. We will present the application of this
\nframework in the analysis of a case study, describing the
\nadoption of a nursing documentation system in several
\ndepartments of a German University Hospital.
\nWith regard to the second question, we will argue that
\nfrom some more philosophical point of view, the exact
\nprediction of success and failure may not be possible at
\nall.
\nPrevious work on IT adoption
\nAnalysis of the factors influencing adoption (and thus
\nalso success and failure) of IT systems in health care has
\nbeen an issue in research for many years. We will define IT
\nadoption as follows, based on the discussion in [13]: for
\nvoluntary used system, IT adoption is reflected in the
\nusage of the IT system; for mandatory used systems, IT
\nadoption is reflected in the overall user acceptance. In the
\nnext paragraph, we will analyse some research results on
\nfactors for IT adoption, focussing on general valid frameworks.
\nAnalysing the concept of information system (IS) success,
\nDeLone [5] developed an information success model for
\nmanagement information systems. This model describes
\nthat the effects of IT on the user (the individual impact)
\nand thus on the overall organization depends on the use
\nand the user satisfaction. Those two aspects themselves
\ndepend on the quality of the IT system and the quality of
\nthe information in this system (Figure 1). This model was
\nused to structure a broad literature review, but seems not
\nto be further validated. The authors discuss that IS success
\nis a multidimensional construct based on the interaction
\nof factors, and that a corresponding measurement instrument
\nshould therefore include not only the described criteria,
\nbut also their interaction.
\nIFnifgourmrea t1ion success model by DeLone [5]
\nInformation success model by DeLone [5].
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\nThe information success model is quite interesting as it
\ndescribes the interaction of various factors. However, its
\nshortcoming seems to be the isolated focus on IT quality
\nand system quality, indicating that only the system’s quality
\nitself determines the overall impact. This does not help
\nto explain why the same IT system can be adopted in a different
\nway, and have rather different effects, in various settings.
\nThe technology acceptance model (TAM) of Davis [14]
\ntries to analyse why users adopt or reject a system. It
\ndefines the constructs “perceived ease of use” and “perceived
\nusefulness” to predict attitude towards using and
\nactual system use. Both factors themselves depend on features
\nof the system (Figure 2).
\nWhile trying to verify his model by questioning 112 users
\nof one company, Davis [14] could partly confirm the
\nexpected links in his model. In his discussion, he stresses
\nthat this model is only usable for voluntary use of IT system,
\nand that further factors should be included in his
\nmodel, such as extrinsic motivation, user experiences with
\nthe system, and characteristics of the task to be supported
\nby IT (e.g. complexity of a task).
\nThis TAM model was adopted and extended by other
\nresearchers such as [15,16] and [17]. For example, Dixon
\n[16] extended it to the Information Technology Adoption
\nModel (ITAM). He tried to refine the “system design
\nfeatures” of the TAM model by describing that an IT system
\nhas requirements (such as required IT knowledge of
\nthe users, or necessary technical infrastructure) that must
\nbe matched with the knowledge and skills of the users and
\nwith the available technical infrastructure. He called this
\n“fit” and argued that perceived usefulness and perceived
\nease of use are not dependent on the system design features,
\nbut on this fit of user and system design features.
\nThe paper stays unclear whether the ITAM model was
\nmore formally validated. It is also unclear why those
\npoints already discussed as missing by Davis [14] (such as
\nextrinsic motivation or task characteristics) were not
\nincluded.
\nAll of the presented models seem to concentrate rather
\nstrongly on individual attribute of the users and of the
\ntechnology, neglecting attributes of the clinical environment
\nand of the supported clinical tasks that in our opinion
\nare of high importance to understand IT adoption
\nprocesses. ITAM is however interesting as it introduced the
\nnotion of fit, explaining that it is not individual attributes
\nwhich are important, but the quality of fit between e.g. IT
\ncomplexity and IT knowledge.
\nThe idea of fit is more comprehensively elaborated in the
\ntask-technology-fit model (TTF) of Goodhue [8,13,18].
\nHe takes into account not only technology and user, but
\nhe also considers the complexity of the clinical tasks
\nwhich have to be supported by an IT system. He examines
\nthe influence of the three factors \u2013 individual abilities,
\ntechnology characteristics, and task requirements \u2013 on
\nperformance and on user Assessment of IT systems, highlighting
\nthe significance of the interaction (fit) of those
\nthree factors (Figure 3). He argues that TTF (task-technology
\nfit, or more correct task-individual-technology fit, as
\nexplained by [13]) is the extent to which technology functionality
\nmatches task requirements and individual abilities.
\nGoodhue argues that user Assessment is a sufficient
\nsurrogate of TTF, and that it is appropriate for both mandatory
\nand voluntary used IT system. The TTF model was
\nused in the area of management information systems, and
\nmany of the proposed links within the model could be
\nvalidated in studies in various studies with hundreds of
\nusers.
\nTTF extends the other described models by concentrating
\non the fit. IT also includes the object of clinical task (e.g.
\ntask complexity, organization of tasks, interdependence
\nwith other tasks) to be supported by IT. However, TTF
\nonly focuses on the fit between user and technology, and
\nbetween task and technology (see Figure 3). It does not
\nconsider the interaction of user and task \u2013 which is, however,
\nin our opinion an important success factor for IT
\nintroduction project ( help with nursing paper writing from experts with MSN & DNP degrees)s. For example, introduction project ( help with nursing paper writing from experts with MSN & DNP degrees)s
\nmay fail because nurses are not sufficiently motivated for
\nnursing process documentation at all, independent of the
\ntool used, or physicians may not be motivated to do a
\ncomplete order entry themselves, instead of ordering a
\nnurse to complete the order, because of the additional
\ntime it will take them. In addition, TTF and derived models
\ndo not reflect on the dynamics of introduction
\nproject ( help with nursing paper writing from experts with MSN & DNP degrees)s. Attributes of users, task and technology frequently
\nchange over time in a clinical environment, and
\nthus also their interaction and their fit change.
\nHowever, the notion of fit has been found useful in many
\nother studies, too. For example, Folz-Murphy [19]
\ndescribed problems of the fit between user requirements
\nand available IT functionality. Zigurs [20] examined the
\nfit between task and technology in the area of group supports
\nsystems. Dishaw et.al. [21] extended the TTF \u2013 com-
\nFTeigcuhrneo l2ogy acceptance model (TAM) by Davis [14]
\nTechnology acceptance model (TAM) by Davis [14].
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\nbined with the TAM model \u2013 with the construct of
\ncomputer self-efficacy. With reference to the domain specific
\nof users abilities the developed model of Dishaw
\net.al. also implied a relation between the attributes of user
\nand task. The idea of fit seems thus to be helpful in various
\ncontexts.
\nOverall, the presented approaches present a good basis for
\nthe analysis of the IT adoption; however, all of them show
\nsome limitations.
\nBases on this analysis of the literature, we will now present
\na framework of fit between individuals, task and technology
\n(FITT framework), taking into account the processoriented
\ncharacter of an IT introduction. We will use our
\nframework in a retrospective analysis of a corresponding
\ncase study.
\nMethods: The FITT framework
\nBased on the literature review, we found it useful to use
\nthe interaction (fit) of users, tasks and technology as the
\nbasis to better understand IT adoptions.
\nOur FITT framework (“Fit between Individuals, Task and
\nTechnology”) is based on the idea that IT adoption in a
\nclinical environment depends on the fit between the
\nattributes of the users (e.g. computer anxiety, motivation),
\nof the attributes of the technology (e.g. usability, functionality,
\nperformance), and of the attributes of the clinical
\ntasks and processes (e.g. organisation, task
\ncomplexity) (Figure 4).
\nAn “Individual” can represent an individual user or a user
\ngroup. “Technology” can stand for the interaction of various
\ntools needed to accomplish a given tasks (e.g. hardware,
\nsoftware, network). But the technology does not
\nonly comprise computer-based tools, but all tools used by
\nthe individuals to execute the tasks, therefore including
\nalso paper-based tools. “Task” comprises the wholeness of
\ntasks and working processes that have to be completed
\n(e.g. nursing documentation, order entry etc.) by the user
\nand that are supported by the given technology.
\nMany researchers focus on the aspect of “organisation”.
\nOrganisational aspects in our model are either part of the
\nindividual aspect (individuals work in various roles and
\nvarious groups in an organization), or they are considered
\nin the task aspect (the clinical tasks and processes are
\norganized in a given way, with defined responsibilities).
\nThe objective of IT management can now be defined as
\nreaching an optimal fit between technology, user and task.
\nThis means that e.g. user involvement in the selection
\nprocess or a good user support can improve the fit
\nbetween the three aspects. Individuals must therefore be
\nsufficiently motivated and knowledgeable to execute a certain
\ntask. The technology must offer sufficient functionality
\nand performance to support a given clinical task. And
\nthe user must be sufficiently trained to use a given technology
\nadequately. An insufficient fit will probably lead to
\nproblems during implementation project ( help with nursing paper writing from experts with MSN & DNP degrees)s.
\nThe quality of fit depends on the attributes of the objects.
\nThe following list presents some examples on attributes
\nthat affect the various fit dimensions:
\n\u2022 Attributes on individual level: IT knowledge, motivation
\nand interest in the task to be completed, flexibility and
\nopenness to new ways of working, team culture, organizational
\ncontext, cooperation within a team, and politics
\nwithin an organisation.
\n\u2022 Attributes on task level: Organisation of the tasks to be
\ncompleted, activities and their interdependence, complexity
\nof tasks.
\n\u2022 Attributes on technology level: Stability and usability of
\na software or hardware tool, costs of a tool, functionality,
\navailable technical infrastructure, integration of tools,
\navailability of tools in a certain clinical situation.
\nIn order to influence and improve the fit, management
\ncan directly influence those attributes of task, individual,
\nand technology. For example, a reorganization of docu-
\nFTiagsku-rTee 3chnology-Fit model (TTF) by Goodhue [8], [13], [18]
\nTask-Technology-Fit model (TTF) by Goodhue [8], [13],
\n[18].
\nTbFehigtewu FreIeeTn T4 i nfrdaimvideuwaol,r tka s(1k) a: nITd- atedcohpntoiolong dyepends on the fit
\nThe FITT framework (1): IT-adoption depends on the fit
\nbetween individual, task and technology.
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\nmentation processes may improve the fit between task
\nand technology; training sessions for users may improve
\nthe fit between technology and individuals; a software
\nupdate may influence both the fit between technology
\nand task (e.g. new functionality being implemented) and
\nbetween individual and technology (e.g. usability being
\nimproved). Here are some examples for possible deliberate
\ninterventions on the three objects to influence and
\noptimize the fit:
\n\u2022 Intervention on the individual level: user involvement
\nin system selection and introduction (change management),
\nuser training sessions, good user support, motivation
\nby the management (leadership issues).
\n\u2022 Intervention on the task level: Reorganisation of task
\nand working processes (e.g. new ways for order entry),
\nclarification of the responsibilities (e.g. for nursing documentation).
\n\u2022 Intervention on the technology level: Hardware and
\nsoftware updates, redesign of paper-based forms, network
\nupgrade.
\nBesides the direct interventions on the three objects, there
\nare also external factors that may influence the fit, but
\nwhich cannot easily be controlled by the IT management.
\nThe following list presents examples for those external
\ninfluencing factors:
\n\u2022 Intervention on the individual level: Staff changes (e.g.
\nreducing IT knowledge), workload of staff (e.g. reducing
\ntime for IT use), changes of hospital strategy (e.g. IT is now
\nseen to contribute to competitiveness of the hospital).
\n\u2022 Intervention on the task level: Rising complexity of the
\ntask (e.g. by new legal documentation requirements), general
\norganisational changes in the organisation, changes
\nin patient profiles.
\n\u2022 Intervention on the technology level: New software
\nstandards, new technological achievements.
\nDue to those external factors, there will never be a complete
\nstatic situation with regard to the three fit dimension
\nand therefore to IT adoption. The external factors can
\nimprove or deteriorate the fit, while the deliberate interventions
\nof IT management will be aimed at steadily
\nimproving the fit. There may only be a partly stable situation
\nwhere the positive and negative changes are mostly
\nbalanced. It is helpful to describe this fit management and
\nfit dynamics as a loop-back system (Figure 5).
\nThe overall aim is to have an optimal fit to allow an easy
\nIT adoption. As described, the fit model allows us to
\ndescribe what we can do to influence and balance the fit.
\nThe larger the difference between the actual fit and the
\nplanned fit, the higher the problems during an IT introduction.
\nFor example, low fit between users and technology
\nmay lead to user frustration and finally to user boycott
\nif no interventions (e.g. IT training sessions) are organized.
\nWe assume that this basic theoretical approach can help
\nanalyzing the process of IT adoption during an IT implementation
\nproject ( help with nursing paper writing from experts with MSN & DNP degrees) in a clinical environment in the following
\nways (Figure 6):
\n1. Any disruptions during an introduction project ( help with nursing paper writing from experts with MSN & DNP degrees) can be
\ndescribed and analysed with regard to the disruption in
\none of the three fit dimensions (task-technology, technology-
\nindividual, or individual-task). This should help
\nplan project ( help with nursing paper writing from experts with MSN & DNP degrees)s, as problems can be anticipated in advance,
\nor can help to analyse problems in a project ( help with nursing paper writing from experts with MSN & DNP degrees) retrospectively
\nin order to learn from them.
\n2. Any intervention that is taken to improve a project ( help with nursing paper writing from experts with MSN & DNP degrees), to
\nmake it successful, can be analysed and described with
\nregard to one of the three objects (task, individual, or
\ntechnology). Any of those interventions on the objects
\nwill thereby indirectly affect the fit dimensions.
\nWe will now present a case study where the FITT framework
\nwas applied in a retrospective analysis, to show how
\nit can help describe and analyse an implementation
\nproject ( help with nursing paper writing from experts with MSN & DNP degrees).
\nReanalysis of a case study: IT adoption and FITT
\nframework in a German university hospital
\nA computer-based nursing process documentation system
\nwas introduced on several wards of the University Hospitals
\nof Heidelberg between 1998 and 2001. This introduction
\nwas accompanied by various Assessment activities
\nwhich among others investigated the following aspects:
\n\u2022 General computer knowledge and attitudes to computers
\nin nursing before, during and after system introduction.
\n\u2022 Nurses acceptance of the nursing care process (the task
\nto be supported by the IT) before, during and after system
\nintroduction.
\n\u2022 User satisfaction with the nursing documentation system
\nbefore, during and after introduction.
\n\u2022 Quality of nursing documentation before, during and
\nafter system introduction.
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\n\u2022 Overall affects of the nursing documentation systems on
\nnursing workflow.
\nThese Assessments were done e.g. based on standardized
\nand validated psychometric questionnaires (given to all
\nnurses, with return rates around 80%), standardized documentation
\nquality audits (analysing the nursing records
\nof 20 patients per ward at three points of time), and focus
\ngroup interviews with 1 \u2013 2 nurses per ward and with
\nnursing and project ( help with nursing paper writing from experts with MSN & DNP degrees) management. Methods and results of
\nthe Assessment studies have been published e.g. in [22-
\n25]. More details on all studies can be found in the corresponding
\nGerman research reports [26-28] as well as in
\n[29].
\nIn general, the Assessment results showed high user acceptance
\nof the IT system, and positive effects e.g. on documentation
\nquality. A detailed analysis, however, showed
\ndifferences in the reactions of the wards with regard to the
\nnew IT system. On one (somatic) ward, user acceptance
\nwas much lower than on the other wards, and several
\nproblems during IT introduction occurred here. On this
\nward (ward C), user acceptance was very low shortly after
\nthe introduction, and remained rather low even months
\nafter it (Figure 7).
\nThe FITT framework was used to analyse the differences
\non the wards, the process of IT adoption, and the effects of
\ninterventions taken by the project ( help with nursing paper writing from experts with MSN & DNP degrees) and IT management to
\nimprove IT adoption. This analysis was based on the available
\nresults of the already mentioned various specific Assessment
\nstudies.
\nIn this paragraph, we will present the result of this analysis
\nfor two somatic and two psychiatric wards. As already discussed,
\nthree of them showed a quick IT adoption, one of
\nthem showed a more problematic introduction (Figure 7).
\nA complete report of this analysis has been published in a
\nGerman project ( help with nursing paper writing from experts with MSN & DNP degrees) report [27].
\nAll wards had used a paper-based documentation system
\nprior to IT introduction which was now in part replaced
\nby a computer-based system. This new IT system covered
\nall steps of the nursing process (nursing anamnesis, care
\nplanning, documentation and Assessment of care \u2013 for a
\ndetailed explanation of the nursing process, see e.g. [30]).
\nHowever, all functionalities were only used on the psychiatric
\nwards where all steps of the nursing process were
\ndocumented. The documentation on the somatic wards
\nconcentrated on the documentation of nursing anamnesis,
\ncare planning, nursing tasks, and omitting the Assessment
\nof care. Nursing notes were written on all wards in the
\nIT system.
\nDermatological ward
\nThe dermatological ward had 20 beds, around 12 nurses
\nand a mean length of stay of about 10 days in 2000. The
\nIT system was introduced in Sept. 2000. Questionnaires
\nand documentation analysis were conducted three
\nmonths before IT introduction and again in Dec. 2000
\nand in June 2001. A focus group interview study was conducted
\nin February 2002.
\nThe analysis on this ward found a rather uncomplicated
\nand quick adoption of the new IT system. We will present
\nthe reanalysis of this case on the three fit dimensions:
\n\u2022 Fit between individuals and task: This fit was mostly
\nuncomplicated from the very beginning. Both ward managers
\nand nurses stated in the interviews that they were
\ntnFThaihegle riu neFrfbIleTuy e T6in fcdreiarsme wcetiwllyl o aarfffkfee c(c2tt )ian: tgDt rteihblieub tetehrsar etoeef itfnaitts ekdr,i vmteeencnthisnoionnlso sagnyd a nedx tfeitr,-
\nThe FITT framework (2): Deliberate interventions and external
\ninfluences will affect attributes of task, technology and fit,
\nthereby indirectly affecting the three fit dimensions.
\nPFliagnunrineg 5, directing and assessment of the fit
\nPlanning, directing and assessment of the fit. While the fit can
\nbe managed by deliberate active interventions (e.g. by IT
\nmanagement), continuous external factors may influence it,
\ntoo.
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\nconvinced of the necessity of a high-quality nursing documentation,
\nfor legal reasons and for the reputation of
\nnursing. The nursing process was mostly well accepted, as
\nthe questionnaires showed. Documentation analysis and
\ninterviews confirmed that nursing documentation was
\nmore complete after IT introduction than before. However,
\nas the intensive documentation audits showed, not
\nall steps of the nursing process were well documented,
\nand the documentation was in part not adequately
\nadapted to the individual patient.
\n\u2022 Fit between individuals and technology: This fit was
\nuncomplicated from the very beginning. The young, motivated
\nteam with high IT skills had no problems in learning
\nthe new technology. Computer acceptance and computer
\nsecurity levels were found to be high from the very beginning
\nboth in the questionnaires and the interviews.
\n\u2022 Fit between task and technology: This fit was a bit problematic
\nat the beginning, as the documentation analysis
\nshowed. The pre-defined nursing care plans offered by the
\nIT system were at first not sufficiently adapted to the need
\nof this ward. In addition, the computer equipment was
\nfirst insufficient (to small number of computers, too slow
\nhardware) to support a timely documentation process.
\nBecause documentation has always been done in the ward
\nheadquarters, no mobile or bedside computers were
\nfound necessary.
\nSummarizing, on the dermatologic ward, we found a
\ngood individual-technology fit after the IT introduction.
\nThe individual-task as well as the task-technology fit were
\nnot optimal at the very beginning (Figure 8).
\nIn order to improve the problematic fit dimensions,
\nproject ( help with nursing paper writing from experts with MSN & DNP degrees) management intervened as follows during the
\nintroduction period:
\n\u2022 Intervention with regard to task: None.
\n\u2022 Intervention with regard to user: Several onsite discussion
\nto increase nurses’ knowledge of the nursing process
\nand how to correctly use pre-defined standardized nursing
\ncare plans, to increase fit between individual and task.
\n\u2022 Intervention with regard to technology: The predefined
\nstandardized nursing care plans were refined, to
\nimprove adaptation to the individual patient; hardware
\nwas updated and extended, thereby increasing fit between
\ntask and technology.
\nThose interventions seem to have improved the fit. The
\nnurses judge the support of documentation by the software
\nand hardware equipment as rather good after two
\nyears both in the interviews as well in the standardized
\nquestionnaires. The documentation analysis also show an
\nimprovement in documentation quality.
\nPaediatric wards
\nThe paediatric ward had 15 beds, around 13 nurses, and a
\nmean length of stay about 5 days in 2000. The nursing
\ndocumentation system was introduced in Oct. 2000.
\nQuestionnaires and documentation analysis were conducted
\nthree months before IT introduction and again in
\nJan. 2001 and in July 2001. A focus group interview study
\nwas conducted in February 2002.
\nCompared to the other wards this ward showed rather low
\nuser satisfaction values with the nursing documentation
\nsystem during the introduction phase. An analysis structured
\naccording to the FITT framework showed several
\nproblematic areas:
\n\u2022 Fit between individuals and task: The detailed documentation
\naudits showed that nursing documentation
\nwas incomplete both before and after IT introduction (for
\ndetails, see [24]). The documentation audits showed that
\nthe amount of documentation rose heavily during IT
\nintroduction, but documentation quality did not increase
\nin the same manner (e.g. inadequate adoption of standardized
\nnursing care plans to the individual patient). User
\nattitudes with regard to the nursing care process strongly
\ndeclined after IT introduction (details e.g. in [23]). In
\nquestionnaires and interviews, users complained about
\nhigh time efforts for documentation. These and other
\nresults indicated that the fit between individuals and task
\nmay have already been problematic before IT introduction,
\nand now deteriorated after IT introduction, as the
\nnew IT tool forced a more complete documentation, without
\nbringing obvious benefits to the nurses.
\n\u2022 Fit between individuals and technology: Validated
\nquestionnaires as well as focus group interviews showed
\nsome initial problems handling the new hardware and
\nsoftware. As the questionnaires showed, the users were
\nrather unfamiliar with computers in the beginning. Some
\nof the users were not too enthusiastic to learn the new IT
\nsystem. However, the general attitudes with regard to
\ncomputers in nursing were comparable to the other wards
\nand on a medium level at the beginning. All in all, there
\nwere only some smaller problems in this fit on this
\ndimension.
\n\u2022 Fit between task and technology: This fit was found to
\nbe very problematic. Focus group interviews with users
\nand managers revealed that in the beginning the software
\nwas not optimally customized. For example, the predefined
\nnursing care plans in the software were found to be
\ninsufficiently adapted to the patients of this ward (a problem
\ncomparable to the dermatological ward). Also, the
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\nfunctionality and performance of the system was judged
\nto be insufficient in some parts. For example, the repeated
\ndocumentation of one item during a longer time period
\nwas not well supported. A big problem was also that no
\nmobile computers or bedside terminals were available,
\nwhich disturbed the common documentation workflow \u2013
\nwhile the nurses on this ward were used to documenting
\nat least some aspects at the patients bedside, this had not
\nbeen reflected by adequate hardware equipment in the
\nintroduction phase. From the users point of view, this all
\nled to high and unnecessary time efforts for documentation.
\nSummarizing, on this ward, all three fit dimensions were
\ndisturbed in the introduction period (Figure 9). Therefore
\nit is not surprising that we found rather low user satisfaction
\n(e.g., about half of the users wanted to stop using the
\nsoftware after three months) during this period.
\nDue to these problems, project ( help with nursing paper writing from experts with MSN & DNP degrees) management decided on
\nthe following interventions which we have structured
\naccording to the FITT framework:
\n\u2022 Intervention with regard to task: The workflow for documentation
\nwas reorganized, e.g. the number of items
\nwhich needed to be documented were reduced, and some
\nintermediate paper-based documentation was allowed to
\nreact on the missing mobile tools. This improved the individual-
\ntask as well as the task-technology fit.
\n\u2022 Intervention with regard to user: Onsite training to
\nrefresh knowledge on nursing process and nursing documentation
\nhelped to increase the individual-task fit. Further
\nindividual training sessions with regard to computers
\nin general and the software were organized. This helped
\nincrease the fit between individual and technology.
\n\u2022 Intervention with regard to the technology: Missing
\nfunctionality was implemented, erroneous functions were
\ncorrected, and hardware was updated to increase the performance,
\nthus increasing the fit between task and technology.
\nAll those interventions affected the three fit dimensions
\ndifferently. The repetition of the quantitative Assessment
\nabout 9 months after implementation indicated a clear
\nimprovement in user satisfaction, reflecting in our opinion
\nan improvement in the fit, which was also supported
\nby the interview study. In addition, in the documentation
\nanalysis, the amount of documentation was now found to
\nbe reduced.
\nPsychiatric wards
\nAs both psychiatric wards were found to be rather similar
\nin IT adoption, they will be discussed here together. The
\nwards had 21 resp. 28 beds and around 19 resp. 17 nurses.
\nMean length of stay was around 21 resp. 14 days in 2000.
\nThe nursing documentation system was introduced in
\nNov. 1998 resp. Nov. 1999. Questionnaires and documentation
\nanalysis were conducted three months before
\nIT introduction, in Febr. 99 resp. March 2000, and again
\nin Aug 2000. A focus group interview study was conducted
\nin February 2002 with nurses from both wards. Both
\nwards had long-term experience with paper-based documentation
\nof the nursing process.
\nBoth wards showed a mostly uncomplicated IT adoption:
\n\u2022 Fit between individuals and task: This fit was uncomplicated
\nfrom the very beginning. Nursing documentation
\nand nursing process were highly accepted by ward management
\nand nurses, as reflected in the questionnaires and
\ninterviews. Documentation analysis found high quality
\nand completeness of documentation, even when some
\nparts still appeared to be too standardized.
\n\u2022 Fit between individuals and technology: Nurses were
\nmotivated to work with the new system. At the beginning,
\nsome nurses were not very IT experienced and had some
\ninitial problems, but computer acceptance scores were
\nnevertheless high. User confidence and security in working
\nwith the IT system was found to be rather high.
\n\u2022 Fit between task and technology: In the beginning, performance
\nand functionality of the IT system were regarded
\na5FAwn6inigst sfhwuow retreh erares l 7)l t no4u wtrhsaienr dgq sud;e o1sc t=uio mnnoe “,nD 4tao =t iy oyoneu ss ;yw isnatdneimtc at”to eo dcno isfno ttuihnreu wem aweradonsr ko(infn ag=l l
\nAnswer to the question “Do you want to continue working
\nwith the nursing documentation system” on four wards (n =
\n56 for all 4 wards; 1 = no, 4 = yes; indicated is the mean of all
\nanswers). The 2nd questionnaire was applied around 3
\nmonth after IT introduction (except Ward B), the 3rd questionnaire
\nat least 6 months after the 2nd.
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\nas insufficient by the nurses. Also the quality of the predefined
\nnursing care plans were found weak. Nurses felt that
\nthe system was not very useful to support nursing documentation
\nin the first months.
\nSummarizing, on these wards, the fit dimensions were
\nrather good, with some problems only in the fit between
\ntask and technology (this comparable to the other wards)
\n(Figure 10).
\nProject management decided on the following interventions
\nthat we have structured according to the FITT framework:
\n\u2022 Intervention with regard to task: None.
\n\u2022 Intervention with regard to user: Some individual computer
\nsupport was offered to increase fit between technology
\nand individual.
\n\u2022 Intervention with regard to the technology: Missing
\nfunctionality was implemented, erroneous functions were
\ncorrected, and hardware was updated to increase the performance,
\ntherefore increasing the fit between task and
\ntechnology.
\nThese interventions helped to optimize the fit. The Assessments
\nafter several months and even years after implementation
\nshowed high user satisfaction and an
\nimprovement in nursing documentation quality,
\nalthough some functions of the system were still being
\ncriticised for not being adequately adapted to the specific
\nneeds of a psychiatric ward.
\nResults: Facilitators and barriers to IT adoption
\nBased on the result of the analysis of our different study
\nwards, we will now collect the factors that seem to represent
\nfacilitators and barriers to adoption of a computerbased
\nnursing documentation system. Based on the
\nassumption that IT adoption depends on the fit between
\nindividual, task and technology, we found indicators in
\nthe reanalysis of our case study that affect IT adoption of
\nnursing documentation systems (formulated in the way
\nthat the “higher\/better” the attribute, the easier IT adoption):
\n\u2022 Relevant attributes of individuals: Commitment to
\nnursing process as basis for nursing, commitment to nursing
\ncare planning, commitment to written nursing documentation,
\ncommitment to own professional nursing role
\n(IT as professional tool), acceptance of computers in general,
\nacceptance of computers in nursing, computer skills,
\ntyping skills (may be correlated with computers skills),
\ngeneral computer knowledge in years, age of nurses (may
\nbe correlated with computer knowledge), professional
\nexperience (may be correlated with age), number and
\nmotivation of key-users, overall motivation of wards to
\nintroduce the system, climate of support and trust within
\nthe nursing team, quality management skills of nurses,
\nlow expectations with regard to computers and nursing
\ndocumentation, low number of staff members and work
\nload of ward, low staff fluctuation, low number of parttime
\nstaff, night watches and nursing trainees on the ward,
\ncommitment to standardisation of nursing tasks (IT as
\nsupport, or IT reducing individuality of nursing).
\n\u2022 Relevant attributes of the task of nursing documentation:
\nLow complexity, amount and level of detail of documentation,
\nclear organization, clearly structured place
\nand time of documentation, quality of implemented predefined
\nnursing care plans, low number of nursing tasks
\nthat have to be documented in each shift, low use of documentation
\n(e.g. once per shift), long length of stay of
\npatients, low complexity of patient profiles (children,
\nadults), high use of documentation by other health care
\nprofessionals, available time during routine work to learn
\nthe system, no parallel redundant use of different documentation
\nmedia (IT, paper), clear agreements with
\nregard to organisation of documentation, availability of
\nnursing standards from other wards or earlier project ( help with nursing paper writing from experts with MSN & DNP degrees)s,
\nhigh degree of standardisation of nursing.
\n\u2022 Relevant attributes of the technology: Quality and
\namount of functionality of software, usability and user
\nfriendliness of software, stability and flexibility of software,
\nquality and performance of hardware and network,
\navailability of sufficient number of computers, availability
\nof mobile computers, clear version and update management.
\nBased on our analysis, the following interventions and
\nexternal factors can be found which may have a positive
\ninfluence on the fit between individuals, technology and
\ntasks (mostly corresponding to the “active interventions”
\nin Figure 5) and therefore on IT adoption:
\n\u2022 Positively affecting individual-technology fit: IT training
\nsessions, positive external norms (e.g. computers
\nbelong to nursing), high computer acceptance by nursing
\nmanagement, high motivation and training of key users,
\nintensive user support, step-wise implementation of functionality
\n(instead of all at one point of time), reduction of
\nnursing workload during the introduction phase (e.g. by
\nadditional staff).
\n\u2022 Positively affecting individual-task fit: Efficient training
\nsessions on the nursing process, high acceptance of nursing
\nprocess by nursing management, high external norms
\n(e.g. nursing is an own profession), clarification of
\nresponsibilities within nursing documentation, reorganiBMC
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\nzation and restructuring of nursing documentation processes,
\nclarification of the sensible amount of nursing
\ndocumentation (to avoid over-documentation), increased
\nuse of predefined nursing care plans, step-wise introduction
\nof nursing process.
\n\u2022 Positively affecting task-technology fit: Reorganisation
\nand restructuring of nursing documentation, local adaptation
\nof predefined nursing care plans, update of software
\nfunctionality enabling the reflection of the tasks characteristics
\nfor a ward, increase in number and availability of
\ncomputers, introduction of mobile tools in case the tasks
\nmake this necessary.
\nPlease note that the interventions do in fact directly influence
\nattributes of individual, technology, or task, thereby
\nonly indirectly influencing one or two of the three fit
\ndimensions. For example, by organizing additional training
\nsession, we can improve the IT skills (attributes) of the
\nindividuals, and thereby also indirectly influence the individual-
\ntechnology fit.
\nThis analysis should highlight that \u2013 even for this rather
\nrestricted case study and the limited focus on nursing documentation
\n\u2013 a variety of factors can be found that influence
\nthe fit between individuals, technology and task and
\ntherefore IT adoption. This supports the often discussed
\nfact that success and failure is a rather complex and multidimensional
\nconstruct.
\nDiscussion
\nIn this paper, we presented \u2013 based on an analysis of other
\nIT adoption frameworks from the literature \u2013 a framework
\nof the interaction between individual, technology and
\ntasks (the FITT framework). This framework was used to
\nsupport a structured retrospective analysis of the introduction
\nof a nursing documentation system in a German University
\nHospital. The detailed analysis of the case study
\nshowed common features, but also differences of IT adoption
\nof the wards which could be easily reflected and analysed
\nbased on the FITT framework.
\nThe FITT framework focuses on the significance of the
\noptimal interaction (fit) of individual user, technology,
\nand task. The fit between the attributes is more important
\nthan the individual attributes themselves. For example, IT
\nskills of the users are not sufficient for the success of an
\nintroduction \u2013 rather, they must match the requirements
\nby the IT software (e.g. software complexity).
\nIn our case study, the clear structure with three objects and
\nthree fit dimensions helped us reflect on the different reactions
\nof the wards we had found in the Assessment studies,
\non the problems which occurred during introduction, and
\non the interventions of project ( help with nursing paper writing from experts with MSN & DNP degrees) management. We did not
\nfind any aspect that we could not easily structure within
\nthis FITT framework. This however can not be regarded as
\nformal proof of completeness of our framework.
\nThe idea of fit has been introduced by other authors
\nbefore, such as [16] or [18]. Nancy Levensen discussed in
\nhere keynote at the Information Technology in Health
\nCare Conference (ITHC 2004) in Portland that system
\nfailure often depends on failures in the interaction
\nbetween components, not on the quality of the components
\nthemselves that often do not present problems from
\nan isolated point of view. Southon [31] discussed the fit
\nbetween organization, technology and user skills. Lundberg
\n[32] examined the interaction between actors (staff),
\nartefacts (technology) and working processes during a
\nPACS installation. And Palvia [33] analysed the significance
\nof the factors task, technologies, user, and organisation
\nduring a system introduction.
\nBut none of those previous and the other analysed
\nauthors, to our knowledge, noticed the important interaction
\nbetween user and task. There are many examples e.g.
\nin the area of nursing documentation systems or computerized
\nphysician order entry where the users were not
\nmotivated to do a certain task \u2013 independent of the quality
\nand functionality of the IT tool that was introduced!
\nThe reason why this interaction is often overlooked seems
\nsimple: In many cases, IT introduction is accompanied by
\norganizational changes (e.g., when CPOE is introduced, a
\nmuch higher documentation burden is suddenly put on
\nthe physicians), often leading to low user satisfaction or
\neven user boycott (see example in [34]). These problems
\nare then often attributed to the IT system (suspecting a
\nlow fit between IT and user or between IT and task). But
\nin fact the problems are mostly coming from a more fundamental
\nill-acceptance of the new task to be done, thus
\nreflecting a low fit between user and task! For an example
\nof this ill-acceptance, see the detailed analysis of a CPOE
\nintroduction by Massaro [35].
\niFAnintgrauolydrseuis c 8toiof nth oef Ftiht eo cno am dpeurtmera-tboalosegdic dwoacrudm sehnotrattliyo na ftseyrs tem
\nAnalysis of the Fit on a dermatologic ward shortly after
\nintroduction of the computer-based documentation system.
\nAn arrow indicates problems with the fit, a sun indicates an
\nuncomplicated fit.
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\nManagement of fit can be regarded as a loop back system,
\nreflecting that the fit is never really stable, but that it is
\nchanging based on external factors or deliberate interventions,
\nmaking fit management a constant and complex
\ntask for the whole life cycle of an IT system.
\nIn our case, all wards showed specific and time-dependent
\nIT adoption processes while starting to work with computer-
\nbased nursing documentation system. Unfortunately,
\nwe could not analyse this process in detail, as the measurement
\npoints of the various studies were too different
\nand irregular (the available data came from four partly
\nindependent Assessment studies). A more refined analysis
\nwould have needed an analysis in regular short intervals.
\nThus, all our presentations with regard to the dynamic of
\nthe IT adoption within the wards must be taken with care
\n\u2013 e.g., in Figure 7, we do not know whether there have not
\nbeen ups or down of user satisfaction in between the two
\nmeasurement points.
\nAll wards are now working rather successfully with the
\ncomputer-based nursing documentation system, however,
\nstill the fit is not in complete balance, as further
\nchanges are steadily occurring (e.g. new staff members
\nneed to be trained, new documentation standards have to
\nbe implemented, software errors lead to updates, refinement
\nof organization of nursing documentation, new
\ndocumentation guidelines leading to training session
\netc.). We expect that managing the fit balance is a continuous
\ntask which is never really completed, and can be
\ndescribed as a loop-back system (cp. Figure 5).
\nOur case study shows the complexity of a broad introduction
\nof an IT system in various settings: Individuals and
\ntasks are rather different in the various settings, requiring
\nhigh flexibility of the IT system and individual IT introduction
\nand support activities to get the best fit for each
\nward. This helps to explain why we can find different IT
\nadoption even when the same software and hardware is
\nintroduced.
\nInterestingly, it seems that the involved users often are not
\nable to distinguish between the various fit dimensions.
\nFor example, the nurses in our study partly expressed the
\nopinion that the new software system was not usable.
\nDetailed analysis revealed that at least some problems
\nwere based on the miss-fit between user and task \u2013 and
\nnot on a miss-fit between user and technology.
\nIn this context, we want to stress the significance of the
\nuser in IT introduction project ( help with nursing paper writing from experts with MSN & DNP degrees)s. Investing in user training
\nand user support can have positive effects on both individual-
\ntask and individual-technology fit. In addition,
\nuser involvement in system design and selection helps to
\nbuild more adequate systems, therefore also improving
\nthe task-technology fit. And, as Goodhue [8] shows, user
\nAssessment is a good surrogate for the overall fit, explaining
\npartly why user acceptance studies have found so
\nwidespread use (which should not be understood as to
\nunderestimate the significance of objective performance
\nmeasures).
\nIn case we accept the FITT framework as a point of basic
\nunderstanding of IT adoption \u2013 what are the following
\nsteps in ongoing development of this framework Some
\nmay argue that the first logical step would now be to
\ndevelop measurement instruments for the fit (as e.g.
\nGoodhue [18] tries for his task-technology fit) which in
\nfact seems necessary. The second step could then be to
\nquantify the factors influencing the fit, to allow better and
\nquantifiable prediction and planning of successful IT
\nadoption \u2013 e.g. if we knew that IT skills explain around
\n65% of the variability of fit between IT and users, then we
\nmay consider it useful to invest in training session. Comparable
\nquantitative oriented research on factors was e.g.
\ndone by [23,36] or [37]. To achieve this goal, we would
\nhave to compile a complete list of attributes of tasks, technology
\nand individual influencing the fit. However, this
\nresearch approach would only make sense from a realistic
\n(or positivistic) point of view where we expect that an
\nabsolute reality exists, where objects have attributes which
\nwe can unambiguously measured.
\nFrom another perspective that is often called relativistic or
\nconstructivistic, this approach may be seen as misleading,
\nas no absolute and measurable reality is thought to exist.
\nIn any case, we are dealing here with people whose reactions
\nto given inputs cannot be precisely predicted \u2013 as
\nvon F\u00f6rster [38] would put it, socio-technical systems are
\nnon-trivial systems. From this point of view, the significance
\nof the various factors influencing the fit can only be
\nanalysed based on the background of a given setting, with
\nall of the political, organizational and individual history
\ninfluencing the fit. The isolated analysis of say four factors
\n(out of an unknown but probably very large number of
\nexisting factors) can never lead to a significant and comdFAuingcautliyorsenis
\n9ooff tthhee cFoitm opnu tae pr-abeadsieadtr idco wcuamrde snhtaotritolyn asfytsetre mintro-
\nAnalysis of the Fit on a paediatric ward shortly after introduction
\nof the computer-based documentation system. One
\narrow indicates smaller problems with the fit, two arrows
\nlarger problems.
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\nprehensive insight into what is going on in a given context.
\nAnd a generalisation of interactions between these
\nlimited numbers of factors could never reflect all possible
\nsettings and would thus not be useful. Summarizing, from
\na more epistemological point of view, it may be difficult
\nor even impossible to analyse the complex and interacting
\nfactors that influence the fit.
\nWithout adopting any specific research paradigm here, we
\nwould like to argue that research on factors influencing
\nthe fit (or IT adoption in general) must try to generalize
\nfrom individual cases. We must come to a valid measurement
\ninstrument for the fit dimensions. And we are convinced
\nthat independent of the setting, there may be some
\npriority of factors (e.g. in our case, we found IT skills to be
\nless important than acceptance of the nursing process on
\nall wards). Even such a rough priority list would help IT
\nmanagers to optimize planning and directing of IT systems
\nin clinical context \u2013 without trying to quantify the
\nindividual impacts and their interactions, which in fact
\ndoes not seem helpful. Research in this direction has been
\ndone e.g. by [39] or [40].
\nIn any case, at the moment, the FITT framework presents
\na straight-forward analytic framework to describe and
\nanalyse IT adoption case studies. It is innovative in the
\nsense that it clearly describes the objects and their interactions
\naffecting the fit, understanding fit management as a
\nloop-back system.
\nThe FITT framework was based on the retrospective analysis
\nof the adoption of a nursing documentation system
\non four wards over 3 years. With regard to the broad literature
\nwe have discussed in the beginning, showing the
\nusefulness of the notion of fit in various settings, we
\nexpect the FITT framework to be valid also for other IT
\ntypes in other settings \u2013 but this still needs to be verified.
\nThe framework should now continue to be refined and
\nalso balanced to other adoption theories. And, as said, we
\nneed a valid quantitative measurement instrument for the
\nthree fit dimensions. The description of the dynamics of
\nchange can be improved by introducing a time axis into
\nthe framework. After further refinement and validation of
\nthis theoretical approach, we expect an even better support
\nfor the planning and Assessment of IT introduction
\nproject ( help with nursing paper writing from experts with MSN & DNP degrees)s.
\nConclusion
\nIn this paper, we presented \u2013 based on an analysis of other
\nIT adoption frameworks from the literature \u2013 a framework
\nof the interaction between individual, technology and
\ntasks (the FITT framework). This framework was successfully
\nused to support a structured retrospective analysis of
\nthe introduction of a nursing documentation system in a
\nGerman University Hospital. Based on this case study, we
\nderived facilitators and barriers to IT adoption of clinical
\ninformation systems. This work should support a better
\nunderstanding of the reasons for IT introduction failures
\nand therefore enable a better prepared and more successful
\nIT introduction project ( help with nursing paper writing from experts with MSN & DNP degrees)s.
\nCompeting interests
\nThe author(s) declare that they have no competing interests.
\nAuthors’ contributions
\nThe case study was planned and executed by EA. CI participated
\nin the qualitative part of the case study, CM in the
\nquantitative part of the study. The FITT framework was
\ndeveloped by EA and CI together. The paper was written
\nby EA with the support of CI and CM.
\nAcknowledgements
\nWe would like to thank all the staff from the various study wards as well as
\nthe large project ( help with nursing paper writing from experts with MSN & DNP degrees) team for their long-time dedication to this research
\nproject ( help with nursing paper writing from experts with MSN & DNP degrees). A preliminary version of this paper was presented at the conference
\n“Information Technology in Health Care (ITCH 2004)” in Portland in
\nSeptember 2004 [41].
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\niFAnintgrauolydrseuis c 1toi0of nth oef Ftiht eo cno tmwpou ptesry-cbhaiasetrdic d wocaurdmse snhtoatritolyn asfytsetre m
\nAnalysis of the Fit on two psychiatric wards shortly after
\nintroduction of the computer-based documentation system.
\nAn arrow indicates problems with the fit; a sun indicates an
\nuncomplicated fit.
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