# Presentation: 515513

## Sociotechnical Aspects of HC Computing

*Annette L. Valenta, DrPH*
*Professor and Department Head*
*Biomedical and Health Information Sciences*
*College of Applied Health Sciences*
*UIC*

- c 2007  Board of Trustees of U of IL

## Learning Objectives

*At the completion of this presentation, the audience will be able to:*
*Describe the importance and relevance of organizational constructs for IT implementation*
*Describe strategies to manage organizational change inevitable with computerization*
*Provide practical suggestions to increase the potential for effectively managing resistance*
*Describe some of the challenges facing IT evaluators*

- c 2007  Board of Trustees of U of IL

## May 07 VA Cyberseminar

*Real Work Complexity for Design and Implementation of IT*
*Planning for change*
*Identification of new workflow process challenges*
_*Education regarding how to manage implementation of new technology in real work*_

- c 2007  Board of Trustees of U of IL

*Golub’s Laws of Computerdom*
*No major computer project is ever installed on time, within budget, with the same staff that started it, nor does the project do what it is supposed to do...most of the time*

- c 2007  Board of Trustees of U of IL

*Golub’s Laws of Computerdom*
*No major computer project is ever installed on time, within budget, with the same staff that started it, nor does the project do what it is supposed to do...most of the time*
*Groove JA, Maximizing return on EDP investments. Data Management 1972(Sep):28-32.*

- c 2007  Board of Trustees of U of IL

## Systems thinking – the what

*System is a set of interrelated elements*
*Framework for seeing interrelationships rather than things, particularly as world becomes more complex*

- c 2007  Board of Trustees of U of IL

## Stages in system implementation

*Discontent*
*Conceptualization*
*Planning*
*Development*
*Testing*
*Cutover*
*Acclimation*
*Acceptance*
*Discontent*

- c 2007  Board of Trustees of U of IL

## Implementation requires assessing...

- Organizational culture
- Organizational approach to information management
- Organizational stage of growth
- Organizational form

- c 2007  Board of Trustees of U of IL

## Organizational culture

_*Culture*_
*behavioral characteristics displayed amongst co-workers*
*culmination of common experiences and interactions*
*culture derived from values*
_*Values*_
*basic assumptions or beliefs that people and organizations possess about what ideals are worth striving to meet or accomplish*

- c 2007  Board of Trustees of U of IL

## Assessing organizational culture

*Assessing organizational culture*

*Lorenzi NM, Riley RT.  Managing technological change:  Organizational aspects of health informatics, 2**nd** edition.*
*New York:  Springer Science & Business Media; 2004.** P. 79.*

- c 2007  Board of Trustees of U of IL

## Org approach to info mgmt

*Technocratic utopianism*
*Anarchy*
*Feudalism*
*Monarchy*
*Federalism*

- c 2007  Board of Trustees of U of IL

## Organizational stage of growth

*Creativity - stage 1*
*Direction - stage 2*
*Delegation - stage 3*
*Coordination - stage 4*
*Collaboration - stage 5*

- c 2007  Board of Trustees of U of IL

## Organizational form

*Centralized*
*Decentralized*
*Matrix*

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## Organizational growth and leadership styles

- c 2007  Board of Trustees of U of IL

## Change strategy

*Assessment*
*Feedback and options*
*Strategy development*
*Implementation*
*Reassessment*

- c 2007  Board of Trustees of U of IL

## Whorton-Quinn Matrix*

****Quinn RE, Whorton JA, Computers and public administration:  Predicting resistance to change.*
*Unpublished manuscript, Spring 1978.*

- c 2007  Board of Trustees of U of IL

## What can managers do?

*Organizational level*
*Determine amount of decentralization desired*
*Involve affected dept. heads to facilitate cooperation*
*Restrain inclination to unnecessarily tighten operating procedures*
*Group level*
*Train supervisors so authority and status not jeopardized*
*Involve group members in discussions of how best to restructure work groups*
*Intentionally maintain social groups*
*Individual level*
*Special recruitment/retention efforts*
*Training to reduce stress and loss of status*

- c 2007  Board of Trustees of U of IL

## Change strategy

*Assessment*
*Feedback and options*
*Strategy development*
*Implementation*
*Reassessment*

- c 2007  Board of Trustees of U of IL

## Evaluation plan

*Focus on variety of technical, economic, organizational concerns*
*Use multiple methods*
*Be modifiable*
*Be longitudinal*
*Be formative as well as summative*

- c 2007  Board of Trustees of U of IL

## Challenges to evaluating IT

*Complexity of the evaluation object*
*Evaluation requires understanding the technology AND the social and behavioral process that affect and are affected by the technology*
*Complexity of the evaluation project*
*Motivation for evaluation*

- c 2007  Board of Trustees of U of IL

## Challenges in evaluation

*HIS are usually implemented as part of a complex change/re-engineering process*

*Carry out pragmatic, not explanatory studies and do not claim the HIS itself caused the benefits*

- c 2007  Board of Trustees of U of IL

## Challenges to evaluating IT

*Complexity of the evaluation object*
*Complexity of the evaluation project*
*Different stakeholders have different conceptions and views of successful IT*
*Motivation for evaluation*

- c 2007  Board of Trustees of U of IL

## Challenges in evaluation

- c 2007  Board of Trustees of U of IL

## Challenges to evaluating IT

*Complexity of the evaluation object*
*Complexity of the evaluation project*
*Motivation for evaluation*
*It is simply very difficult to organize IT evaluation in the form of an experiment; even if the results are negative, the IT very likely won’t be removed*

- c 2007  Board of Trustees of U of IL

## Challenges in evaluation

*HIS are ubiquitous; we cannot disrupt live system*

*Exploit natural experiments—system maintenance, network outages, monitor helpline calls, workload*

- c 2007  Board of Trustees of U of IL

## Ensuring successful change

*Proactive vs. reactive change*
*Global and local issues*
*Vision for change*
*Key change leaders*
*Leadership commitment*
*End-user needs*
*Organizational stress*

- c 2007  Board of Trustees of U of IL

## References

*Ammenwerth E, Graber S, Herrmann G, Burkle T, Konig J.  Evaluation of health information systems – problems and challenges. International Journal of Medical Informatics 2003;71:125-135.*
*Berg M. Implementing information systems in health care organizations: myths and challenges. International Journal of Medical Informatics  December 2001;64(2 – 3):143-156.*
*Berg M.  Patient care information systems and health care work:  a sociotechnical approach. International Journal of Medical Informatics  1999; 64(55): 87-101.*
*Lorenzi NM, Riley RT.  Managing technological change:  Organizational aspects of health informatics, 2**nd** edition.New York:  Springer Science & Business Media; 2004*
*Lorenzi NM, Riley RT, Blyth AJC, Southon G, Dixon BJ. Antecedents of people and organizational aspects of medical informatics: Review of the literature. Journal of the American Medical Informatics Association 1997;4(2):79-93** .*
*Pare G, Sicotte C, Jacque H.  The effects of creating psychological ownership on physician’s acceptance of clinical information systems.  Journal of the American Medical Informatics Association 2006;13(2):197-205. *
*Sobol MG, Alverson M, Lei D.  Barriers to the adoption of computerized technology in health care systems.  Topics in Health Information Management, 19(4):1-19, May 1999.*
*Soderholm P. Continuous improvements of complex technical systems: A theoretical quality management framework supported by requirements management and health management. Total Quality Management 2004 Jun;15(4):511-525.*
*Weir C, Lincoln M, Roscoe D, Turner C, Moreshead G.  Dimensions associated with successful implementation of a hospital based integrated order entry system.  Proc Annu Symp Comput Appl Med Care, 1994:653-7. *
*Weir C, Lincoln M, Roscoe D, Moreshead G.  Successful implementation of an integrated physician order entry application:  a systems perspective.  Proc Annu Symp Comput Appl Med Care, 1995:790–4.** *
*Worthley, J. A. (2000). Managing Information in Health Care:  Concepts and Cases. Chicago: Health Administration Press.*
*Wyatt JC, Wyatt SM.  When and how to evaluation health information systems? International Journal of Medical Informatics 2003;69:251-259.*

- c 2007  Board of Trustees of U of IL

## Questions?

- c 2007  Board of Trustees of U of IL