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.
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)
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Overcoming Resistance To Change
Involve all stakeholders
Create effective lines of communication
Identify champions
Alleviate fears
Collaborate to solve problems
Elicit feedback
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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
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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
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
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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
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
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The Culture of Healthcare
Sociotechnical Aspects: Clinicians and Technology
Lecture c
Health IT Workforce Curriculum
Version 3.0/Spring 2012
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, 15
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_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
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.pdf




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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