BackgroundAdvanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption.MethodsQualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors (n = 30). We used a constant comparative approach to develop a framework for guiding implementation.ResultsWe identified six clusters of experiences of, and attitudes towards CDSSs, which we label as “positions.” The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians’ perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians’ reasoning and fostering organizational learning.ConclusionsBarriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians’ attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships, and an organizational ethos of transparency and accountability need to be considered when exploring the readiness of a hospital to adopt CDSSs.Electronic supplementary materialThe online version of this article (10.1186/s13012-017-0644-2) contains supplementary material, which is available to authorized users.

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In this paper, we build on the results of a participatory action research project in healthcare to discuss a number of methods that can strengthen the link between reflexive work and authoring in organizational contexts. We argue that from an organizational point of view, the challenge is to devise new ways to configure (and consider) people as the authors of their work. This means assuming responsibility for, and constructively contributing to, the goals of the organizations to which they belong. Combining insights from theoretical reflection and experience from the field, the paper discusses the tools, process and material conditions for fostering practical reflexivity and organizational authorship. We conclude that much is to be gained if we distinguish between authorship and authoring. Authorship is the general process whereby managers and organizational members contribute to the reproduction of organizational realities. Authoring is constituted by the special circumstances whereby authorship is brought to critical consciousness and becomes open to deliberate reorientation.

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