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unexpected changes are inevitable, given the adaptive complex sociotechnical system
where implementation takes place, and the inevitable limitations of all technologies. The
case study hospital EHR implementation is not an exception. The theory of collective
mindfulness applied to this case gives insights into the ways ‘the unexpected’ (i.e. the
inevitable surprises during implementation) is dealt with, that may turn a problematic
implementation process into a ‘success’.
In the specific case study described, the organisation demonstrated the capacity to
support the discovery of ambiguities, solve emerging issues and progress with an
otherwise ambiguous ill-defined project (‘the scanning’). The five dimensions of
collective mindfulness were present, both to anticipate and contain the unexpected (e.g.
issues for others’ clinical work generated by changes in workflows). Crucial elements
and fundamental premises for collective mindfulness were: widespread questioning of
assumptions, of preconditions and of effects of decisions; collective discussion; under-
specification of structures; support from project management. These enabled
sensemaking activities akin to those practiced in user-centred system design, such as ‘co-
design sessions’ and ‘workflow mapping exercises’.
The project team also encountered barriers that made the sensemaking activity more
difficult. For example, clinicians were too busy to participate in meetings; expertise in
‘their part of the workflow’ was missing from the ‘appropriate mix’ necessary to
understand repercussions of proposed changes across the whole process. This was
addressed by taking note of necessary questions that one of the team members would ask
doctors after the meeting. There was also the inevitable tension of most HIT
implementations between standardisation and local customisation. The solution that
worked for this hospital was the design of a ‘hierarchy of standards’: a level 1 hospital-
wide procedure, and a level 2 specific to each local department. This structure allowed
for a standardised flexibility where local work redesign would take into account
interconnections with other departments.
Overall, the case shows how ‘mindful managers of change’ ‘can draw on the five
characteristics of mindfulness to ensure more productive organizing to support mindful
sensemaking’ [16, p26].
4. Discussion and conclusion
The theory of collective mindfulness has been challenged on a number of grounds.
HROs as an organisational type remain ill-defined; achieving reliability is not necessarily
equivalent to achieving safety; and the five mindful organising principles could be
viewed as representing more ideals an organisation may aspire to than a description [17-
19]. The five principles are not sufficient on their own for an organisation to operate
safely, but need to build on structural preconditions, such as human resources practices
that foster trust and respect, and selection and allocation of resources, including IT [20].
The HRO model represents the appropriate organisational response to a certain type of
risks and environment, but must not be considered the right response for all environments
[21]. Recommendations for practice drawn from the theory may be challenging to put
into effect as they involve, for example, changing organisational culture or
communication practices.
Despite some criticisms and limitations, the theory of collective mindfulness has
been used in healthcare as foundation for informing the development of interventions
proposed to improve quality, safety and resilience [18, 22]. However, the theory of
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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