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Social challenges when implementing Information Systems in a Swedish healthcare organization
Blekinge Institute of Technology.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

When the Swedish National IT Strategy for Health and Social Care was introduced in 2006, intensive work started in implementing Information Systems (IS) in Swedish healthcare organizations. To follow up on the requests for more research with a combined socio-technical focus on challenges, the overall aim of this thesis was to identify social challenges when implementing IS in a Swedish healthcare organization. Furthermore, the aim was to understand the impact of identified social challenges when implementing IS in this context by putting them in an interdisciplinary Applied Health Technology theoretical framework. Institutional ethnography and phenomenological hermeneutics influenced the study design. Study 1 aimed to investigate different meanings of accessibility when implementing Health Information Technology in everyday work practice. The results indicate that accessibility depends on working routines, social structures and patient relationship. When an IT strategy and interaction in everyday work use the same word in different ways there will be consequences. Study 2 sets out to describe experience-based reflections on discharge planning as narrated by nursing staff in primary healthcare, along with their concerns about how the introduction of video conferencing might influence the discharge planning situation. It was found that there is a need for improvement in communication and understanding between nursing staff at the hospital and in primary healthcare. The aim of study 3 was to explore social challenges when implementing IS in everyday work in a nursing context. Power (changing the existing hierarchy, alienation), Professional identity (calling on hold, expert becomes novice, changed routines), and Encounter (ignorant introductions, preconceived notions) were categories presented in the findings. The aim of study 4 was to explore and obtain a deeper understanding of how identified social challenges have an influence on the implementation process of IS, based on healthcare staff’s experiences on micro, meso and macro levels of Swedish Healthcare organizations. It was found that the challenges were related to the steps of putting into practice, making IS a part of everyday work routine and establishing an identity in the implementation process. In the thesis’s discussion, social challenges when implementing IS in Swedish healthcare organizations and how they might be met and dealt with constructively are further reflected upon in relation to the interdisciplinary theoretical framework and as possible consequences of the modernity-era. This thesis contributes to the starting up of a discussion of how ingrained professional characteristics are important to feel secure of being part of an established profession. If the characteristics are questioned, the whole professional performance is threatened. One consequence of this insight is the reinforcement of the realization that a basic understanding of IS and IS implementation processes in healthcare organizations needs to be integrated in to the construction of professional identity of nurses already from the start in nursing education.

Place, publisher, year, edition, pages
Karlskrona: Blekinge Tekniska Högskola, 2014. , p. 96
Series
Blekinge Institute of Technology Doctoral Dissertation Series, ISSN 1653-2090 ; 14
National Category
Other Engineering and Technologies not elsewhere specified
Research subject
Health and Caring Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-73281ISBN: 978-91-7295-293-5 (print)OAI: oai:DiVA.org:lnu-73281DiVA, id: diva2:1199891
Available from: 2018-04-23 Created: 2018-04-23 Last updated: 2018-04-23Bibliographically approved
List of papers
1. The importance of Interaction in the implementation of information technology in health care: A symbolic interactionism study on the meaning of accessibility
Open this publication in new window or tab >>The importance of Interaction in the implementation of information technology in health care: A symbolic interactionism study on the meaning of accessibility
2012 (English)In: Informatics for Health and Social Care, ISSN 1753-8157, E-ISSN 1753-8165, Vol. 37, no 4, p. 277-290Article in journal (Refereed) Published
Abstract [en]

A challenge when groups from different disciplines work together in implementing health information technology (HIT) in a health-care context is that words often have different meanings depending upon work practices, and definition of situations. Accessibility is a word commonly associated with HIT implementation. This study aimed to investigate different meanings of accessibility when implementing HIT in everyday work practice in a health-care context. It focused on the perspective of nurses to highlight another view of the complex relationship between HIT and information in a health-care context. This is a qualitative study influenced by institutional ethnographic. District nurses and student nurses were interviewed. The results indicate that when implementing HIT accessibility depends on working routines, social structures and patient relationship. The findings of the study suggest that interaction needs to take on a more important role when implementing HIT because people act upon words from the interpreted meaning of them. Symbolic interactionism is proposed as a way to set a mutual stage to facilitate an overall understanding of the importance of the meaning of words. There is a need for making place and space for negotiation of the meaning of words when implementing HIT in everyday work practice.

Place, publisher, year, edition, pages
Informa Healthcare, 2012
Keywords
Co-constructed meaning of words, everyday work practice, health information technology, institutional ethnography, symbolic interactionism
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-44605 (URN)10.3109/17538157.2012.710683 (DOI)
Available from: 2015-06-16 Created: 2015-06-16 Last updated: 2018-04-23Bibliographically approved
2. Discharge planning: narrated by nursing staff in primary healthcare and their concerns about using video conferencing in the planning session - an interview study
Open this publication in new window or tab >>Discharge planning: narrated by nursing staff in primary healthcare and their concerns about using video conferencing in the planning session - an interview study
2013 (English)In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 3, no 1, p. 88-98Article in journal (Refereed) Published
Abstract [en]

Background/Objective: This paper sets out to describe experience-based reflections on discharge planning as narrated by nursing staff in primary healthcare, along with their concerns about how the introduction of video conferencing might influence the discharge planning situation.

Methods: Interviews were conducted with nursing staff working at a primary healthcare centre in South East Sweden. Each interview took place was conducted on a one-to-one basis in dialogue form, using open questions and supported by an interview guide. It was then analysed using a phenomenological hermeneutic method. Participants were eligible for the study if they had given their informed consent and if they worked with discharge planning and home-based healthcare provision. In total, 10 of the 30 persons working at the primary healthcare centre participated in the study.

Results: It was found that nursing staff in primary healthcare regarded the planning session as stressful, time-consuming and characterised by a lack of respect between nursing staff at the hospital and nursing staff in primary healthcare. They also described uncertainty and hesitation about using video conferences where patients might probably be the losers and nursing staff the winners.

Conclusions: It is suggested that there is a need for improvement in communication and understanding between nursing staff at the hospital and nursing staff in primary healthcare in order to develop discharge planning. There is also a need for the nursing staff in primary healthcare to obtain more information about how Information Technology (IT) solutions could support their work and help them to find ways to collaborate.

Place, publisher, year, edition, pages
Sciedu Press, 2013
Keywords
Discharge planning, Healthcare, Information technology (IT), Nursing staff, Phenomenological hermeneutical, Video conference
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-41019 (URN)10.5430/jnep.v3n1p88 (DOI)
Available from: 2015-03-19 Created: 2015-03-19 Last updated: 2018-04-23Bibliographically approved
3. Social Challenges when implementing Information Systems in everyday work in a nursing context
Open this publication in new window or tab >>Social Challenges when implementing Information Systems in everyday work in a nursing context
2014 (English)In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 32, no 9, p. 442-450Article in journal (Refereed) Published
Abstract [en]

Implementation of information systems in healthcare has become a lengthy process where healthcare staff (eg, nurses) are expected to put information into systems without getting the overall picture of the potential usefulness for their own work. The aim of this study was to explore social challenges when implementing information systems in everyday work in a nursing context. Moreover, this study aimed at putting perceived social challenges in a theoretical framework to address them more constructively when implementing information systems in healthcare. Influenced by institutional ethnography, the findings are based on interviews, observations, and written reflections. Power (changing the existing hierarchy, alienation), professional identity (calling on hold, expert becomes novice, changed routines), and encounter (ignorant introductions, preconceived notions) were categories (subcategories) presented in the findings. Social Cognitive Theory, Diffusion of Innovations, organizational culture, and dramaturgical analysis are proposed to set up a theoretical framework. If social challenges are not considered and addressed in the implementation process, it will be affected by nurses’ solidarity to existing power structures and their own professional identity. Thus, implementation of information systems affects more aspects in the organization than might have been intended. These aspects need to be taken in to account in the implementation process.

Place, publisher, year, edition, pages
Wolters Kluwer, 2014
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-44600 (URN)10.1097/CIN.0000000000000075 (DOI)
Available from: 2015-06-16 Created: 2015-06-16 Last updated: 2018-04-23Bibliographically approved
4. The influence of social challenges when implementing information systems in a Swedish health-care organisation
Open this publication in new window or tab >>The influence of social challenges when implementing information systems in a Swedish health-care organisation
2016 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, no 6, p. 789-797Article in journal (Refereed) Published
Abstract [en]

Aim

To describe and obtain a deeper understanding of social challenges and their influence on the implementation process when implementing Information systems in a Swedish health-care organisation.

Background

Despite positive effects when implementing Information systems in health-care organisations, there are difficulties in the implementation process. Nurses' experiences of being neglected have been dismissed as reasons for setbacks in implementation.

Methods

An Institutional Ethnography design was used. A deductive content analysis was made influenced by empirically identified social challenges of power, professional identity and encounters. An abstraction was made of the analysis.

Results

Nineteen nurses at macro, meso and micro levels were interviewed in focus groups. Organisational levels are lost in different ways in how to control the reformation, how to introduce Information systems as reformation strategies and in how to translate new tools and assumptions that do not fit traditional ways of working in shaping professional identities.

Conclusion and implication for nurse management

Different focus may affect the reformation of health-care organisations and implementation and knowledge processes. An implementation climate is needed where the system standards fit the values of the users. Nursing management needs to be visionary, engaged and work with risk factors in order to reform the hierarchical health-care organisation.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences, Caring Science; Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-52140 (URN)10.1111/jonm.12383 (DOI)000387215400011 ()27121147 (PubMedID)2-s2.0-84991387208 (Scopus ID)
Available from: 2016-04-19 Created: 2016-04-19 Last updated: 2018-04-23Bibliographically approved

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