The role of organizational culture in health information technology implementations: A scoping review

Abstract

Introduction The exponential growth in health information technology (HIT) presents an immense opportunity for facilitating the data‐to‐knowledge‐to‐performance loop which supports learning health systems. This scoping review addresses the gap in knowledge around HIT implementation contextual factors such as organizational culture and provides a current state assessment. Methods A search of 13 databases guided by Arskey and O'Malley's framework identified content on HIT implementations and organizational culture. The Consolidated Framework for Implementation Research (CFIR) was used to assess culture and to develop review criteria. Culture stress, culture effort, implementation climate, learning climate, readiness for implementation, leadership engagement, and available resources were the constructs examined. Rayyan and Qualtrics were used for screening and data extraction. Results Fifty two studies included were mainly conducted in Academic Health Centers (n = 18, 35%) and at urban locations (n = 50, 96%). Interviews frequently used for data collection (n = 26, 50%) and guided by multiple frameworks (n = 34). Studies mostly focused on EHR implementations (n = 23, 44%) followed by clinical decision support (n = 9, 17%). About two‐thirds (n = 34, 65%) reflected culture stress theme and 62% (21 of 34) acknowledged it as a barrier. Culture effort identified in 27 studies and was a facilitator in most (78%, 21 of 27). Leadership engagement theme in majority studies (71%, n = 37), with 35% (n = 13) noting it as a facilitator. Eighty percent (42 studies) noted available resources, 12 of which identified this as barrier to successful implementation. Conclusions It is vital to determine the culture and other CFIR inner setting constructs that are significant to HIT implementation as facilitators or barriers. This scoping review presents a limited number of empirical studies in this topic highlighting the need for additional research to quantify the effects of culture. This will help build evidence and best practices that facilitate HIT implementations and hence serve as a platform to support robust learning health systems.

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“…This study complements and adds to what is already known about the barriers to implementing HIT interventions. For example, two recent reviews used CFIR to better understand barriers and facilitators of HIT implementation, one regarding learning health systems [ 24 ] and the other regarding chronic disease management [ 25 ]. The most commonly cited factors included Intervention constructs such as Relative Advantage over other interventions, Inner Setting constructs such as Culture, Implementation Climate (including compatibility with workflow), Readiness for Implementation (including leadership engagement and available resources), and Individual Characteristics such as health literacy and digital literacy.…”

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“…We posit that perhaps a program that has already implemented a computerized scheduling system and an electronic billing system may have a higher propensity or advanced level of knowledge that could be foundational and facilitate the adoption of an EHR system [34]. A greater technology use capability (eg, a computerized scheduling system and an electronic billing system) could also indicate that the organizational culture and context would be more supportive of using the EHR system [37,38]. For example, organizational culture has been shown to moderate the relationship between attitudes toward EHR and intentions to adopt EHR [39].…”

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“…Having a strong informatics team in place that is knowledgeable about technical, clinical, and organizational factors influencing HIT implementations is critical to success and subsequent adoption and use of HIT. 1,2 Adaptation of HIT is vital to account for the sociotechnical variability and the different trajectories within organizations because of different implementation plans and timelines. 3 Many of the HIT implementations are complex and need coordinated teams with diverse skills and knowledge in this implementation journey.…”

“…The exponential rise of digitalization in healthcare requires implementation of numerous health information technology (HIT) tools to meet various needs of patients, providers, payors, and policy makers. Having a strong informatics team in place that is knowledgeable about technical, clinical, and organizational factors influencing HIT implementations is critical to success and subsequent adoption and use of HIT 1,2 . Adaptation of HIT is vital to account for the sociotechnical variability and the different trajectories within organizations because of different implementation plans and timelines 3 .…”