Seite - 103 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

1.4. Collective mindfulness and IT implementation The theory of collective mindfulness has been applied in the field of information systems (IS) to both explain aspects of IT implementation and as a recommendation for improvement [15]. For example, in relation to information system development, Butler and Gray [9] suggest that a collective mindfulness approach may lead to more successful IT projects (better able to manage project risk). They argue that agile development techniques, in contrast to formal development methods, may promote mindfulness by focusing attention on ‘what is needed and what exists, rather than the abstractions of what is expected or promised’ (with risks of premature cognitive commitments) [9][p220]. Once systems are implemented and put into use, they are often found to be ‘fundamentally unreliable’ [9][p217]. Butler and Gray [9] argue that collective mindfulness can explain how organisations using such systems achieve reliability, for example, by mindfully managing business continuity and disaster recovery and organising operations of a ‘technical support’ unit. The authors also point out how paradoxically, systems designed for ease of use may have negative implications on users’ ability to achieve reliable outcomes when they ‘provide results tailored to one perspective, and avoid revealing alternative perspectives’ [9][p220]. Here they argue that such design approaches may hinder collective mindfulness when they ‘mask unexpected variation’, ‘promote efficient routinized behaviour’ and restrict choice [9][p221]. 2. Use of collective mindfulness in health informatics A rare case of the application of the theory of collective mindfulness in health informatics, is Aanestad and Jensen’s study [16] of a Norwegian hospital adoption of an electronic health record (EHR) system. Their interest lies in the post-implementation adaptation processes, and in particular those changes that ‘technology triggers’ after implementation is officially over and ‘the dust has settled’ [16][p15]. With respect to the traditional life-cycle of an IT implementation, understanding these processes is an important part of the evaluation phase, where evaluation overlaps with, and informs, further adaptive design and development. 2.1. The case, as recounted in Aanestad and Jensen, 2016 [16]: A Norwegian hospital rolled-out an EHR system to achieve paperless workflows. However, the new EHR system did not initially replace patient (paper-based) records as other information about the patient remained on paper. Thus, in parallel to EHR use, digital records were printed and kept in storage together with any other paper-based documents (e.g. incoming letters). After about three years from the initial EHR roll-out, the organisation decided to address the sustainability issue of this practice by purchasing scanners, including small ones that clinical departments would use to scan paper-based documents to add to the electronic record. This was considered a low-cost ‘IT project’, ‘entailing simple hardware purchase and installation’, without the perceived need for changes in workflows or specifically allocated resources. This scanning project began with a pilot of four hospital units, but without an implementation strategy. The researchers were able to observe how this initiative was received by the users in one of these units (the Women’s clinic). V.LichtnerandJ.I.Westbrook /CollectiveMindfulnessandProcessesofSensemaking 103