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from dichotomizing towards stakeholder sense making activities, to negotiation and
aligning differing actor perspectives/behaviors.
A range of perspectives reflected different views surrounding “success” and
“failure” resulting from different positions within the network at different points in time.
For instance, the new software resulted in increased workloads for nurses, who may have
viewed the implementation as a “failure” at least in the short- to medium-term. Policy
makers, in turn, focused on the progress of developing the infrastructural components
underlying the EHR technology. They therefore viewed this aspect of the national
implementation as a “success”.
The introduction of the new EHR also affected stakeholders in many different ways
and revealing these simplifications was a key analytical task. The level of influence
depended on their role (healthcare professionals, managers, policy makers, information
system suppliers, patients), their local setting (existing relationships, physical
environments), and the technology adoption time (short-, medium-, long-term). Common
to all contexts and individuals, however, was that the technology adopted was an
immature solution that lacked usability and had mostly negative effects. It for instance,
increased workloads of users and negatively affected reputations of managers and
suppliers. Over time, as the solution matured, some networks began to stabilize with the
record gradually fulfilling its purpose of coordinating care effectively and stakeholders
acclimatizing to these changes. However, these changes were only visible on a very small
scale and in settings that had invested a significant amount of time and resources.
The new information system was procured nationally, so policy makers and system
vendors were initially in a relative position of power. Over time, clinical users became
more powerful, as they refused to use a technology that was viewed to lack usability.
This changed power dynamic led to changes in the national procurement model. It is not
to say that other sociotechnical dimensions (including other social, political and
organizational factors) are not important in determining “success”, but this work has
illustrated that the most important pre-requisite for “success” from all perspectives is a
usable technology.
When mapping out the larger network and tracing the technology, we ensured that
all human actors were either directly or indirectly (i.e. through another actor) related to
the EHR. ANT-informed analysis indicated that there were two different networks that
were not effectively connected through strong associations (e.g. aligned interests)
beyond the technology itself (see Figure 1). These were the users of the technology (i.e.
healthcare professionals and organizations) and the national implementers (i.e. policy
makers and information system suppliers). Both groups had different views of and
intentions for the technology: Policy makers wanted to make or save money/lives on a
large scale through improving organizational processes. Users wanted to improve
immediate patient care in their own micro-environments. There was thus a tension
between the micro and the macro networks in the following ways:
1. Policy makers and suppliers foregrounded the vision of the technology as an
integrated national EHR, whilst users had to cope with its manifestations and
its lack of usability in everyday life.
2. New technology was designed to structure care to make it more effective
(including the imposing of rules, categories and regulations). This was at odds
with the nature of clinical reality as these rules inhibited the timely provision
of care and also increased individual workloads.
K.Cresswell /UsingActor-NetworkTheory toStudyHealth InformationTechnology
Interventions94
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book Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners"
Applied Interdisciplinary Theory in Health Informatics
Knowledge Base for Practitioners
- Title
- Applied Interdisciplinary Theory in Health Informatics
- Subtitle
- Knowledge Base for Practitioners
- Authors
- Philip Scott
- Nicolette de Keizer
- Andrew Georgiou
- Publisher
- IOS Press BV
- Location
- Amsterdam
- Date
- 2019
- Language
- English
- License
- CC BY-NC 4.0
- ISBN
- 978-1-61499-991-1
- Size
- 16.0 x 24.0 cm
- Pages
- 242
- Category
- Informatik