Preparing an organisation for electronic clinical information systems: Does culture matter?

1. Preparing an organisation for electronic clinical information systems: Does culture matter? Dr Joanne Callen Senior Research Fellow Health Informatics Research and Evaluation Unit The University of Sydney j.callen@usyd.edu.au

2. Overview of presentation • Organisational culture – what is it? • Sub-cultures in large organisations • Is there a relationship between culture and clinical information systems? • Models to assist with implementing information systems HIMAA National Conference Perth 2009

3. Background • Organisational culture has been identified as a significant factor for successful implementation of clinical information systems • Gosling et al. Int J Med Inf. 2003; Aarts et al. JAMIA, 2004; Callen et al. Soc Sci & Med 2007 HIMAA National Conference Perth 2009

4. What is organisational culture? • “the basic pattern of shared assumptions, values and beliefs governing the way employees within an organisation think about and act on problems and opportunities” • McShane & Von Glinow, 2000, p. 498 HIMAA National Conference Perth 2009

5. Subcultures • Pronounced in health care organisations • Based on professional, occupational, gender, functional distinctions • Can reflect or differentiate organisation-wide culture • Can draw values from outside (example medical sub-specialties) HIMAA National Conference Perth 2009

6. Research study • Is there a relationship between hospital sub-cultures and attitudes to, and satisfaction with, clinical information systems? Callen et al. The importance of medical and nursing sub-cultures in the implementation of clinical information systems. Methods of Information in Medicine. 2009 48(2):196-202 HIMAA National Conference Perth 2009

7. Research setting Two clinical units: Emergency Department and Haematology/ Oncology Ward 400 bed metropolitan public teaching hospital Methods HIMAA National Conference Perth 2009

8. Computerised physician order entry system used to order and view all laboratory and radiology tests Clinical information context HIMAA National Conference Perth 2009

9. Survey design • Two survey instruments • Organisational culture inventory • User satisfaction survey • Population (n=103) • All doctors (n=42) and nurses (n=61) in two clinical units HIMAA National Conference Perth 2009

10. Organisational culture inventory (OCI) • Constructive culture work cooperatively; high motivation; teamwork • Passive/defensive culture please those in authority; wait for others to act first • Aggressive/defensive culture oppose new ideas; compete; appear competent and independent HIMAA National Conference Perth 2009

11. Constructive culture Achievement style Self-actualising style Humanistic/ encouraging style Affiliative style Passive/defensive culture Approval style Conventional style Dependent style Avoidance style Culture and cultural styles in OCI HIMAA National Conference Perth 2009

12. Aggressive/ defensive culture Power style Competitive style Perfectionistic style Oppositional style Culture and cultural styles in OCI HIMAA National Conference Perth 2009

13. User satisfaction survey • Impact of CPOE on: • work practices • patient care • satisfaction with CPOE • attitudes to CPOE HIMAA National Conference Perth 2009

14. Results: Population and Respondents OCI User satisfaction survey Population – 103 Response Rate – 73% Population – 103 Response Rate – 93% HIMAA National Conference Perth 2009

15. Doctors & Nurses Perception of Culture HIMAA National Conference Perth 2009

16. Constructive Culture Styles HIMAA National Conference Perth 2009

17. Passive-Defensive Cultural Styles HIMAA National Conference Perth 2009

18. Aggressive-Defensive Cultural Styles HIMAA National Conference Perth 2009

19. Attitudes to CPOE system HIMAA National Conference Perth 2009

20. Discussion • Cultures are not uniform in large hospitals • Constructive culture of nurses – support CPOE • Aggressive-defensive culture of doctors – discourage uptake of new innovations • High perfectionist style of doctors – counterproductive to implementation of new technologies HIMAA National Conference Perth 2009

21. Implications of the results • Examine sub-cultures prior to implementation • Strategies for moving to a constructive culture can be employed HIMAA National Conference Perth 2009

22. Strategies to move to constructive culture • Individual level • Goal setting; job design; motivational processes • Unit level • Performance appraisal; inclusive meetings • Organisational level • Communication; respect for staff; employee involvement HIMAA National Conference Perth 2009

23. Models to assist with implementing information systems • Change management models Rogers EM Diffusion of Innovations, 1995 • Ash’s principles Ash et al. Proc AMIA 2003 • Contextual Implementation Model Callen et al. JAMIA 2008 HIMAA National Conference Perth 2009

24. Contextual Implementation Model • Grounded in data • Core theme of ‘contextual differences’ • Diversity at 3 contextual levels • Organisational level • Clinical or departmental level • Individual level • Dimensions for consideration within each level (organisational culture, unit leadership, diverse ways of working) HIMAA National Conference Perth 2009

25. Organisational Context Government policy Economy Use of clinical information systems Individual Context Clinical Unit Context IT industry Professional groups Contextual Implementation Model HIMAA National Conference Perth 2009

26. Value of models and theories • To realise the potential benefits of I&CT to patients, clinicians and government we need to develop and test models of evaluation and implementation HIMAA National Conference Perth 2009

27. Role of the health informatics specialist in implementation • Health Information Managers function at the core of the change process in healthcare • Play a major role in implementing, managing, and leading IT adoption to improve health care • Change theories and implementation models provide a framework for understanding and supporting these large scale IT implementations HIMAA National Conference Perth 2009

28. Thank you • J.callen@usyd.edu.au