Table 1 Themes, subthemes and quotes

Implementation strategy

Support during the implementation

“I find the helpline really useful as well. I have called them like five times, I think. They are really helpful.” (P7)

Training

“More practice (with the system) and hands-on (training) is needed.” (D4)

User engagement/ownership/involvement

“They (Clinicians) were heavily involved in that build process. There was an endocrinologist to put his hands up to help. He was heavily involved, and some of the nurses were involved as well. They accepted the system even prior to our go-live.” (IT1)

Administrative support

“I think the big thing is that we had that governance that supported us. We had that leadership from the executive level from the beginning.” (IT1)

Infrastructure

“It has helped a lot, improved what you said that, you know, with giving the medication, the duration, how many days to wean off (medications), its good in a way, I think it’s just a lack of the equipment.” (N2)

Super-users

“Each ward has got a super-user.” (N1)

Communication among the support staff

“That instant messaging, can’t speak enough [about it]. Not that I’ve used that much, but that’s what lots of other people did (during the roll-out).” (IT2)

Capacity building

“The super user team would ensure that the receiving staff were able to do what they need to do.” (IT4)

Organisational outcome of EMMS

Legibility and information completeness

“The EMMS is useful because the medication orders are a lot clearer and we can read them easily.” (N2)

Alerts and Prompts

“Emergency Department has made a folder of the most commonly used medications list (in EMMS), and you can choose from there. Each department is trying to make its own list to save time while ordering medications.” (D2)

Access to the system

“I know it is quite useful to be anywhere in the hospital, I mean if you are in ED and if you would have to come all the way up to level six or seven, it is a big deal. So, it really helps in that sense too.” (D2)

Visibility of information

“It (EMMS)changed the particular way that previously we look at a medication chart I would look at which dose from the pharmacokinetic and pharmacological point of view, which patient is considered lower priority which is the higher priority. So I do the high priority (task).” (P2)

Workflow

“It changed the particular way that previously we look at a medication chart enabled to assess the clinical context.” (P2)

Individual impact of EMMS

Change in the way of working

“Before I would leave that job. Now do that job straight away, because it’s very easy thing to change.” (D4)

Accountability

“That is right, you know whom to contact if there is an issue with a dose whereas before when you ring and say “I never charted that”, but (now) you can read on the top and see who charted it.” (P3)

Self-efficacy

“There’s a lot of things each and every one of us has figured out. Like I figured out some things I’m dying to tell it to XX.” (P4)

IT product

Design and Build process (Process Design)

“So we looked at what the other sites had done and made it (the system) better basically.” (IT7)

Design issues (System Design)

“That’s the only thing that’s a bit confusing if you do not read the full order sentences you would not know if it is paracetamol or paracetamol with codeine.” (N2)

Technical issues

“Our other barrier is mainly to do with listings of product that do not match with what we have got and having to do all these unnecessary steps of having to change the products.” (P3)

Workarounds

“I think I just like re-charted it like in a slightly different way. It’s a bit time-consuming.” (D4)

Organisation culture

Organisational readiness

“I think the facility has the right culture, and this is only something this hospital just brings itself to make changes to be innovative, develop and work around the new system and develop strategies.” (IT1)

Communication with colleagues

“The interactions with other colleagues like doctors or pharmacist are better than before” (N1)

Cultural factors

“Perhaps we could have some IT person to teach some of our different generation of practitioner how to use the short cut key instead of grabbing the mouse and waste a lot of time.” (P2)