The Pivotal Role of Change Appropriation in the Implementation of Health Care Technology (original) (raw)
Related papers
2016
Purpose: In this presentation we share our latest research on the role coworker social influence and workarounds play in the implementation of electronic health records (EHR). This study relies on theories of organizational change and adaptive structuration theory to build and test an HIT workaround model. The findings suggest the workarounds are symbolic of a socially shared solution to overcome inadequacies in new EHR technology. While our study did not examine the impact on outcomes like patient safety, our findings challenge scholarship that depicts workarounds as stunting communication in organizations and resembling erratic, individually executed, quick fixes to immediate problems. The hypotheses constructing our model include:
Health Communication, 2017
The American Recovery and Reinvestment Act passed by the U.S. government in 2009 mandates that all healthcare organizations adopt a certified electronic health record (EHR) system by 2015. Failure to comply will result in Medicare reimbursement penalties, which steadily increase with each year of delinquency. There are several repercussions of this seemingly top-down, rule-bound organizational change-one of which is employee resistance. Given the penalties for violating EHR meaningful use standards are ongoing, resistance to this mandate presents a serious issue for healthcare organizations. This study surveyed 345 employees in one healthcare organization that recently implemented an EHR. Analysis of variance results offer theoretical and pragmatic contributions by demonstrating physicians, nurses, and employees with more experience in their organization are the most resistant to EHR change. The job characteristics model is used to explain these findings. Hierarchical regression analyses also demonstrate the quality of communication surrounding EHR implementation-from both formal and informal sources-is negatively associated with EHR resistance and positively associated with perceived EHR implementation success and EHR's perceived relative advantage.
IJSR, Vol (3), No (8), August 2024, 2024
This study evaluates the effectiveness of using change management methodologies to improve employee adoption of new Electronic Healthcare Systems (EHS) in the Kingdom of Saudi Arabia (KSA). The research identifies three primary categories of barriers to EHS implementation: technical, organizational, and human factors. Technical challenges include system compatibility issues, data integration problems, and security concerns. Organizational barriers encompass large capital requirements, process redesign, and alignment with strategic goals. Human factors involve resistance to change and the need for continuous training and support. The study aims to assess the current status of EHS adoption, identify the types of EHS being implemented, and examine the factors influencing their adoption. It also investigates the major challenges hindering EHS implementation and evaluates the performance of various change management approaches. The research methodology combines quantitative and qualitative methods, including surveys, interviews, focus group discussions, and document analysis. The findings indicate a positive attitude towards EHS among healthcare professionals in KSA, with change management methodologies significantly enhancing employee acceptance and reducing resistance. Effective strategies for implementation include comprehensive assessments, open communication, clear reasons for change, employee participation, and regular training and support. The study concludes that change management methodologies are crucial for the successful adoption of EHS, with improving communication and ensuring proper training and support being the most successful aspects. The overall effectiveness of these methodologies is highlighted by a positive response rate of 73.10%.
International Journal of Medical Informatics, 2007
Quality improvement Electronic health record Electronic medical record a b s t r a c t Implementing an information technology system can impact more than just quality of care and patient outcomes. The purpose of this 4-year, observational research project is to examine changes in organizational culture, quality improvement (QI) maturity, and quality of care following adoption of a single, electronic health record (EHR) system within an integrated healthcare network. The primary outcome measure, the Culture and Quality Questionnaire (CQQ), assesses the perceived culture of an organization and the degree of CQI maturity in seven quality management areas. Baseline surveys were distributed prior to conversion to the EHR. Subsequent data collection occurred at 12 months post "go live" and will occur at 24 and 36 months after the first hospital "go live". Secondary data were abstracted from routinely collected patient satisfaction measures and standard quality indicators. Contrary to expectation, our findings from the Baseline and 12-month follow-up data suggest that employees perceived the organizational culture as becoming more, rather than less, hierarchical. We also hypothesized that quality indicators would show improvement due to enhanced information flow and ease of information retrieval. This hypothesis was not supported by 1-year results. However, follow-up data from years two and three may provide different results.
eHealth and Organizational Change in Hospital Setting a Case Study on Electronic Health Records
2018
This chapter introduces a socio-technical organizational perspective on a EHR implementation in hospital setting through a qualitative a case study from one of the major hospital facilities in Portugal: the Hospital Doutor Fernando Fonseca in Amadora, Portugal. Through the account of eight key representatives pertaining to the main professional categories of the hospital, the researchers pinpointed the core organizational adjustments, strategic choices and relative challenges that anticipated, accompanied and followed the EHR implementation as perceived by key professionals, further capturing expectations concerning adjustments estimated but not yet realized. The study’s main contributions are identified in deepening the link between qualitative organizational studies and EHRs, offering an empirical case study portraying a change management experience that could be replicated in similar framesets, and furnishing practical recommendations and insights on what adjustments are to be en...
2019
Background: Electronic Health Records (EHR) are integrated software applications used by healthcare providers to create, share, retrieve, and archive patients’ health status information. Especially for large healthcare organizations, implementing Electronic Health Records organization-wide is a complex endeavour. The EHR literature generally suggests that contextual factors play a major role in adoption. We demonstrate how the work context influences adoption at the departmental level in a situation where each department has its own medical specialty or patient stream, clinical authority, and accountability. Here, the achievement of full adoption by all departments is not self-evident. Drawing on EHR implementation in a Dutch hospital, this study explores how the clinical departments’ work context characteristics contribute to their pre-implementation intended adoption and their post-implementation EHR uptake. Methods: This embedded case study allowed us to examine the EHR adoption ...
Studies in health technology and informatics, 2012
The historical National Programme for Information Technology (NPfIT) in England was the most expensive (~$20billion) and ambitious politically-driven IT-based transformations of public services ever undertaken. Nationwide implementation of integrated electronic health record (EHR) systems in hospitals was at the heart of the NPfIT (~$10billion). We conducted the first longitudinal, prospective, and sociotechnical case study-based evaluations of the implementation and adoption of national EHRs implementations in 12 'early adopter' hospitals across England. This paper reports the arrival, implementation process, and stakeholders' experiences of one EHR software (Millennium) at a National Health Service's (NHS) general hospital participating in NPfIT, hereafter called Alpha. From the outset, Alpha envisioned the implementation of EHR as a practice of change management to improve its performance. This vision attributed to the establishment of a 'design authority' at Alpha, including users from various capacities and levels. The 'design authority' was perceived a key contributor to appropriate (compared to other hospitals we studied) clinical engagement and bottom-up approach to deploying EHR. Through conducting several hundreds of group and individual workflow familiarization, Alpha adopted a novel approach to training staff on EHR software. This led to greater local configuration and high sense of ownership among users, which transformed work practices towards overall better performance of the hospital. Contrary to painful and turbulent experiences of EHR implementation via NPfIT route in the English hospitals, this in-depth case study revealed the importance of vision (change management) and insightful leadership in 'working out' EHR. We advocate envisioning EHRs as change management endeavors to enhance their complex, multi-dimensional, and sociotechnical adoption in healthcare settings.
Journal of the American Society for Information Science and Technology, 2012
Although electronic medical records (EMR) adoption by health care organizations has been widely studied, little is known about the determinants of EMR individual use by physicians after institutional adoption has taken place. In this study, the determinants of inpatient physicians' continuous use of EMR were studied. Four dimensions of EMR use were analyzed: use intensity, use extent, use frequency, and use scope. A web-based survey was administered to physicians at a large university hospital; respondents filled out a survey with questions relating to their EMR use, attitude, beliefs, work style, and dispositional resistance to change. Structural equation modeling was carried out to analyze the relationship between these factors. Physicians were found to differ substantially in the scope, extent, and intensity of their EMR use. Their attitude toward EMR use was associated with all use dimensions. Dispositional resistance to change was negatively related to perceived ease of use and with perceived usefulness both directly and through the mediation of compatibility with preferred work style. Time loss was negatively related to both perceived usefulness and attitude toward EMR use. Implications for research and practice are discussed.
PLOS ONE, 2020
The implementation of hospital-wide Electronic Medical Records (EMRs) is still an unsolved quest for many hospital managers. EMRs have long been considered a key factor for improving healthcare quality and safety, reducing adverse events for patients, decreasing costs, optimizing processes, improving clinical research and obtaining best clinical performances. However, hospitals continue to experience resistance from professionals to accepting EMRs. This study combines institutional and individual factors to explain which determinants can trigger or inhibit the EMRs implementation in hospitals, and which variables managers can exploit to guide professionals' behaviours. Data have been collected through a survey administered to physicians and nurses in an Italian University Hospital in Rome. A total of 114 high-quality responses had been received. Results show that both, physicians and nurses, expect many benefits from the use of EMRs. In particular, it is believed that the EMRs will have a positive impact on quality, efficiency and effectiveness of care; handover communication between healthcare workers; teaching, tutoring and research activities; greater control of your own business. Moreover, data show an interplay between individual and institutional determinants: normative factors directly affect perceived usefulness (C = 0.30 **), perceived ease of use (C = 0.26 **) and intention to use EMRs (C = 0.33 **), regulative factors affect the intention to use EMRs (C =-0.21 **), and perceived usefulness directly affect the intention to use EMRs (C = 0.33 **). The analysis carried out shows that the key determinants of the intention to use EMRs are the normative ones (peer influence) and the individual ones (perceived usefulness), and that perceived usefulness works also as a mediator between normative factors and intention to use EMRs. Therefore, Management can leverage on power users to motivate, generate and manage change.
2016
The goal of this study was to test a multi-level model of organizational change that examined how various antecedents, employee reactions, and organizational and personal outcomes relate to one another. The research was conducted via online surveys and as a longitudinal study. Participants were employees at a large supply distribution company, and were a part of the Pilot implementation of a new Enterprise Resource Planning (ERP) system. Results from the study revealed that job stress was closely related to organizational commitment, job satisfaction, and psychological well-being, while change commitment was associated with higher organizational commitment and job satisfaction. Positive training reactions were linked to increased change commitment and organizational commitment, and change-specific self-efficacy also predicted commitment to change. Additionally, change self-efficacy and principal support significantly moderated the relationship between coping and organizational commi...