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The Culture of Health Care

The Culture of Health Care. Sociotechnical Aspects: Clinicians and Technology. Lecture c.

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The Culture of Health Care

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  1. The Culture of Health Care Sociotechnical Aspects: Clinicians and Technology Lecture c This material (Comp 2 Unit 10) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award Number 90WT0002. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

  2. Sociotechnical Aspects: Clinicians and Technology Learning Objectives • Describe the concepts of medical error and patient safety (Lectures a, b). • Discuss error as an individual problem 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 (Lectures a, b).

  3. 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

  4. 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

  5. Clinicians and Technology Continued • 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

  6. 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 EHR and a clinical information system has changed the paradigm of information collection, storage, and recovery in medicine

  7. Technology in Medicine Continued • 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

  8. Technology in MedicineContinued 2 • 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

  9. Technology in MedicineContinued 3 • The primary focus of clinical medicine is the clinician-patient relationship • Technology is changing the relationship • Computers play a major role in the exam room in addition to the clinician and the patient

  10. 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, cell phone technology, and mobile devices because the technology allows them to respond remotely • However, some technologies are intrusive and significantly change the workflow • Example: EHR implementation in the clinical setting with limited inclusion of clinicians during implementation

  11. Intersection of Social and Technical Changes • Change occurs simultaneously and in parallel with the delivery of health care • In the past, the clinical workflow of physicians was independent of technology • Now, with the advent of the EHR, clinical systems, and other technologies, social and technical aspects of patient care are interdependent • Changes in technology require clinicians to make substantial changes to the way they deliver patient care, and vice versa

  12. 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

  13. Overcoming Resistance to Change • Involve all stakeholders • Create effective lines of communication • Identify champions • Alleviate fears • Collaborate to solve problems • Elicit feedback • Keep communication channels open at all times • Welcome all questions and comments

  14. Work Processes and Technology • Clinicians have developed their own work processes • Health care professionals use multiple tools and technologies to assist their work • Technology has become an essential component of workflow and processes • Implementing new technology requires clinicians to adapt their work processes

  15. 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

  16. 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 some cases • No significant long-term improvements in care • Less agile • Less adaptable to future changes

  17. 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

  18. The Impact of Sociotechnical Change Continued • Changes in job descriptions • Role for new experts in health IT • Role for clinicians who are technologists, and technical specialists who have exposure to the clinical environment • Expanded opportunities across many types of employers

  19. Sociotechnical Aspects: Clinicians and TechnologySummary – Lecture c • Role of technology in health care • 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

  20. Sociotechnical Aspects: Clinicians and TechnologySummary • 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

  21. Sociotechnical Aspects:Clinicians and Technology References – Lecture c References Doherty N. F, & 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 Ebright, P. (2014). Culture of safety part one: Moving beyond blame. University of California. MERLOT. Retrieved from https://www.merlot.org/merlot/materials.htm%3Bjsessionid= F7A1AA5120282BC1123A261CCB3EEEDC?pageSize=&page=10&userId=19195 Eden, K.B., Totten, A. M., Kassakian, S. Z., Gorman, P. N., McDonagh, M. S., Devine, B., . . . Hersh, W. R. (2016). Barriers and facilitators to exchanging health information: A systematic review. International Journal of Medical Informatics, 88, 44–51. McGlynn, E., Asch, S., Adams, J., 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., Milstein, A. (2009). How can we make more progress in measuring physicians' performance to improve the value of care? Health Affairs, 28, 1429-1437. Sociotechnical system. (2016). In Wikipedia. Retrieved from http://en.wikipedia.org/wiki/ Sociotechnical_system Tang, P., Ralston, M., Arrigotti, M. F., Qureshi, L., & Graham, J. (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. JAMA, 14, 10–5.

  22. Sociotechnical Aspects:Clinicians and Technology References – Lecture c Continued Timeline of medicine and medical technology. (2016). In Wikipedia. Retrieved from 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. (2002). Quality of care: Patient safety. Report by the Secretariat. Retrieved from http://apps.who.int/gb/archive/pdf_files/WHA55/ea5513.pdf

  23. The Culture of Health CareSociotechnical Aspects: Clinicians and TechnologyLecture c This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award Number 90WT0002.

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