A critical realist exploration of hospital staff experiences of using nutrition dashboard technology

BACKGROUND: The Nutrition Dashboard is a validated nutrition informatics tool to display hospitalised patient food intake data. Despite demonstrated potential for malnutrition identification, research regarding the conditions required for successful implementation of the Nutrition Dashboard is lacking. This study explores dietitians' and food service staff's experiences with the Nutrition Dashboard to understand contextual factors and mechanisms shaping its use. METHODS: Using critical realism methodology, semi-structured interviews and focus groups were conducted with 17 dietitians and seven food service staff across nine hospitals in New South Wales, Australia. Data were thematically analysed before retroductive reasoning to generate Context-Mechanism-Outcome (CMO) statements that explore Nutrition Dashboard use. RESULTS: Five themes and CMO statements were evident: 1) Visibility and recognition: when food service staff see their data influence patient care, their increased engagement and data accuracy contributes to professional efficacy. 2) Partners in nutrition care: valued partnerships between food service staff and dietitians are enabled through communication and recognition, strengthening collaboration and nutrition care. 3) Education makes data meaningful: training on dashboard functionality and clinical value improves data accuracy and use. 4) Optimising data and systems: Nutrition Dashboard data has potential to enable efficient, technology-supported nutrition care through improved workflows and automation. 5) Proactive nutrition care: nutrition risk surveillance through Nutrition Dashboard data offers potential for objective, proactive and targeted care and improved nutrition outcomes. CONCLUSION: The Nutrition Dashboard's value and acceptability depend on more than technical functionality and accuracy. Relational mechanisms, meaningful training and workplace structures and supports are essential to effective implementation, especially when the technology spans professional boundaries. Genuine partnership between food service staff and dietitians, including mutual respect and communication are identified key factors contributing to acceptability of the Nutrition Dashboard. These findings offer actionable recommendations for health services implementing nutrition informatics technology, such as the Nutrition Dashboard.