Theory applied to informatics: Socio-Technical Theory

New Socio-Technical Paradigm (Trist, 1981) Old Paradigm New Paradigm The technological imperative Joint optimization People as an extension of the machine People as complementary to the machine People as an expendable spare part People as a resource to be developed Maximum task breakdown, simple narrow skills Optimum task grouping, multiple broad skills External controls (supervisors, specialist staffs, procedures) Internal controls (self-regulating subsystems) Tall organisation chart, autocratic style Flat organisation chart, participative style Competition, gamesmanship Collaboration, collegiality Organisation's purposes only Members' and society's purposes also Alienation Commitment Low risk-taking Innovation Socio-technical Dimensions or Subsystems Generally, the socio-technical system consists of three main dimensions or subsystems: the social, technical, and environmental (Figure 1). Trist encouraged leaders and designers to focus on networks and collaborative ways to harness the new promising technologies to strengthen organizational and societal open systems where the social and technical subsystems were optimized within a supportive and resource-rich environmental system. All humans affected by the technology should be considered since "socio-technical systems design valued not just the end user but all operational and nonoperational stakeholders” (Abbas & Michael, 2021, p. 57). Since its advent, the socio-technical theory has been applied to many research studies in a variety of disciplines, including the health professions (Lin et al., 2016;Booth et al., 2017). "Information systems design and implementation is a complex and challenging endeavor that has both technical and social dimensions and requires changes in the behavior of actors, social structures, culture, and processes to succeed. [...]adopting an STS perspective is essential to increase the chances of success by taking into consideration both technical, social, and organizational factors and the interactions between various actors in the healthcare environment” (p. 160).

Shifting into Recovery – How Informatics can help

Digital Delivery – by scaling and sustaining new care models and adapting existing workflows and optimizing change Workforce Agility – supporting healthcare professionals to adapt to new ways of working, reviewing labour force distribution and utilization Resilient Operations – operationalize excellence to maximize capacity, and strengthen supply chains Financial Recovery – establish planning for recovery, update and model financial position McKinsey Company has “laid out an agenda that focuses on four efforts: refocusing and accelerating digital investments in response to evolving customer needs, using new data and AI to improve business operations, selectively modernizing technology capabilities to boost development velocity, and increasing organizational agility to deliver more quickly” (Baig et al, 2020, p. 2). According to Aghina et al., (2020) “to increase the level of enterprise agility, companies face implementation choices across five operating-model dimensions” (p. 2) These five dimensions include: Customer satisfaction – clients and students become the key focus, ‘the North Star’ of the healthcare or educational organization Employee engagement – a nonhierarchical approach means employees can develop a strong sense of autonomy, mastery, and purpose operational performance – productivity,planning time, system implementation financial performance – costs, budget balance, savings, investments All in all, informatics in the form of theory, skill, software, and infrastructure is a key foundation for post-Covid recovery and must be harnessed within both healthcare and education to ease the transition and optimize performance.

The Rise of Telehealth: COVID-19 and beyond

Hospitals that don’t address these expectations increasingly will be challenged by new market entrants and other disruptors that seek to attract new health care consumers and encroach on existing patient-provider relationships” (American Hospital Association, 2019b, p. 3). “The health care field must work to ensure that all individuals have access to affordable and equitable health, behavioural, and social services;provide increased value to individuals;embrace the diversity of individuals and serve as partners in their health, including connecting with them in ways that make sense in the digital age;focus on well-being and partnerships with community organizations;and coordinate and integrate care” (Bhatt & Bathija, 2018, p. 1271). Limited Access to High Speed Internet Limited Access to Smartphones Credentialing and Licensing Requirements for Telehealth Reimbursement issues Sustainability issues Malpractice policies may exclude telehealth Transportation issues may still exist if client must go to a clinic or office for consult Interoperability issues Mistrust of Technology and Healthcare Concerns about Security of information Lack of Provider Buy-in or Utilization (Rural Health Information Hub, 2019, p.1). Patients on treatment protocols who need close follow up care and multiple visits to ensure compliance and manage medication Care for chronic and complex conditions, including virtual consults on lab results, symptom triage, lifestyle management, and remote patient monitoring (RPM) check-ins Post-operative wound care Group education consults with pre-diabetic and diabetic patients on health eating, exercise and wellness tips Address shortages in local or on-site mental health services in rural or underserved populations by connecting patients to a specialist For routine follow-ups with anxiety, depression and ADHD patients who are adjusting to new medications Routine virtual psychotherapy appointments Urgent care for established patients with low-risk, infectious diseases, such as conjunctivitis or urinary tract infection (American Medical Association, 2019c, p. 11).

Support for Nursing Education during COVID-19

High-quality nursing education must be maintained to safeguard the health of Canadians: Graduation of nursing students should not be delayed given the urgent health service needs;Nursing faculty/instructors must maintain their educator role during this crisis as nursing education is essential;and Creative and appropriately supervised ways of optimizing entry-to-practice competencies in senior students while supporting the delivery of health care services during this crisis is a priority. Recommended Resources Books Creative Clinical Teaching in the Health Professions (2019). https://clinicalteaching.pressbooks.com This Canadian peer reviewed open-source e-book is a must-read for nurses and other health professionals who strive to teach with creativity and excellence in clinical settings. Clinical Procedures for Safer Patient Care (2015) https://opentextbc.ca/clinicalskills/ This Canadian “open educational resource (OER) was developed to ensure best practice and quality care based on the latest evidence, and to address inconsistencies in how clinical health care skills are taught and practised in the clinical setting.”

Informatics in the time of COVID-19

Privacy of Health Data– IS and IT also dedicate a lot of energy to ensure staff and clients stay safe: this includes protecting their personal health information (PHI) as well as employee data. System Interoperability– EHR based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19 are all supported by system interoperability. “The biggest benefit of telehealth may be preventing people who have been exposed to the coronavirus from leaving their homes and spreading it to a physician’s practice or an entire emergency department, putting patients at risk and potentially putting health care workers out of commission for 14 days of quarantine” (Ostherr, 2020, p. 1). [...]physicians find themselves toggling between their EMR — holding important lab results and consultation notes — and their video screens.