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

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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

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        - 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

Stages in system implementation
        - Discontent
        - Conceptualization
        - Planning
        - Development
        - Testing
        - Cutover
        - Acclimation
        - Acceptance
        - Discontent

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Implementation requires assessing...

Organizational culture

Organizational approach to information management

Organizational stage of growth

Organizational form

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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

Assessing organizational culture

Lorenzi NM, Riley RT.  Managing technological change:  Organizational aspects of health informatics, 2nd edition.

New York:  Springer Science & Business Media; 2004. P. 79.

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Org approach to info mgmt
        - Technocratic utopianism
        - Anarchy
        - Feudalism
        - Monarchy
        - Federalism

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Organizational stage of growth
        - Creativity - stage 1
        - Direction - stage 2
        - Delegation - stage 3
        - Coordination - stage 4
        - Collaboration - stage 5

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Organizational form
        - Centralized
        - Decentralized
        - Matrix

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Organizational growth and leadership styles

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Change strategy

Assessment

Feedback and options

Strategy development

Implementation

Reassessment

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Whorton-Quinn Matrix*

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

Unpublished manuscript, Spring 1978.

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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

Change strategy

Assessment

Feedback and options

Strategy development

Implementation

Reassessment

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

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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

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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

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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

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Challenges in evaluation

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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

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Challenges in evaluation
        - HIS are ubiquitous; we cannot disrupt live system
        - Exploit natural experiments—system maintenance, network outages, monitor helpline calls, workload

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

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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, 2nd 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

c 2007  Board of Trustees of U of IL