Seite - 175 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Implementation of the EHR might involve staff within different GP surgeries, or different role groups within the same surgery (e.g. reception, community nursing), actively seeking feedback on proposed changes and/or eliciting questions about implementation from colleagues. Why should a person participate? (Legitimation) Successful involvement of key people in the intervention, as well as wider enrolment of those working in the implementation space also implies that those involved believe that it is right for them to be, and that they can make valid contributions [3]. Organizational behavior change projects in health (such as improving infection control, or nutritional care for older people) often involve attempts to widen the sphere of concern with a particular activity (e.g. information governance, child protection, infection control) by, for example, stating that a given area is ‘everyone’s responsibility’ [4–6]. Often, perceptions of legitimacy may be constrained by membership of specific professional groups (e.g. a nutritional care intervention might be seen initially as the exclusive responsibility of dietitians). Additional relational work is therefore often necessary to establish legitimacy with other groups. In the case of health informatics interventions, this may involve establishing relationships by meeting directly with clinicians and administrators using the system and establishing an understanding of how they will contribute to intervention and development. What processes will support people staying on task? (Activation) Projects in which participants have made sense of an intervention (coherence), identified key people (initiation), and bought those involved on board (enrolment) are well placed to begin initial implementation of their intervention. In these initial stages the tasks, relationships, and resources that have been established to support this work are activated – that is, they ‘go live’ and enter everyday work. These processes, being new, are vulnerable to various forms of disruption, particularly in settings where they compete with other tasks for the time and attention of participants. Processes associated with activation are the practical means by which those involved will be stay ‘on the case’, and how potential points of disruption may be identified and dealt with [3]. 1.4 The operational work of implementation (Collective action) Having made sense of the new set of practices and objects associated with the intervention (Coherence) and undertaken the relational work of understanding who should do what in the initial implementation of new practices (Cognitive Participation), we turn to the actual processes of implementation. Components in this construct highlight forms of operational work commonly necessary to support initial implementation. How does the intervention affect existing working practices and relationships? (Interactional Workability) Once the intervention goes live, is it in any way disruptive to normal ways of working? Does it ‘get in the way’ of other activities? While other constructs have pointed M.BracherandC.R.May / ImplementingandEmbeddingHealth InformaticsSystems 175