From the May 23 CMAJ: [free full text]
Zitner D. Physicians will happily adopt information technology [commentary]. CMAJ 2006;174:1583-1584.
Excerpt: In this issue [of CMAJ], Lapointe and Rivard report on their analysis of computer information system (CIS) implementations at 3 hospitals to understand better the dynamics of physicians' resistance to such implementations. The level of resistance varied. In 2 cases it was met with responses from implementers that reinforced the resistance behaviours, and the systems were eventually removed; in the other case the responses to the resistance were supportive, the resistance decreased and the system was ultimately successful.
Lapointe and Rivard suggest that an understanding of power dynamics is critical to learn why modern health information tools and techniques are not readily adopted. The slow adoption of health information systems in Canada is startling because Canada is thought of as a civilized country that often undertakes collective action around shared interests. Although an understanding of power and the relationships between various constituencies is important in a civilized society, theories of power and how power is exercised are not critical to learn why most Canadian physicians fail to adopt modern health information tools.
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Lapointe L, Rivard S. Getting physicians to accept new information technology: insights from case studies. CMAJ 2006;174:1573-1578.
BACKGROUND: The success or failure of a computer information system (CIS) depends on whether physicians accept or resist its implementation. Using case studies, we analyzed the implementation of such systems in 3 hospitals to understand better the dynamics of physicians' resistance to CIS implementation.
METHODS: We selected cases to maximize variation while allowing comparison of CIS implementations. Data were collected from observations, documentation and interviews, the last being the main source of data. Interviewees comprised 15 physicians, 14 nurses and 14 system implementers. Transcripts were produced; 45 segments of the transcripts were coded by several judges, with an appropriate level of intercoder reliability. We conducted within-case and cross-case analyses of the data.
RESULTS: Initially, most staff were neutral or enthusiastic about the CIS implementations. During implementation, the level of resistance varied and in 2 instances became great enough to lead to major disruptions and system withdrawal. Implementers' responses to physicians' resistance behaviours played a critical role. In one case, the responses were supportive and addressed the issues related to the real object of resistance; the severity of resistance decreased, and the CIS implementation was ultimately successful. In the other 2 cases, the implementers' responses reinforced the resistance behaviours. Three types of responses had such an effect in these cases: implementers' lack of response to resistance behaviours, antagonistic responses, and supportive responses aimed at the wrong object of resistance.
INTERPRETATION: The 3 cases we analyzed showed the importance of the roles played by implementers and users in determining the outcomes of a CIS implementation.
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