Ranked Levels of Influence model: selecting influence techniques to minimize IT resistance.

Implementation of electronic health records (EHR), particularly computerized physician/provider order entry systems (CPOE), is often met with resistance. Influence presented at the right time, in the right manner, may minimize resistance or at least limit the risk of complete system failure. Combining established theories on power, influence tactics, and resistance, we developed the Ranked Levels of Influence model. Applying it to documented examples of EHR/CPOE failures at Cedars-Sinai and Kaiser Permanente in Hawaii, we evaluated the influence applied, the resistance encountered, and the resulting risk to the system implementation. Using the Ranked Levels of Influence model as a guideline, we demonstrate that these system failures were associated with the use of hard influence tactics that resulted in higher levels of resistance. We suggest that when influence tactics remain at the soft tactics level, the level of resistance stabilizes or de-escalates and the system can be saved.

Negative CPOE attitudes correlate with diminished power in the workplace.

Power changes have been identified as a frequent and unintended consequence of the implementation of computerized physician order entry (CPOE). However, no previous study has described the degree or direction of power change, or even confirmed that such a relationship exists. Using a validated, standardized instrument for measuring personal power, we collected data from 276 healthcare workers in two different hospitals before and after implementation of CPOE. We identified a significant correlation between power perceptions and attitudes toward CPOE. Examining the direction of change by healthcare position, we found that the power perception values decreased for all positions and that attitudes toward CPOE varied based on use of the system. Understanding the relationship between power and CPOE is the first step in enabling systems developers to change the direction of power changes from negative to positive.

Development of an instrument for measuring clinicians' power perceptions in the workplace.

We report on the development of an instrument to measure clinicians' perceptions of their personal power in the workplace in relation to resistance to computerized physician order entry (CPOE). The instrument is based on French and Raven's six bases of social power and uses a semantic differential methodology. A measurement study was conducted to determine the reliability and validity of the survey. The survey was administered online and distributed via a URL by email to 19 physicians, nurses, and health unit coordinators from a university hospital. Acceptable reliability was achieved by removing or moving some semantic differential word pairs used to represent the six power bases (alpha range from 0.76 to 0.89). The Semantic Differential Power Perception (SDPP) survey validity was tested against an already validated instrument and found to be acceptable (correlation range from 0.51 to 0.81). The SDPP survey instrument was determined to be both reliable and valid.

Predicting the impact of a new information system on workflow using a discrete event simulation.

Computer simulation of an information system prior to its implementation can predict time and workflow changes in a hospital department, while offering a common ground of communication across various levels in the organization. Often, the simulation can predict unexpected effects of changes to the work environment and allow experimentation with alternative scenarios at minimal cost to the department or the organization. In this paper we describe a discrete-event simulation experiment that predicted an unexpected increase in routine specimen processing time with the introduction of an information system in the HLA tissue typing lab at a major transplant center. The computer simulation enabled the reallocation of existing staff prior to the system implementation.