title: The Natural Hospital Environment: a Socio-Technical-Material perspective.
abstract: OBJECTIVE
  This paper introduces two concepts into analyses of information security and hospital-based information systems-- a Socio-Technical-Material theoretical framework and the Natural Hospital Environment.
  
  
  METHODS
  The research is grounded in a review of pertinent literature with previously published Australian (Victoria) case study data to analyse the way clinicians work with privacy and security in their work. The analysis was sorted into thematic categories, providing the basis for the Natural Hospital Environment and Socio-Technical-Material framework theories discussed here.
  
  
  RESULTS
  Natural Hospital Environments feature inadequate yet pervasive computer use, aural privacy shortcomings, shared workspace, meagre budgets, complex regulation that hinders training outcomes and out-dated infrastructure and are highly interruptive.
  
  
  CONCLUSIONS
  Working collaboratively in many cases, participants found ways to avoid or misuse security tools, such as passwords or screensavers for patient care. Workgroup infrastructure was old, architecturally limited, haphazard in some instances, and was less useful than paper handover sheets to ensure the quality of patient care outcomes. Despite valiant efforts by some participants, they were unable to control factors influencing the privacy of patient health information in public hospital settings.
  
  
  CONCLUSIONS
  Future improvements to hospital-based organisational frameworks for e-health can only be made when there is an improved understanding of the Socio-Technical-Material theoretical framework and Natural Hospital Environment contexts. Aspects within control of clinicians and administrators can be addressed directly although some others are beyond their control. An understanding and acknowledgement of these issues will benefit the management and planning of improved and secure hospital settings.
authors.affiliation: Faculty Medicine, Nursing & Health Sciences, Monash University, Wellington Road, Monash, VIC 3800, Australia. Electronic address: juanita.fernando@monash.edu.
authors.forename: Juanita
authors.initials: J
authors.lastname: Fernando
authors.affiliation: Faculty of Social Sciences, University of Wollongong, NSW 2522, Australia. Electronic address: lindad@uow.edu.au.
authors.forename: Linda
authors.initials: L
authors.lastname: Dawson
mesh_terms: D002017:Budgets; D004526:Efficiency; D006779:Hospitals, Public / Q000191:economics / Q000458:organization & administration*; D012637:Security Measures; D014739:Victoria
keywords: Computer security; Delivery of health care; Environment; Evaluation; Framework; Health information technology; Medical informatics; Model; Organisational framework; Outcomes; Technology framework