Clinicians' perceptions of organizational readiness for change in the context of clinical information system projects: insights from two cross-sectional surveys

Abstract

BackgroundThe adoption and diffusion of clinical information systems has become one of the critical benchmarks for achieving several healthcare organizational reform priorities, including home care, primary care, and integrated care networks. However, these systems are often strongly resisted by the same community that is expected to benefit from their use. Prior research has found that early perceptions and beliefs play a central role in shaping future attitudes and behaviors such as negative rumors, lack of involvement, and resistance to change. In this line of research, this paper builds on the change management and information systems literature and identifies variables associated with clinicians' early perceptions of organizational readiness for change in the specific context of clinical information system projects.MethodsTwo cross-sectional surveys were conducted to test our research model. First, a questionnaire was pretested and then distributed to the future users of a mobile computing technology in 11 home care organizations. The second study took place in a large teaching hospital that had approved a budget for the acquisition of an electronic medical records system. Data analysis was performed using partial least squares.ResultsScale items used in this study showed adequate psychometric properties. In Study 1, four of the hypothesized links in the research model were supported, with change appropriateness, organizational flexibility, vision clarity, and change efficacy explaining 75% of the variance in organizational readiness. In Study 2, four hypotheses were also supported, two of which differed from those supported in Study 1: the presence of an effective project champion and collective self-efficacy. In addition to these variables, vision clarity and change appropriateness also helped explain 75% of the variance in the dependent variable. Explanations for the similarities and differences observed in the two surveys are provided.ConclusionsOrganizational readiness is arguably a key factor involved in clinicians' initial support for clinical information system initiatives. As healthcare organizations continue to invest in information technologies to improve quality and continuity of care and reduce costs, understanding the factors that influence organizational readiness for change represents an important avenue for future research.

Stage 1 of the meaningful use incentive program for electronic health records: a study of readiness for change in ambulatory practice settings in one integrated delivery system

“…Existing measures we identified included 40 or more items [10,11,13]. We therefore developed a brief web-based survey instrument that would measure our primary variables of interest and also collect information that would be useful for UNC HCS leaders.…”

“…However, the only article we identified that focused on readiness for health-IT related change reported mixed evidence from two studies—one of home care organizations and one of a large teaching hospital. For example, the presence of an effective champion and top management support each were statistically significant predictors in only one of the two studies [13]. Such results suggest that predictors of readiness may be context dependent, with some variables being important for only some changes in some organizations.…”

“…Literature from the field of implementation science suggests that readiness for change involves both psychological and behavioral components—that is, both willingness and ability to make a specific change [7,9]. Furthermore, perceived appropriateness of the impending change and management support are commonly cited predictors of readiness for change [10,11,13,18]. We were interested in two aspects of appropriateness of the change—(1) the fit between MU and the department’s goals for patient care and (2) the extent to which MU would divert attention from other high priority patient care activities.…”

Evaluating Perceptions of the Healthcare Providers Concerning Accreditation in Healthcare Organizations in the R. Macedonia

“…Resistance toward changes in this study regarding the answers of the respondents has no significant statistical difference in the perceptions having versus not having resistance and without opinion. Prior research has shown that early perceptions and beliefs play a central role in shaping future attitudes and behaviors such as negative rumours, involvement in the planning and design phases, and resistance (Paré, Sicotte, Poba-Nzaou, & Balouzakis, 2011). Understanding the factors which affect organizational changes can lower resistance toward them.…”

Understanding process change management in electronic health record implementations

“…van der Meijden et al (2003) analyze past literature on Health IT and find that in addition to the IS Success model constructs, factors such as redesign of work practices, communication, training, priorities chosen, technical support and user involvement also influenced information systems adoption, use and net benefits. Paré et al (2011) explore the role of clinician perceptions in influencing the implementation success of health information technologies and report that change appropriateness, vision clarity, organizational flexibility, change efficacy, effective project champion and collective self-efficacy are significant predictors of organizational change readiness, which eventually leads to adoption of IT-based changes. Following an extensive review of health information technology implementation literature and a workshop discussion, Kaplan and Harris-Salamone (2009) identify communications, workflow and quality as the key factors that make HIT implementations difficult, and emphasize the need for further research and best practices to handle these issues.…”