Comp2 Unit10c Lecture Slides

The Culture of HealthcareSociotechnical 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)

2The Culture of Healthcare

Sociotechnical Aspects: Clinicians and TechnologyLecture 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




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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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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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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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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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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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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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




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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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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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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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




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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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 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 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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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




3.0/Spring 2012


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




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, 1–5• 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 55th 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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References – Lecture c

http://en.wikipedia.org/wiki/Sociotechnical_systems

http://en.wikipedia.org/wiki/Timeline_of_medicine_and_medical_technology

http://apps.who.int/gb/archive/pdf_files/WHA55/ea5513.pdf

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