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To analyze the effects that hands-free communication device (HCD) systems have on healthcare organizations from multiple user perspectives.This exploratory qualitative study recruited 26 subjects from multiple departments in two research sites located in Portland, Oregon: an academic medical center and a community hospital. Interview and observation data were gathered January through March, 2007.Data were analyzed using a grounded theory approach. Because this study was exploratory, data were coded and patterns identified until overall themes ‘emerged’.Five themes arose: (1) Communication access—the perception that HCD systems provide fast and efficient communication that supports workflow; (2) Control—social and technical considerations associated with use of an HCD system; (3) Training—processes that should be used to improve use of the HCD system; (4) Organizational change—changes to organizational design and behavior caused by HCD system implementation; and (5) Environment and infrastructure—HCD system use within the context of physical workspaces.HCD systems improve communication access but users experience challenges integrating the system into workflow. Effective HCD use depends on how well organizations train users, adapt to changes brought about by HCD systems, and integrate HCD systems into physical surroundings.