It was late in the evening on St. Patrick’s Day 2017 when the nurse entered the room for the second time to administer my medication. This was also the second time I noted he had not washed his hands or sanitized prior to conducting what is referred to in health care as an “invasive procedure.” (The administration of my medication necessitated a needle piercing my skin.)
He was rushed, I could tell. I kindly asked if he would mind sanitizing his hands before he “stuck me.” I couldn’t help it. I had been in health care for 12 years and this was my third night in the intensive care unit (ICU). I knew this was a place where hospital-acquired infections are more common due to the nature of illnesses and invasive procedures conducted. But, I also understood he was working against the clock. He complied, but it was obvious he was perturbed. It wasn’t necessarily his fault. He was rushed because of the decisions someone in hospital administration had made influencing the design of his workflow.
There was a computer in the corner of the room networked to the electronic health record (EHR). The nurse would have to scan the medication label and then scan my wristband to ensure I was, indeed, the right person to get this medication. He would then have to log the administration of the medication into the EHR, which would provide a time and date stamp as to when the medication was given. If he was late in doing this, he would be held accountable. And that was only one metric affecting my care. There were many others: If the doctor did not document my diagnosis correctly along with the need for the medication, the hospital might not get paid. If, upon discharge, I returned to the emergency room with complications, there could be a black mark against the hospital’s ratings.
At that point, I had spent a considerable amount of my life designing EHRs and other health care technologies. I had attended meetings with administrators who would direct my team to design these systems for compliance, regulation, and efficiency — not realizing the unintended consequences such direction would have on the overall design or user workflow. They…