1. The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c This material (Comp2_Unit10c) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Sociotechnical Aspects: Clinicians and Technology Learning Objectives Describe the concepts of medical error and patient safety (Lecture a, b) Discuss error as an individual and as a system problem (Lecture a) Compare and contrast the interaction and interdependence of social and technical “resistance to change” (Lecture c) Discuss the challenges inherent with adapting work processes to new technology (Lecture c) Discuss the downside of adapting technology to work practices and why this is not desirable (Lecture c) Discuss the impact of changing sociotechnical processes on quality, efficiency, and safety (Lecture a, b) 2 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

3. Sociotechnical Systems Sociotechnical system: System that involves interaction between people and technology Organizational characteristics are modified by this interaction for better or for worse Optimization of one element without attention to the other may be detrimental to the organization 3 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

4. Clinicians And Technology Medicine is dependent on technology for progress –Microscope invented in 1590 –In 1675 Anton van Leeuwenhoek uses a microscope to examine blood, cells, and bacteria –In 1938 Ernst Ruska develops electron microscopy –Researchers now have a detailed understanding of structure of organs in health and disease 4 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

5. Clinicians And Technology Clinicians integrate technology into their medical practice –Example: In 1816 Rene Laennec invents the stethoscope –Refined since then –Clinicians have adopted iterative modifications of technology into their practice 5 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

6. Technology In Medicine Technology is the primary driving force of medicine A vast array of technological resources are now available in clinical practice Availability of an electronic health record has changed the paradigm of information collection, storage, and recovery in medicine 6 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

7. Technology In Medicine Technology has assisted evolution of the scientific method –Example: complex statistical calculations in studies Technology helps advance reproducible scientific breakthroughs –Example: Use and production of penicillin Technology essential to practice some forms of medicine –Example: in vitro fertilization 7 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

8. Technology In Medicine Clinicians need to constantly update their knowledge base –Example: In the past, clinicians relied on textbooks and on other clinicians –Now, reliance on an online database of medical literature Advances in technology require clinicians to learn new skills –Example: changes in cardiac pacemaker technology –Invasive cardiologists need to update skills as technology advances 8 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

9. Technology In Medicine The primary focus of clinical medicine is the clinician-patient relationship Now there is a new focus in the exam room in addition to the clinician and the patient – the computer 9 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

10. Change Change is an alteration in organizational structure and/or function Implementation of technology may be entirely transparent and may be welcomed by individuals and groups –Example: most physicians embraced pagers and cell phone technology because it allowed them to be reached (and respond) remotely However some technologies are intrusive and significantly change the workflow –Example: EHR implementation in the clinical setting 10 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

11. Intersection of social and technical changes Change occurs simultaneously and in parallel with the delivery of healthcare In the past the clinical workflow of physicians was independent of technology Now, with the advent of the EHR, there is interdependence between social and technical aspects of patient care Changes in technology require clinicians to make substantial changes to the way they deliver patient care, and vice versa 11 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

12. Resistance To Change Resistance to change is the action taken by individuals and groups when they perceive that the change is a threat to them –Three phases of change –Inertia –Transition –Achieving the new model Resistance to change is promoted by defenders of the status quo 12 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

13. Overcoming Resistance To Change Involve all stakeholders Create effective lines of communication Identify champions Alleviate fears Collaborate to solve problems Elicit feedback 13 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

14. Work Processes And Technology Clinicians have developed their own work processes Healthcare professionals use multiple tools and technologies to assist their work Technology has become an essential component of workflow Implementing new technology requires clinicians to adapt their work processes 14 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

15. Unintended Consequences of Technological Change Changes in workflow may not improve overall system efficiency Clinicians may be unable to adapt to the change Outcome measures may not be positive The implementation is just as important as the technology or the system 15 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

16. Managing Sociotechnical Change Organizations look for the right people for the right tasks at all levels to lead change Organizations make a fundamental choice -- either adapt work processes to new technology, or adapt technology to current workflow New technology can be designed to improve work processes Adapting work processes requires leadership to carefully manage change But adapting technology to current work processes is counterproductive in most cases –No significant long term improvements in care –Less agile –Less adaptable to future changes 16 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

17. The Impact Of Sociotechnical Change Improvement in quality and process improvement Improved process and outcome measures Improvement in efficiency Enhanced workflows Improved efficiencies of procedures dependent on technology Improvement in safety Reduction in errors 17 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

18. The Impact Of Sociotechnical Change Changes in job descriptions Role for new experts in healthcare IT Role for clinicians who are technologists, and technical specialists who have exposure to the clinical environment 18 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

19. Sociotechnical Aspects: Clinicians and Technology Summary – Lecture c Role of technology in healthcare Social and technical “resistance to change” in the context of sociotechnical interdependence Adaptation of work processes to new technology Changing sociotechnical processes in the context of quality, efficiency, and safety 19 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

20. Sociotechnical Aspects: Clinicians and Technology Summary Medical error and patient safety Adaptation of work processes to new technology Changing sociotechnical processes in the context of quality, efficiency, and safety Resistance to change among clinicians 20 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012

21. References Doherty NF, King M. (2005). From technical to socio-technical change: tackling the human and organizational aspects of systems development projects. European Journal of Information Systems.14, 1–5 McGlynn, E., Asch, S., et al. (2003). The quality of healthcare delivered to adults in the United States. New England Journal of Medicine, 348: 2635-2645. Miller, T., Brennan, T., et al. (2009). How can we make more progress in measuring physicians' performance to improve the value of care? Health Affairs, 28: 1429-1437. Sociotechnical systems at http://en.wikipedia.org/wiki/Sociotechnical_systemshttp://en.wikipedia.org/wiki/Sociotechnical_systems Tang, P., Ralston, M., et al. (2007). Comparison of methodologies for calculating quality measures based on administrative data versus clinical data from an electronic health record system: implications for performance measures. Journal of the American Medical Informatics Association, 14: 10-15. Timeline of medicine and medical technology at http://en.wikipedia.org/wiki/Timeline_of_medicine_and_medical_technology http://en.wikipedia.org/wiki/Timeline_of_medicine_and_medical_technology Vonnegut, M. (2007). Is quality improvement improving quality? A view from the doctor's office. New England Journal of Medicine, 357: 2652-2653. World Health organization 55 th World Health Assembly. Quality of care: patient safety. Report by the Secretariat, 2002 http://apps.who.int/gb/archive/pdf_files/WHA55/ea5513.pdfhttp://apps.who.int/gb/archive/pdf_files/WHA55/ea5513.pdf 21 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture c Health IT Workforce Curriculum Version 3.0/Spring 2012 Sociotechnical Aspects: Clinicians and Technology References – Lecture c