Page - 105 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Table 3. Dimensions of collective mindfulness in HRO compared to those of a HIT project Concerns Collective mindfulness processes in HROs Collective mindfulness processes in HIT project Description Anticipating the unexpected Preoccupation with failure Preoccupation with constraints and preconditions Widespread questioning of preconditions and effects of decisions, seeking to check and validate the assumptions acted upon before decisions were implemented. [16] Reluctance to simplify interpretations Reluctance to premature commitment Unwillingness to proceed on insufficiently known ground. Decisions and proposals questioned and examined for their upstream and downstream requirements and consequences. Plans considered tentative. [16] Sensitivity to operations Sensitivity to interdependencies and continuous prioritisation Collectively constructed understanding achieved through collaborative workflow mapping and graphical charting to detect interconnections and dependencies between elements in the work system. [16] Containing the unexpected Commitment to resilience Commitment to avoid disruptions Maintaining as smooth an operation as possible and minimising disruptive changes as guiding principles in the decision processes. [16] Deference to expertise Seeking out appropriate mix of expertise In considerations of the effects of planned changes, seeking appropriate mix of expertise - a constellation of actors that would be able to cover the necessary domains and ensure that preconditions and consequences are noticed. [16] 3. Explanations of success or failure of the health IT implementation Practitioners and researchers of HIT implementations are often concerned with the success or failure of projects. They seek rules or guidelines as ‘paths to success’, or to prevent or solve HIT implementation failures. What does the theory of collective mindfulness, applied to the case above, contribute to this perspective? The theory of collective mindfulness originally described activities of HROs as mindful organising enabling the achievement of reliability (prevention and containment of hazards) in high risks businesses. In this light, success and failure pertained to organisations as a whole and reflected the actualisation (or not) of hazards. Instead, the case explored in this chapter draws attention to the ongoing processes of adoption that make organisational IT evolve and change. From this perspective, the definition of ‘implementation success’ is rather loose and fuzzy. The hospital eventually reached the goal of ‘going paperless’ – what we may call ‘success’ –, but in a more roundabout way than originally envisaged and taking longer than planned. Surprises and V.LichtnerandJ.I.Westbrook /CollectiveMindfulnessandProcessesofSensemaking 105