Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study

Greenhalgh, Trisha; Stramer, K; Bratan, Tanja; Byrne, Emma; Russell, Jill; Potts, Henry W W

doi:10.1136/bmj.c3111

Cited by 213 publications

(185 citation statements)

References 33 publications

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“…7 Lack of realisation of their hoped-for benefits was attributed mainly to the fact that they were not being used. [8][9][10][11] Similar findings were documented by the evaluators of the implementation of hospital records within the NPfIT. 3,[12][13][14] At the time of writing, most of the technologies in the NPfIT (including hospital-based records and HealthSpace) had been withdrawn because of delays in supply and/or non-uptake by clinicians, and a new policy emphasising local development and/or procurement introduced.…”

Section: Chapter 1 Background and Literature Reviewsupporting

confidence: 77%

Rethinking resistance to ‘big IT’: a sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies

Greenhalgh

Swinglehurst

Stones

2014

Health Services and Delivery Research

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BackgroundNationally mandated information and communication technology (ICT) systems are often locally resented and little used. This problem is sometimes framed in behaviourist terms, depicting the intended user of technology as a rational actor whose resistance stems from Luddism and/or ignorance, and viewing solutions in terms of training, incentives and sanctions. The implication is that if we get the ‘rewards’ and ‘punishments’ right, people will use technologies. Previous research in the social sciences, notably sociotechnical systems theory, actor–network theory and normalisation process theory, have considered the human, social and organisational context of technology use (and non-use). However, these have all had limitations in explaining the particular phenomenon of resistance to nationally mandated ICT systems.ObjectiveTo develop a sociologically informed theory of resistance to nationally mandated ICT systems.Theoretical approachWe drew on Anthony Giddens’ notion of expert systems (comprising bureaucratic rules and classification systems delivered through technology) as well as theories of professional roles and ethical practice. A defining characteristic of expert systems is that they can produce ‘action at a distance’, allowing managerial control to be exerted over local practice. To the extent that people use them as intended, these systems invariably ‘empty out’ social situations by imposing rules and categories that are insensitive to local contingencies or the unfolding detail of social situations.Study design and settingSecondary analysis of data from case studies of three nationally mandated ICT systems in the English NHS, collected over the period 2007–10.ResultsOur analysis focused mainly on the Choose and Book system for outpatient referrals, introduced in 2004, which remained unpopular and little used throughout the period of our research (i.e. 2007–13). We identified four foci of resistance: to the policy of choice that Choose and Book symbolised and purported to deliver; to accommodating the technology’s sociomaterial constraints; to interference with doctors’ contextual judgements; and to adjusting to the altered social relations consequent on its use. More generally, use of the mandated system tended to constrain practice towards a focus on (the efficiency of) means rather than (the moral value of) ends. A similar pattern of complex sociological reasons for resistance was also seen in the other two technologies studied (electronic templates for chronic disease management and the Summary Care Record), though important differences surfaced and were explained in terms of the policy inscribed in the technology and its material features.Conclusion‘Resistance’ is a complex phenomenon with sociomaterial and normative components; it is unlikely to be overcome using atheoretical behaviourist techniques. To guide the study of resistance to ICT systems in health care, we offer a new theoretical and empirical approach, based around a set of questions about the policy that the technology is intended to support; the technology’s material properties; the balance between (bureaucratic) means and (professional) ends; and the implications for social roles, relationship and interactions.We suggest avenues for future research, including methodology (e.g. extending the scope and scale of ethnographic research in ICT infrastracture), theory development (e.g. relating to the complexities of multi-professional team working) and empirical (e.g. how our findings might inform the design and implementation of technologies that are less likely to be resisted).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Chapter 1 Background and Literature Reviewsupporting

confidence: 77%

Rethinking resistance to ‘big IT’: a sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies

Greenhalgh

Swinglehurst

Stones

2014

Health Services and Delivery Research

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“…Rather, HIT interventions must be understood in the context of their simultaneous effects across multiple dimensions of the model. For instance, a recent evaluation of a national program to develop and implement centrally stored electronic summaries of patients' medical records in the UK revealed their benefits to be lower than anticipated and cautioned that complex interdependencies between many sociotechnical factors at the clinical encounter-, organizational-and the national-level are to be expected in such evaluations [32]. These study findings are illustrative of how and why our proposed model could be useful.…”

Section: Moving Towards a New Socio-technical Model For Hitmentioning

confidence: 87%

A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems

Sittig

Singh

2015

Health Informatics

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Conceptual models have been developed to address challenges inherent in studying health information technology (HIT). This manuscript introduces an 8-dimensional model specifically designed to address the socio-technical challenges involved in design, development, implementation, use, and evaluation of HIT within complex adaptive healthcare systems. The 8 dimensions are not independent, sequential, or hierarchical, but rather are interdependent and interrelated concepts similar to compositions of other complex adaptive systems. Hardware and software computing infrastructure refers to equipment and software used to power, support, and operate clinical applications and devices. Clinical content refers to textual or numeric data and images that constitute the "language" of clinical applications. The human computer interface includes all aspects of the computer that users can see, touch, or hear as they interact with it. People refers to everyone who interacts in some way with the system, from developer to end-user, including potential patient-users. Workflow and communication are the processes or steps involved in assuring that patient care tasks are carried out effectively. Two additional dimensions of the model are internal organizational features (e.g., policies, procedures, and culture) and external rules and regulations, both of which may facilitate or constrain many aspects of the preceding dimensions. The final dimension is measurement and monitoring, which refers to the process of measuring and evaluating both intended and unintended consequences of HIT implementation and use. We illustrate how our model has been successfully applied in real-world complex adaptive settings to understand and improve HIT applications at various stages of development and implementation.

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“…2,3 The UK government has also released a White Paper for consultation on the use of information, which will have a major impact on how we use information within health services. The Department of Health hailed it 'the information revolution' that is 'part of the Government's agenda to create a revolution for patients -''putting patients first'' -giving people more information and control and greater choice about their care.…”

mentioning

confidence: 99%

Clinical dashboard: use in older adult mental health wards

et al. 2013

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Aims and methodTo explore the experiences and attitudes of mental health professionals working in acute elderly care to a new clinical dashboard system. Metrics were identified from the Royal College of Psychiatrists' Accreditation for Inpatient Mental Health Services – Older People (AIMS-OP); these were tracked from baseline to 6 months. A questionnaire was developed and distributed across the three clinical areas involved in the clinical dashboard mental health pilot.ResultsStaff completed the questionnaire 3 months after the initial implementation. At this point the benefits of the introduction of the dashboard were suggested as: improved access to information, increased communication and information-sharing, increased staff awareness, and data quality.Clinical implicationsThe introduction of the clinical dashboard in older adult mental health services allowed for better data availability and resulted in better data quality.

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Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study

Cited by 213 publications

References 33 publications

Rethinking resistance to ‘big IT’: a sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies

Rethinking resistance to ‘big IT’: a sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies

A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems

Clinical dashboard: use in older adult mental health wards

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