A Systemic Perspective on the Design and (Lack of) Use of an Artefact in the Hospital

A seemingly straightforward artefact, a certain bracket for mounting a drain to a hospital bed, failed to meet the needs of nurses, both in its original form and in its redesign. We hoped that studying this example would provide clear answers on designing and implementing technology in the hospital. However, we found this artefact’s failure to signal systemic challenges concerning hospital product design and implementation.
We used an ethnographic approach; visiting and observing on the units, and interviewing involved parties. We then analysed our field notes and photos, and the gathered documents and emails, to identify actors and to better understand what caused these brackets to fail.
These observations and materials range from December 2016 to November 2019. In 2024, we incorporated additional information from the engineer, whom we contacted for a member check on this article’s findings. Surprising information prompted further unit visits and information gathering.
This article reports our findings on why these brackets failed and discusses why mismatches between nurses’ needs and technology occur. This study also aimed to explore whether networks and narratives would be valuable in design and implementation of new technology. We applied two ways to explore, visualise and present our findings: we created a network of actors showing the connections and dependencies for this bracket, and we transformed the timeline of consequential events into narratives.
This research shows the difficulty of developing and implementing a simple mounting bracket in the complex system of a hospital. It discusses why mismatches occur between technologies and nurses’ needs in the hospital, related to the characteristics of complex systems, including the diversity of actors and the dynamics in the hospital. It also highlights the necessity of systemic design in developing technology for nurses, which has implications for practitioners and design researchers concerned with product development in complex settings such as hospitals.