Organizational and Behavioral Factors

The human factors associated with implementing a new system should not be taken lightly. A great deal of change can occur as a result of the new system. Some of the changes may be immediately apparent; others may occur over time as the system is used more fully. Many IT implementation studies have been done in recent years, and they reveal several strategies that may lead to greater organizational acceptance and use of a new system:

• Create an appropriate environment, one in which expectations are defined, met, and managed.

• Know your culture and do not underestimate user resistance.

• Allocate sufficient resources, including technical support staff members and IT infrastructure.

• Provide adequate initial and ongoing training.

• Manage unintended consequences, especially those known to affect implementations such as CPOE and EHR systems.

• Establish strong working relationships with vendors.

Each of these strategies is described in the following sections.

Create an Appropriate Environment

If you ask a roomful of health care executives, physicians, nurses, pharma­ cists, or laboratory managers if they have ever experienced an IT system failure, chances are over half of the hands in the room will go up. In all likelihood the people in the room would have a much easier time describing a

system failure than a system success. If you probed a little further and asked why the system was a failure, you might hear comments such as these: “the system was too slow,” “it was down all the time,” “training was inadequate and nothing like the real thing,” “there was no one to go to if you had ques­tions or concerns,” “it added to my stress and workload,” and the list goes on. The fact is, the system did not meet their expectations. You might not know whether those expectations were reasonable or not.

Previously we discussed the importance of clearly defining and communicating the goals and objectives of the new system. Related to goal definition is the management of user expectations. Different people may have different perspectives on what they expect from the new system; in addition, some will admit to having no expectations, and others will have joined the organiza­tion after the system was implemented and consequently are likely to have expectations derived from the people currently using the system.

Expectations come from what people see and hear about the system and the way they interpret what the system will do for them or for their organiza­tion. Expectations can be formed from a variety of sources—they may come from a comment made during a vendor presentation, a question that arises during training, a visit to another site that uses the same system, attendance at a professional conference, or a remark made by a colleague in the hallway. Furthermore, the main criterion used to evaluate the system’s value or success depends on the individual’s expectations and point of view. For example, the chief financial officer might measure system success in terms of the financial return on investment, the chief medical director might look at impact on physicians’ time and quality of care, the nursing staff members might con­ sider any change in their workload, public relations personnel might compare levels of patient satisfaction, and the IT staff members might evaluate the change in the number of help desk calls made since the new system was implemented. All these approaches are measures of an information system’s perceived impact on the organization or individual. However, they are not all the same, and they may not have equal importance to the organization in achieving its strategic goals.

It is therefore important for the health care executive team not only to establish and communicate clearly defined goals for the new system but also to listen to needs and expectations of the various user groups and to define, meet, and manage expectations appropriately. Ways to manage expectations include making sure users understand that the first days or weeks of system use may be rocky, that the organization may need time to adjust to a new workflow, that the technology may have bugs, and that users should not expect problem-free system operation from the start. Clear and effective communication is key in this endeavor.