Getting physicians to accept new information technology: insights from case studies

Abstract

ResearchT he potential contribution of a clinical information system (CIS) to the quality of health care 1-3 is generally acknowledged, and numerous hospitals have been engaged in their implementation. [4][5][6] Investment in information technology (IT) in the health care sector is higher than ever. Physicians play a critical role in the success of CIS implementation, 10-13 but many are reluctant to use IT tools. 14,15Rather than viewing resistance as a barrier to be removed, 16or taking for granted that resistance will be dysfunctional and even destructive, 17 we considered that it can also be useful in preventing the implementation of systems that are flawed 18 or that would have negative organizational impacts. 17 We analyzed cases of CIS implementation in 3 hospitals to understand better the dynamics of physicians' resistance to CIS implementation. We also sought to determine whether resistance was an a priori reaction or whether it developed only later, during the implementation. MethodsFor our analytical framework, we drew from a model that suggests that, when a CIS is introduced, resistance behaviours occur if users perceive threats from the interaction of initial conditions and system features.12 During implementation, triggers may change the nature of the initial conditions or change the object of resistance, and resistance behaviours may vary in intensity, from apathy to aggressive actions (Appendix 1). 12For our study, we selected 3 hospitals in which CIS had been or was being implemented. The cases were selected with enough similarities and differences so as to maximize variation and allow for comparison (Table 1). 19,20For data collection, we used direct observation, documentation and interviews, with interviews being the principal source of data. The initial people interviewed were the project manager, the nursing director and the medical director at each hospital. A snowball sampling strategy 21,22 was then used, whereby those interviewed identified additional people whom they thought held critical information about the project, had exhibited extreme behaviours of acceptance or resistance, or portrayed the typical behaviours of their professional group. Data collection ended when information obtained from additional respondents could not be justified in terms of effort and resources.23 We used open-ended questions and asked respondents to describe the implementation, from project initiation to termination. Following an interview protocol, additional questions were prompted to ensure data completeness Getting physicians to accept new information technology: insights from case studies Background: : The success or failure of a computer information system (CIS) depends on whether physicians accept or resist its implementation. Using case studies, we analyzed the implementation of such systems in 3 hospitals to understand better the dynamics of physicians' resistance to CIS implementation.Methods: : We selected cases to maximize variation while allowing comparison of CIS implementations. Data were coll...

Surgeons' Perspective of a Newly Initiated Electronic Medical Record

“…Th ese interactions are productive and increase utilization. Resistance behaviors, on the other hand, are counterproductive and lead to diminished productivity (17). Chen found several factors that were significant in physician acceptance of the EHR.…”

Factors for the Acceptance of Enterprise Resource Planning (ERP) Systems and Financial Performance

“…The negative impact of the failure of systems can be significant, especially in the modern era as organizations are increasingly using information systems to gain and sustain a competitive advantage, and as the systems are becoming the integral part of the information systems in the organization [25], [26]. There issues are also important for managers, as they want to ensure that they are able to develop a deep understanding of the needs of their employees, and ensure that they put into practice those systems which motivate the employees, and can therefore improve the financial performance of the organization [27].…”

Investments in information systems and technology in the healthcare: Project management mediation

“…Stakeholder's needs and requirements are crucial to ensure project success (Miller & Oliver, 2015). One of the most critical factors recognised by the academic literature is resistance to change by healthcare professionals, particularly amongst doctors (Lapointe & Rivard, 2006;Phansalker et al, 2008). The complexity of systems, together with organisational diversity and the volume of investment required, as well as failure in adopting IS/IT, are all justified largely by the way IS/IT is implemented, and by the need to identify best practices and to act on a number of critical factors in order to reduce the chance of failure (Davenport, 1998;Olson & Zhao, 2007).…”

“…Furthermore, users generally showed good acceptance of the system (Kamadjeu et al, 2005), reduced clinical productivity due to extra work (Scott et al, 2005), and, reduced work efficiency. Poor content design, system function, and system integration (Lee, 2007) was also detected, and the level of resistance varied and became sufficiently large to lead to major disruptions and system withdrawal (Lapointe & Rivard, 2006). Paré et al (2006) demonstrate that encouraging and cultivating a positive attitude towards the new system significantly improves doctors' overview of patients' current status in different clinical situations during the clinical process, based on the doctors' actual needs (Møller-Jensen et al, 2006), and organisational issues within hospitals that cause problems and delays during the transmission of reports came to light (Machan et al, 2006), generating more and new work for doctors.…”